Guest Blog today By Kent Bottles, MD

1. You Will Have to Move a Lot

I went to medical school in Cleveland and did my pathology residency at University of California San Francisco (UCSF). I was on the medical school faculty at UCSF, Iowa, Allegheny University of the Health Sciences and Michigan State.

Since leaving academic medicine, I have worked at a bio-tech start up in Cambridge, MA; an educational and research institute in Grand Rapids, MI; a $2 billion integrated delivery system in Iowa; and an evidence-based medicine consortium in Minneapolis.

In my experience, physician executive positions do not always last a long time because the environment changes, career aspirations evolve and getting the job done sometimes means alienating enough people to get in the way of long job tenure.

2. You Will Have to Reinvent Yourself Over and Over Again

My main professional roles have included: medical school pathology course master, surgical pathologist, division head, vice chair of an academic department, chair of an academic department, medical director of managed care, corporate operations officer of ambulatory care, special assistant to the president of a Big Ten university for managed care, search consultant, chief knowledge officer of a genomics bio-tech start up, president and CEO of an educational consortium, chief medical officer of a delivery system, president and CEO of an evidence based medicine institute and health policy professor at a school of population health.

My only educational credentials are a bachelor’s degree in history and a MD degree. Although I have taught in MBA programs, I do not have a MBA. Although I headed up a genomics repository of DNA, I had to teach myself genomics and proteomics on my own. Although I teach health policy and population health, I did not formally study these subjects. I have discovered that if I read a lot, go to conferences in different fields and talk to smart people, I can pick up what I need to know without collecting graduate degrees.

3. Everything is in the New York Times and The Wall Street Journal

I am amazed at how much I am able to keep up with payment reform, federal health care reform and other major trends just by reading these two newspapers every day. It is also good to see how liberals and conservatives interpret the same story, often with dramatically different conclusions.

4. The Killer App in Social Media is Community

Twitter has become the most important technology in my career as a physician executive. I follow about 2,000 key opinion leaders in health care and about 7,000 people follow me.

I use Twitter to crowdsource subjects I need to master to give keynotes or consult with health care systems. For example, Einstein Medical School asked me to give a presentation on social media and undergraduate medical school education. To prepare, I tweeted the following: “Help; need best practices of social medical and medical school education.”

I received responses from all over the world that formed the basis for my all-day seminar, which was well received and consisted of concrete examples from the Cleveland Clinic to the UK of medical educators using Twitter and Facebook in ways I never imagined.

An important point here is I am now obligated to my social media community of practice to provide knowledge to others when they are reaching out for assistance.

5. If I Can’t Understand It, I Don’t Believe It

When I started out in leadership, I did not always trust my own judgment. I sometimes thought I was not smart enough to grasp situations that made no sense to me.

When I was interim head of pathology at Iowa, I thought my lack of training in clinical pathology was the reason I could not understand the classification of all the technologists in the hospital labs. It took a while to grasp that job classifications and titles had multiplied and proliferated in a way that did not serve us well in a changing health care environment. It was only when I truly understood the system made no sense that I could lead a simplification of job titles that worked better in a time of managed care.

I will never forget going to a meeting in Palm Springs of venture capitalists. What made them different from others I had encountered was their skepticism and insistence on understanding how start-up companies make money. If they could not understand the business plan, they did not invest.

6. You Will Fail; Do it Quickly and Cheaply

A successful entrepreneur in Iowa taught me failure is inevitable. The trick is to recognize when you have failed, learn from it, and move on as quickly and cheaply as possible. When I was helping to raise $36 million dollars for a genomics company, I was amazed to learn from venture capitalists they do not try to predict winners and losers. They don’t think it’s possible. When they invest in 20 companies, they are hoping that one of them will be a Google or an Apple. They fully expect the others to fail.

In contrast, I have noticed health care organizations have a hard time killing programs that are simply not working.

7. You Must Become a Life-Long Learner

When I graduated from Case Western Reserve School of Medicine in 1980, there was no Internet, no Google, no disease called AIDS and no smartphones. You must continue to learn about the world you live in, and the world will continue to change in amazing and confusing ways.

8. Master the Gartner Hype Cycle and Learn Behavioral Economics

Do yourself a favor. Master the Gartner Hype Cycle to understand why all those revolutionary disruptive technologies fail and those startup stocks go down. You can find a good resource here.

Read Nobel Prize winner Daniel Kahneman’s book Thinking, Fast and Slow; you will understand why you and those you work with often act irrationally.


Kent Bottles, MD, is a consultant, keynote speaker and frequent contributor to the PEJ, ACPE’s medical management journal.