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Epic Career Moves - Step Three

September 18, 2009
by Joe Bormel
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Epic Career Moves - Step Three

Reflections on the SEAK conference experience

Over my last year blogging, I've discovered, through various feedback channels, what readers value. Readers are uniformly interested in learning, and those who read these blogs are generally sophisticated learners. You read blogs to improve your performance, to learn new ways of looking at things, for tricks, and to re-learn old tricks for that matter. Some of the strongest positive feedback has come from your personal stories, trying to do the good work of clinical healthcare informatics. So, in that spirit, here are my observations after attending and speaking at the SEAK conference this past weekend.

1. Doctors in clinical practice and non-clinical careers: There are several really distinct sub-types:

a. Those who didn't attend, wanted to, but could not. I mention this group because they reach out to me every week in my travels, solicit my advise on non-clinical careers, and then I don't hear from them until my next visit. My point: it's hard for many docs to divert time from a busy practice, to simply read the newspaper, books or professional articles, much less build a social network or attend a conference. It's a tough pill for folks who went into medicine for the intellectual stimulation.

b. A large percentage of the several hundred physicians in attendance were broad-based, already doing a variety of things in addition to clinical practice. They had LLCs, Internet domains, brands, and often a pedigree of things they were already trying or had tried to improve the world and earn a reasonable return for their efforts. They had broken free and were focused on maintaining an awareness of their options. I spoke with about two dozen of them. Half or so were maintaining clinical practices, but clearly no more than 20 to 30 hours a week.

c. Roughly a quarter, based on my sample, who came to the conference hadn't broken free. For several, this wasn't their first year attending this event. To their credit, they continue searching for a new path even when there isn’t one at a given time that can work for them.

d. There were quite a few docs who, upon completing their residencies, felt that a clinical medical career wasn't a fit for them. I suspect the percentage of that occurrence has been steadily rising.

2. What I Learned: From my one-on-ones the day preceding my presentation, I learned that a number of the attendees were already serving as CMIOs in their hospitals. Informatics? They got it. But many others assumed that informatics must mean an IT doc who mostly does computer programming. In fact, one very experienced clinician who didn't attend my lecture was disappointed when she learned my focus was on ways to gain the management skills to be effective at driving desired change. It really does pay to read the free conference program guide!

During and after my informatics presentation (here) I asked a few survey questions. How many docs use either e-Prescribing or CPOE? Almost all hands went up. What's wrong with the paper chart? The access and legibility issues were brought up. I asked how many people knew what social networking is. Two hands went up. They were probably the two lecturers who included social networking in their recommendations. Later, when I asked others one-on one what they knew about social networking, even some of the most worldly said, "Oh, that means Facebook and LinkedIn." See my presentation for notes on social networking. Suffice it to say Facebook and LinkedIn are minor tools. And without my asking, lots of folks offered what they thought is wrong with EMRs.

About a dozen different physicians, on separate occasions, told me they felt excluded from the communication and decision making process regarding selection or roll-out of EMRs in their institutions. Most said, or implied, that this appeared to be deliberate behavior by their administration or IT toward all physicians.

3. My closing advice: If you’re grooming yourself for a career move to informatics, lead a quality or performance improvement team, preferably an IHI collaborative effort. Focus on getting results with and through others. Then list those results on your resume and be prepared to speak for two minutes on exactly what you did to get them. And, of course, Read, Read, Read, starting with my presentation.



Thanks for this post Joe. It's just amazing organizations are still rolling out clinical technologies they expect physicians to embrace without involving them in the selection process. Do they know nothing about human nature? Do they know nothing about the specific nature of those that decide to practice medicine by opening up their own business? Hospital administrations that take such an arrogant view of the process deserve the push back they usually get.

Thanks for your kind words and perspective. There's only so much about career transition opportunities and necessary "soft skills" that seems to be disclosed at these meetings.

