Can We Talk?

Posted on April 19, 2013 by John G. Self

Let’s talk candidly about career management.

More than likely the professionals who should read this probably won’t read this.

I talk to a lot of people at conferences, airports and on the telephone. Executives, especially those in healthcare, are troubled by tough economic times with less than robust job creation, continued high rates of unemployment and, in the case of healthcare, a daunting transformation as the federal government is forced to reduce payments to hospitals, doctors and other providers in order to reduce the escalating deficit and debt. They are concerned with the instability.

Here is my candid advice for seasoned executives as well as early careerists and the people they supervise:

Be flexible
Get outside your comfort zone
Think outside of the box

Be flexible – Geographically. Candidates must be willing to go where the jobs are. If you want to be a senior leader, four to five job changes may be required. Executives who limit themselves geographically – regardless of the reason – must be willing to accept the career consequences.

Get outside your comfort zone – Every executive, every employee, every candidate has strengths and weaknesses. We all have things we like and things we don’t like to do. We try to avoid those “don’t likes” at all costs. However, in a tough, competitive market you have to deliver results, even when this means you have to do those things you would rather not do. You cannot ignore something that is integral to meeting performance deliverables. Get out of your comfort zone and do what has to be done before your boss asks you to leave and you fall into the unemployment pit.

Think outside the box – One of the challenges posed by the new economy is that fewer employees are asked to do more work. Productivity is required. Smart companies are looking for employees who are flexible, who are not afraid of change, and who welcome challenges with an eye for innovation. This is especially true in the healthcare industry. Executives and employees who can think outside the box and who relish change and innovation are becoming increasingly valuable for companies.

Here are some phrases and workplace behaviors to avoid:

It’s not my job
We have always done it this way
I don’t like change (non-union)
I am not going to change (union)
I need a job so I can be a good provider but my family refuses to relocate
My boss is totally unrealistic
My boss is an idiot
I am not going to sacrifice time with my friends and/or family for my job
I am a nurse and I have worked here a long time, they can’t fire me
Some of the people I work with work too hard. They are making the rest of us look bad
That patient doesn’t have insurance so it is OK to make them wait
I am tired. There are things I’d rather do so I am not going to see any more patients today

If you are someone who gets it, feel free to share this blog with someone who doesn’t.

The Elephant in the Room Is Fat

Posted on April 12, 2013 by John G. Self

It has been a long, tough day, a good day but stressful nonetheless. A delicious ice-cold martini sounds incredibly tempting.

But as I lean back in my chair, I bump into the elephant in the room.

My waistline is greater than the insurance target of 40 inches – not much, but enough to drive up the cost of my health coverage. One martini, as tempting as it may be, represents 388 calories. If you want to add an olive, or four, that is another 12.5 calories per olive. The gym in the lobby of my building, by comparison, helps to burn calories and represents lower health benefit costs and, ultimately, better health.

First, let me go on record and say that I think it is inherently unfair that gin, a clear spirit, should have any calories at all. Scotch or bourbon should have a lot of calories based on their rich looking golds and browns. But gin, or vodka? Well, that seems wrong. But it isn’t and that brings me back to the elephant in the room.

The room is really a metaphor for our country. We have become a nation of overweight – fat – people whose eating and wellness habits are contributing mightily to the rising cost of healthcare.

Something must be done, but people are not going to like it. It will be painful because sacrifice – and exercise – will be involved. If you don’t like this message, and you think that I am as full of sh*t as a Christmas Turkey – or in text/SMS shorthand, AFOSAACT – then pay attention to this: your employer may insist you change.

That’s right. Increasingly, employers are telling their employees to lose weight and lower their blood pressure or face $1,000 or more in out-of-pocket costs for health coverage. Companies have finally come to the conclusion that voluntary wellness programs rarely work on the majority of employees and so companies like Michelin North America, the premium tire maker, are requiring their employees to share personal health information such as body-mass index, weight and blood-sugar levels, or face higher premiums, according to a Wall Street Journal article earlier this week [paid article].

No one argues that the connection between poor eating habits, obesity and high blood pressure, significantly increase the risk of stroke or heart disease, two very costly illnesses. But, already, employees and worker rights advocates are using the silliest three words when it comes to personal accountability: That’s not fair.

Employee rights advocates are saying the Michelin program, and others like it, amount to “legal discrimination,” the WSJ quoted Lew Maltby, a worker’s rights advocate in Princeton, NJ. “While companies are calling them wellness incentives, the penalties are essentially salary cuts by a different name.”

“It means workers are getting their pay cut for no legitimate reason,” he said.

Good grief. Don’t you love it?

OK, so it is apparently not fair to hold employees accountable for their personal health.

Let’s shift to the other side of the healthcare cost equation, providers – doctors, hospitals and others. They, too, are being criticized for contributing to increasing healthcare costs. Consumer advocates – I wonder if Mr. Maltby is in that loosely defined group – are arguing for reimbursement recalibration.

What an innocuous sounding word, “recalibration,” until you understand that what it really means is that the federal government and private insurance companies are going to cut the money they pay to hospitals and doctors under healthcare reform and deficit reduction initiatives. It is a cut in the pay for a group of workers who went to school for 10 years or more, who pay the earth for malpractice coverage, and who work long hours – for “no legitimate reason.”

Maybe I will have that martini after all.

Cost Reductions and Internal Recruiters

Posted on April 8, 2013 by John G. Self

As many major healthcare systems across America continue sweeping expense reduction initiatives to lower their costs below Medicare because they want to avoid trouble, and not because they are in it, the impact this will have on recruiting is potentially significant.

At this point, for better or for worse, talent management and acquisition is not a high priority in many health systems. It is right up there with succession planning. Roughly translated, recruiting is an expense line, not an investment. The conventional wisdom is that many health systems will begin to shed their internal recruiting overhead over the next 24 months. There are some health systems that plan to retain much, if not all, of their infrastructure, but the vast majority will not.

Lest you think this is a blog post about external recruiters engaged in some very wishful thinking, you miss the point. I cannot speak for my many competitors/colleagues but I am very busy today. No, this is a post to suggest that the dynamics of finding a job will change over the next several years. In many cities, where large health systems have controlled the overwhelming majority of their own recruiting, candidates will, over time, see a return of external recruiters handling these projects in a variety of arrangements:

Contingency – the health system or hospital will pay only if the recruiter successfully places a candidate. The contingency firm will get a professional fee. Expenses incurred in the project will be to the account of that firm. Contingent firms, most of which offer placement guarantees from 90 to 180 days, will face more pressure to strengthen their accountability
Outsourcing – health systems will engage a sole source provider to handle 90 percent of their recruitment needs. Their professional fees will be tied to performance and the budgets will be designed to reduce recruiting costs by 30 to 40 percent with tough performance metrics governing time to hire, etc
Retained recruiting firms — can expect to see an increase in senior level searches but clients will be more demanding in terms of the firm’s value proposition, from the size of professional fees and expense budgets, to the length of the placement guarantee

While this trend will create disruption for candidates who have nurtured relationships with the internal recruiters, there is potentially a silver lining because it will loosen the structure giving more candidates a chance for choice positions.

This is just another example of where it pays for candidates to be flexible and to build relationships with any number of recruiters.