In the ever-changing healthcare administration profession, like in many other specialized fields, you have to cross one hurdle at a time to achieve your goal. Your undergraduate curriculum should include subjects such as accounting, finance, organizational behavior, technology support, public speaking and basic writing skills in order to have the basics for entering graduate school. It is important to practice public speaking and business writing as often as possible. Graduate school is important because most of the executives who rise to senior management in a health care setting have a master’s degree in healthcare or business. When choosing a graduate school, check the percentage of students placed into residencies or mid-level management positions upon graduation. If that percentage is 90 percent or above, its worth continued follow through to see if the school would be a good match for you.

Stay busy during your summer vacation by working or volunteering in a hospital or health care setting doing whatever you can. It will give you an opportunity to " feel the pulse" of the organization and most likely meet some interesting executives. There are several opportunities for summer internships during your college career with our professional organizations. In particular, the Institute for Diversity in Healthcare Management headquartered in Chicago, IL, offers college and graduate students summer internships in various cities. There are also several colleges and universities that offer summer learning programs to students interested in the health care field. Check with your placement office or just call around to some Medical Schools and inquire about summer opportunities. You will likely be pleased with the outcome.

The very first job that most graduates seek after earning their master’s degree is an Administrative Residency in the healthcare setting of your choice. In this position, the resident learns about the organizational structure and political culture of an organization. Each resident is assigned to an executive level team member (often the CEO) and serves as their assistant for one year. During that year, the resident is assigned projects that directly impact hospital operations and are directed so that they may apply their formal training in problem solving. This hands-on opportunity generally gives the resident the unique opportunity to work directly with senior management in a learning capacity. If you work hard and gain the respect of senior management, the individual that leads you through this year of residency usually carries the honor of your mentor/preceptor throughout your career. My mentor, Eugene Cashman, CEO for LeBonheur Children’s Hospital in 1985, told me to use the hospital as my laboratory for the one year of my residency. He encouraged me to independently practice my management skills while he remained close enough to guide me. Salaries for the Administrative Residency typically start around $25,000 per year.

During your residency, you will be able to decide if you would like a line management or a staff role as your career foundation. Line management is the track to the CEO’s position, while staff roles are organizational support functions such as human resources or quality management. The CEO has to set the organization’s strategic plan, understand customer service, master organization behavior and rules of financial management to move the organization forward. Elliott Roberts (right), retired CEO of the Medical Center of Louisiana in New Orleans and one of the first African-American hospital administrators in the country, says students considering the line management track may begin, after their administrative residency, as a department or service line director. In a support role, one usually develops one area of specialty or expertise. In Human Resources for instance, you must understand things like labor laws, employee grievance procedures, and payroll methods. There are even specific computer programs designed specifically for human resource management like PeopleSoft, and it is a great benefit to know how to operate such a system. Computer buffs may become expert in Wide Area Network (WAN) or Local Area Network (LAN) development for health care systems like Columbia/HCA or Tenet. There are also hospital finance software packages that are designed for hospital/healthcare billing and accounts receivable. Because of increased automation, the health care industry has recognized technology as an integral hospital entity and many are recruiting for Chief Information Officers (CIO), also a specialized staff role.

Managed Care companies are thriving all over the country and provide a wonderful opportunity for recent graduates. The theory of the managed care industry is to give individuals a limited choice of where they will receive their medical care and negotiate with the healthcare providers to reduce their cost of service to members of the managed care network. Many are also realizing the importance of Long Term Care and its overreaching effects on our aging population. Nursing Home/Assisted Living Care is one of the fastest growing segments of the healthcare industry. As we see the never-ending media coverage of patient abuse in the nursing home industry, there is a great need for talented administrators to enter the field. The health care consulting industry takes on a broad number of issues where expertise in every aspect of healthcare operations is necessary. Many of the big ten firms in the country seek recent graduates so that they can mold them into accomplished consultants. Usually when a healthcare facility seeks the service of a consulting agency, they want the agency to focus on one or two major challenges facing their particular facility. Consultants must know how to work with all levels of health care delivery staff and give formal professional advice in an effort to improve operational effectiveness. Some other career areas of specialty include information technology, marketing, architecture, financial management, food service administration, medical records, pharmacy, engineering and of course, medical personnel like physicians, nurses and adjunct therapists.

