by Dr. Kenneth H. Cohn

One of the wonderful privileges of being a guest blogger on Hospital Impact is that any time I need inspiration, I have always been able to find it in someone else's posts. So it was with Christopher Cornue's insightful, "Where did all the strategists go?"

Chris makes the point that as a result of the recession, people who plan strategy have become an endangered species, as hospitals focus on cost-containment and daily survival. His comments have prompted me to tell my own story. Like a news reporter who warns the audience before showing graphic footage, I apologize ahead of time to anyone who finds the edgy content or language offensive.

[More:]

In retrospect, I was guilty of the same hubris that prompted many of my colleagues to boast earlier that healthcare was recession-proof. I had never been busier speaking and consulting on physician-hospital relations than during the first quarter of 2009 and angered the gods by telling my wife three months ago, "I think that 2009 may be my best year yet."

In April, my business comet crashed through the atmosphere in a fiery blaze as one client "postponed" an oncology practice merger when one of the groups went bankrupt and a CEO vetoed a planned speaking engagement in favor of an internal speaker whom he did not plan to pay. I had been categorized "discretionary expense."

In contrast to the Elizabeth Kubler-Ross model, I bypassed denial and went straight to anger as I talked with a colleague in Tennessee who was kindly helping me improve a column on physician recruiting and contracting published recently in the Journal of Healthcare Management. He related that his 13-hospital system was in hunker-down mode for the next two years. "Do you mean to tell me that if the orthopedists and/or neurosurgeons decided to contract with an outside vendor to establish an ambulatory surgical center, people would say, 'So be the will of God?'" He laughed and said, "No, we just go from crisis to crisis, spending as little as we can to plug holes in the levee."

I do not know how many steps are in my ultimate plan, but my first step was to admit that I did not have the answers. In retrospect, I have been fortunate that this recession is the first one that limited demand for my services. I have no prior experience to call upon.

I made up a survey for my final Journal of Healthcare Management column on innovation in the face of recession and asked senior healthcare leaders what they were experiencing, what was helping, what was not helpful, and if I were a genie, what three wishes would they want me to grant.

I hired a coach who motivated me to do activities that I had avoided previously, like calling people. It is so much safer to use email. I had even convinced myself that email was a more efficient use of my limited time. When I work in isolation, I can convince myself of anything. At the end of these telephone interviews, I asked senior healthcare leaders what they thought I should do. They unanimously offered a two-part strategy:

• In the short term (next three months): Ride it out, earn income any way you can, and don't waste a lot of time trying to reason with people who live in fear.
• In the medium term (next year): Keep doing what you are doing to help physicians and community hospitals make sense of what is happening, offering practical strategies to deal with widespread disruptive changes.

In the short term, I hired a publicist who booked 21 radio interviews and one TV interview. I led with "healthcare's hidden drain," that we could save money if physicians and hospital leaders worked more interdependently and discussed 10 steps that we can take now to improve communication and collaboration.

I revised my ACHE seminar "Practical Strategies for Engaging Physicians" to include more information on how to engage physicians to cut costs and improve clinical outcomes, and how hospital leaders could support employed physicians without alienating independent physicians. To celebrate the courage of hospital leaders who continue to invest in their education and networking with colleagues, I am offering for the first time a lawyer-proof guarantee whereby I provide free consultation to anyone who does not achieve a hundred-fold return on their seminar fee in terms of decreased expenses and increased revenues within one to two years. It is my way of influencing events over which I have little control.

In the long term, I feel blessed that I can still work as a general surgeon in New Hampshire, Vermont and Maine, where I can reconnect with the feelings that attracted me to healthcare in a previous century. This unexpected time off from the speaking and consulting circuit has given me time to plan a talk that I will give September 13 of this year on Transitioning to Non-Clinical Careers and to develop a website, http://thedoctorpreneur.com in support of aspiring physician entrepreneurs like me.

As a result of my recent night journey, this year may be my best yet. A mentor confided, "Change feels like failure when we are in the middle of it," something that achievement-oriented professionals like me are programmed to resist. I have learned, as Christopher Cornue alluded that:

• We all face danger of extinction in this troubled economy.
• Making oneself indispensable requires active, ongoing effort.
• Email alone is insufficient for staying in touch with a rapidly changing marketplace.
• Pain can be a powerful motivator.
• Daily exercise boosts serotonin and can keep depression manageable.
• Forcing myself to write down three things for which I am grateful every night helps me keep my present helplessness in perspective.
• I can permit myself to grieve (briefly); as a colleague advised, "It's OK to visit pity city as long as you don't live there."
• More importantly, I can reward myself at the time and place of my choosing, which has helped the local ice cream parlor thrive despite difficult times.
• I can be in touch with the majority of my body composition that is liquid and flow in occasionally different directions when a customary route is dammed.
• In "The Question Behind the Question", John Miller points out that the only question that matters does not begin with "who" or "why," but "what can I do?" or "how can I help?"; perhaps my experience is teaching me to substitute "I" for "they" when I form the words, "If only...."

What do you think?

• Have current events prompted you to feel like an endangered species?
• How have you dealt with those feelings?
• What have you found helpful?

We are all in this together. Please send me your input.

Ken is a practicing general surgeon/MBA who divides his time between providing general surgical coverage and speaking, writing, teaching and consulting on physician-hospital relations. Learn more about what he does by visiting http://healthcarecollaboration.com.