When It’s Time for Succession

This morning Fidel Castro announced that he was stepping down as President of Cuba and commander of the Army. Here in the US, we are in the midst of an exciting campaign for the presidency. Both of these events are about succession – a change in power and leadership.

Succession events occur when there is a change in the leadership of a practice, or a physician leaves (whether by resignation, retirement, death or disability). A practice should plan for these events and have procedures in place for these events.

I’ve written earlier about shareholder agreements, those internal contracts among the practice physician-owners as to how power and money will be allocated. The bylaws of the practice corporation should provide for the means of selecting the president of the corporation and their respective powers. The shareholder agreements will outline how shareholders – or their heirs – can “sell” their share back and withdraw their capital contributions that had grown over the years. In these agreements, there needs to be a procedure laid out for setting a valuation on the practice so that there will be (hopefully) little dispute as to the amount to be paid out and the terms of the payout – one time, spread out over several years, and so on.

When a physician leaves, the practice (presumably) should have a means of replacing them. Ideally, a physician contemplates retirement and there is a period of 1-2 years to recruit a new physician and to transfer patients over a period of time. The departing physician is the stability for the patient, offering some history and perspective that may not be apparent from the chart.

A sudden departure is a different situation. In these situations, the remaining physicians have to accommodate the workload until help can arrive. A nurse practitioner may be more readily available to handle some of the less-serious matters, allowing the physicians more time for the current and newly assumed patients that they need to see.

The second area of succession is a leadership transition. Ideally, this is planned for in the shareholder agreement, so that the designation of positions, the allocation of powers, and the means of selection – and removal – are laid out and agreed to by the owners. Many times it is the founding physician who is the president, and will continue in that role unless someone challenges them. Unfortunately, any challenge will be divisive, which is not good. This is where help may be needed for the owners to meet and come together around a plan. Unless the founder agrees to it, any move to limit the number of years that an owner can be president will be viewed as disrespectful and divisive. Giving up this kind of control of their “baby” – and it is their offspring – is difficult even for the most secure of people.

One route to share authority is to create a new position, the “managing physician”. This person is akin to a chief executive officer, and the president – the founder – is more akin to a non-executive chair. There is moral as well as some legal authority, and there is still the prestige and respect that is deserved. I won’t discount the difficulty in accomplishing these changes, but a good planning process, often with the help of a neutral facilitator (yes, I can do this, as do other very good people) will achieve a stronger leadership for a practice.

These are not always easy issues to deal with, but they will pay off in a stronger practice and a fairness in how people are treated in some difficult times.