Minorities in the Executive Ranks

In 1997, the American College of Healthcare Executives (ACHE), the Institute for Diversity in Healthcare Management and the National Association of Health Services Executives (NAHSE), three large professional organizations representing health administrators, performed a survey of 410 African Americans, 408 Caucasians, 264 Hispanics and 124 Asians about their career outcomes, factors that might account for differences in those outcomes and respondents’ attitudes. It follows by five years, a similar survey by the ACHE and NAHSE in 1992, which documented dissatisfaction among minorities and a pronounced pay gap between minorities and whites at similar levels in the organization. The 1997 study showed that minorities are well represented in the health care workforce but have not entered the executive ranks in proportion to their numbers. The study revealed that only about five percent of executive level healthcare executives are African American. The number of top-level executives has not changed significantly over the past five to ten years when comparing the 1992 and 1997 surveys. This is due to several factors, not the least of which is that minorities eventually hit the glass ceiling of the hospital hierarchy and may not be allowed to enter the executive ranks. Also, the healthcare industry is rather conservative and has failed to encourage minorities into graduate and executive-training programs. Also, hospital/healthcare consolidations increase competition among talented hospital administrators.

The healthcare field, both current and long term, is ever changing. Healthcare continues to be one of the most passionately debated topics in our society for a number of reasons which include the ever-increasing cost of technology and medication, insurance issues related to covered services, the struggle to remain profitable in this tumultuous climate, the medicare and medicaid crisis, and more. Keep in mind that even a healthcare facility must cover the cost of providing care plus generate some surplus in dollars to keep the organization viable. This has become very difficult with managed care, medicare and medicaid reductions, and hospital mergers coupled with the increasing costs of providing care. For the past ten years, healthcare organizations have been reshaping themselves; merging, acquiring, aligning, and partnering – positioning themselves to provide quality services and remain viable. Health care experts point out that these factors continue to set the challenge, even for the new millennium.

Networking is an opportunity to interact on a personal level with individuals in your area of interest. I cannot stress enough the importance of networking. Allison Wright, M.P.H. (left), a recent graduate of the master’s program at Southern University in Baton Rouge, says, "You must seize any opportunity which provides a setting in which you will be exposed to established African-American health care professionals." Every job opportunity that I have had has been enhanced by the result of networking and mentorship. To know a person in the company that you want to be a part of is extremely beneficial as your career moves up through the years. Organizations like the National Association of Health Service Executives (NAHSE) at www.NAHSE.org and The Institute for Diversity in Health Care Management at www.institutefordiversity.org cater to the needs of students interested in making health administration their career. Scholarships and summer internships are offered to talented students by these organizations.

The premier health administration organization for all administrators is the American College of Health Care Executives (ACHE) at www.ACHE.org where you have an advancement tract which leads to getting credentials in the field. Also, read, read, read every healthcare article and journal that you can possibly read. Keeping abreast of trends in the health care industry is of utmost importance. Researching the organization that you want to join is essential. Many professional health care organizations publish journals and newsletters. There are also many healthcare trade journals like Modern Healthcare, Hospitals and Health Networks and Healthcare Executive. Many healthcare organizations subscribe to these publications and are members in the professional organizations listed above. Just to know someone in the organization can provide access to these opportunities. Robert Currie, CHE, national president of NAHSE says, " involvement in a professional association such as NAHSE creates opportunities for students to develop lifelong relationships with seasoned African-American healthcare executives. These relationships lead to mentorships and career opportunities." Business etiquette is also a key component in achieving career success. Walter McLarty, vice president of Human Resources at Ochsner Foundation Hospital in New Orleans, says, " The most important attribute that each of us has is our attitude - it is also the one thing that we have control over and ultimately determines our professional outcomes." As you leave one job, don’t burn bridges. There is nothing better than an outstanding recommendation from your old boss or professor.

Final Reflections

After interviewing many African-American healthcare executives across the country, I found that there were no glamour stories about their rise to success. There were only lessons to be learned of hard work, determination and careful planning. A true passion exists in these individuals to ensure that quality healthcare is provided to all. They also know that it would be wonderful if diversity in health care management was reflective of the diverse communities we are charged to serve. Though the outlook for hospital and healthcare services continues to remain uncertain, we can be sure that the need for quality services will continue to be ever present. To make a prediction about the future of the health care industry would be futile because health care issues will continue to be heavily debated. Probing questions such as the following remain unanswered. Will physicians unionize? Will medicare reform take on a positive direction? Will hospital mergers continue? Or, will all patients receive one quality level of health service regardless of their ability to pay? These and many other challenging questions will continue to be debated into the next millennium. Therefore, if you choose healthcare administration as your career goal, buckle up and get ready for an exciting ride!