Amongst those unknown skills are a set of 48 Law of Power, with their associated behavioral response requirements. You might find these laws worth a review:

The 48 Laws of Power 

  by Robert Greene

Product Description
Amoral, cunning, ruthless, and instructive, this piercing work distills three thousand years of the history of power in to forty-eight well explicated laws. As attention--grabbing in its design as it is in its content, this bold volume outlines the laws of power in their unvarnished essence, synthesizing the philosophies of Machiavelli, Sun-tzu, Carl von Clausewitz, and other great thinkers.
Some laws teach the need for prudence ("
Law 1: Never Outshine the Master"), the virtue of stealth ("Law 3: Conceal Your Intentions"), and many demand the total absence of mercy ("Law 15: Crush Your Enemy Totally"), but like it or not, all have applications in real life. Illustrated through the tactics of Queen Elizabeth I, Henry Kissinger, P. T. Barnum, and other famous figures who have wielded--or been victimized by--power, these laws will fascinate any reader interested in gaining, observing, or defending against ultimate control.

IA, if nothing else, it will give you greater clarity on what you're up against!

I agree with the reviewer who said "... most of the Laws covered in this book can be used for great evil or for great good. It depends on the reader."  I share it here in the spirit of defense against the dark arts.

Thanks for the enjoyable blog post.  Interesting observations.  I'd
have to add that it has been the biggest astonishment of my career that
really talented, dedicated people just get ground down and used, rarely
even acknowledged.  Yet others with or without talent but over-sized
egos, schmoozing, and self-aggrandizement usually become the big dogs,
exploiting others and claiming the fruit of their labors.  

The skills to navigate that matrix are unknown or unconscionable to those who are not
among the notable and powerful.  There are notable exceptions, but they
are minority.  

Therein lies the straw man in a conference such as SEAK.

People may have extraordinary talent and commitment, but at a minimum without
tutelage in the "ways of the world" (at least to recognize and avoid being
manipulated and used) they will be cannon fodder.  Often the harder and
more productively people work, the more they are taken for granted and
less appreciated.  Mixed metaphors, but they'll do for now.

I spent a little time on your blog Saturday and Sunday, but will be
spending more as time allows.  Some great photos!  Now, I'm still at the
hospital after 16.5 hours, and have to be back at 0630.  At least 3
hours of that are because of having to work-around dysfunctional
[*** Major Commercial Vendor Name Removed ***] that
encumbers almost everything that [we] do.


Thanks for your comment and your kind words about my work.

I cannot let your comment "[Hospital administrators] ... deserve the push back they usually get" go without comment. So, to steal a line from SNL, "Really Anthony?"

I liked your comment about human nature and doctors. It explains the "1b" doctors I described above.  So let's work that into comment, which I'll interpret as 'neglect at your own peril.'

I know that the many CEOs I've met, large organizations and small, really do understand human nature. They're almost always very sophisticated about people and finance. Their priorities include preserving the stability of their organizations, which, like any businesses, have fluctuating revenues and costs which at best they can influence but not control.

They're dealing with two dynamics you might want to consider that I often forget. First, the hospitals are in competition (for dollars) with physicians, directly or potentially. The sophistication to collaborate in one space and compete in another is tricky.

Second, hospitals in most community and rural areas that I travel in are employing the majority of their physicians already, or expect to as private practice economics evolve. So, the hospitals are dealing with merger and acquisition mentality, both their own and their newly employed, individualistic physicians. As we discussed before, several things follow, like night follows day.

a. Organizational decision rights are poorly placed.
b. information flow is poorly conducted.
c. Management is inattentive to individual motivators.
d. and the organizational structure is discordant with achieving the above three (a,b,c).

And that's the real reason organizations who don't effectively involve physicians in HCIT selection processes. They attempt, instead, to use last minute, command-and-control tactics (you term arrogant), appearing to know nothing of human nature.   My other pet peeve around this is confusing demonstrating system functionality with setting a vision and charter for improvement. 

If you start your physician communication with a demo of a system or various competing systems, and contextualize HCIT as an IT project, you're sending a message to the physicians.  A horribly wrong and completely backward message.  [The alternative is to discuss situation and options, as a true dialogue, and seek all stakeholders input into the prioritization of organizational need.  You'll usually end up at the same place, but with committed participants (link).]

The solution? A combination of sales, marketing, and project management for HCIT. Find the video of Berwick talking about planning the 100 thousand lives campaign. Or, request a link and I'll find it for you!

Please post the link Joe. I would love to see it, and I'm sure many readers feel the same.

I'll look for the video this weekend.  Here's the gist:


So Berwick asked his son the question: "What makes your work so effective?" Dan explained what it takes to run a successful political campaigncoming up with concrete numbers (i.e. how many people you want to reach), establishing field offices to reach more people locally, inviting the widest possible participation, giving specific instructions to workers, and setting a deadline.