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1. Seeking the complete package
"Centers are really looking for stars, and they're taking the time and effort to find the right people," says Zachary Besheer, MHA, FACHE, vice president of business development for B.E. Smith. "In the past, we would often pull someone from the hospital; now ASCs are looking for a CEO ? someone who can negotiate with insurers, develop new business and maintain customer relationships."

In order to meet that end, ASCs seek out two types of administrators, says Joe Feldman, president of The Spring Group, which runs www.AmbulatorySurgeryCenterCareers.com: BSN (master's preferred) with ASC experience, or MBA with some healthcare background.

"With freestanding, hospital-partnered or corporate-partnered facilities, I find them leaning toward the strong clinical background with some management experience," he says. "I think that is driven by the mindset that a nurse understands physician needs more than a straight-up administrator. But a nurse must have a strong financial background for it to be successful. The management companies are more likely to look for the MBAs, I find, because they're focused on strong financial acumen to run the business. Because that's what an ASC is: a business."

And the ASC business has become increasingly complex over the past two decades.

"It's just not fair to expect a BSN or MSN to understand cash flow models and capital funding unless they have some experience with it," says Mr. Feldman.

Roger Manning, the president of Manning Search Group, agrees.

"ASCs now need someone who knows about general management, can oversee clinical and financial operations, can manage a profit and loss statement, understands investing and syndication, and who also has a personality conducive to marketing the center to physicians," he says. "It shows that the ASC is a business, and it needs to be run like a little corporation. To be competitive in the market, ASCs have to look for the complete package."

2. Changing salary models
With the economy in trouble, base salaries are holding steady, but ASCs are making up for it by putting more into bonuses. While this puts more of the salary at risk for the individual, it provides an opportunity to earn more and gives the center a way to lay out financial, quality and patient satisfaction performance expectations up front, says Mr. Besheer.

"You don't see this as much in hospitals, where they figure out what they are going to pay you based on credentials and experience," says Mr. Feldman. "Here, productivity counts. Packages breaking down the facilities goals and the bonuses based on achieving each of those goals are being offered more often. It helps the employer get what it wants, helps the employee serve the employer well and, further, recognizes the value that the administrator brings. What better way to say, 'Thank you for your efforts'?"

3. Increasing responsibility
ASC management companies are going leaner with their directors of operations, and asking administrators to take on more responsibility.

"Depending on the philosophy of the company, we're seeing some hire administrators that have 'been there, done that,' and can manage operations independently while the director of operations oversees things," says Mr. Besheer. "In other cases, we're seeing administrators charged with running clinical operations, while the director of ops is highly involved on the business side, with negotiations and the like. In all cases, they're looking for executive-level positions to take on more responsibility than ever."

4. Staying within the market
ASCs are increasingly looking for local candidates.

"A lot of employers are focused on bringing in people who are already within the marketplace," says Mr. Feldman. "The reasons are the cost of relocation, the difficulties with the housing market in many prime regions across the country, and wanting people who already understand the market and who already have good, solid relationships with physicians in the area."