Many of today's ambulatory surgery center management and development company leaders made a name for themselves as administrators before moving into the role of executive. The following four executives discuss their transition from administrator to executive:
- Sandi Baber, RN, MHA, vice president of operations for Blue Chip Surgical Partners
- Susan Kizirian, RN, MBA, chief operating officer for Ambulatory Surgical Centers of America
- Sarah Martin, RN, MBA, CASC, vice president of operations for Meridian Surgical Partners
- Robert Welti, MD, senior vice president of operations and medical director for Regent Surgical Health
Note: Responses are listed in alphabetical order of respondent's last name.
Q: Where did you serve as administrator, when did you make the change to company executive and what was the position you moved into?
Sandi Baber: I have held several administrator positions within the St. Louis area in both large and small centers. I originally worked with physicians to develop de novo single specialty centers with emphasis in orthopedics and ENT. In 1998, I moved into an executive position as a vice president of six surgery centers for a large management company.
Susan Kizirian: My last position as the administrator of an ASC was at University of Virginia Health Systems. I was a medical center director. UVA purchased a freestanding ASC and I was hired to convert it to an HOPD while keeping its ASC efficiencies. I moved into a vice president of operations [position] with ASCOA in 2005.
Sarah Martin: I was in a unique position as the administrative director for four freestanding surgery centers in the Memphis, Tenn., area, which were joint ventures with a local hospital system. Two were multi-specialty surgery centers, one was urology and one was all pediatric. I learned about coding, how to bill, schedule, about collections and still assisted in staffing in all areas, preop, operating room and PACU. It was a wonderful experience as I had overall responsibility for the clinical, financial and quality aspects of four centers, which set me up for taking on a regional role with an additional volume of centers.
My first executive role was with Symbion as a regional director of operations for their Midwest Region, and I had six facilities of varying specialties: several multi-specialty centers, a surgical hospital and an imaging center, so it was an eclectic mix of facilities.
Dr. Robert Welti: I was a practicing anesthesiologist in Santa Barbara (Calif.). We opened an ASC in 2001. I went over as medical director and on-site anesthesiologist. I did that until 2006. The administrator at Santa Barbara Surgery Center then left for another location. I was very involved as medical director, so the management company of the ASC and physicians asked me to go ahead and try to be an administrator. I had done a lot as medical director, more than usual, and learned from the job from the administrator there. I was administrator from 2006-2008. In 2008, after we were able to orchestrate a turnaround of the surgery center and get it to a stable and profitable situation, Regent Surgical Health asked me if I'd be interested in becoming an executive with the company. I became the senior VP of operations to provide regional oversight for their Western U.S. surgery centers.
Q: What was the motivation or circumstances which led to your move from working as an administrator to an executive?
Ms. Baber: I found that I was very interested in development and recruitment of physician-partners. The reimbursement climate and increased competition has dramatically changed the healthcare industry. The key is staying competitive by focusing on our patients and our physician partnerships while enhancing our revenue and product lines. I found this balance very exciting and challenging.
Ms. Kizirian: As administrator I had run the gamut of experiences including writing the business plan, obtaining financing and getting one off the ground to converting an ASC to an HOPD. The challenge of learning, moving fast through multiple and/or complex operational issues with top results, managing multiples, creating process and protocol to obtain systemwide improvements and the big picture focus getting even bigger were primary motivators.
Ms. Martin: I love to be challenged and to continue to grow and learn. I was ready for a change from day-to-day operations. I left the hospital system to become a consultant for ASCs. In the process of consulting for Symbion, I was asked to interview for the RVP position when it came available.
Dr. Welti: I had practiced anesthesiology for 27 years, and it was through the administrator experience that this opened up a whole new career, a whole new world. I had practiced anesthesiology for a long time, and my kids were out of the nest — they were all grown up. It seemed like an opportunity to try something new. I really enjoy the organizational aspects of business and helping centers to turn them into good places for physicians to work.
Q: How is life different on the "other side of the fence"?
Ms. Baber: The work is focused more on the business of ASC life rather than the patient focus of an administrator. Administrators face the daily challenge of creating a quality environment for patient care while maintaining the essential and sometimes monumental tasks required for licensure and accreditation.
Ms. Kizirian: The details are different. Administrators deal in the day-to-day, much of it mixing components of human, materials and financial management with good communications for great outcomes.
While I don't deal in center-specific details, I do deal in the who, what, when, where and why of the changing ASC industry and market impact for all our facilities. And that is, in essence, a much broader field involving finding the right formula of mixing human, materials and financial management with clear, concise communications that translates with high consistency to excellent results. Fundamentally, [it's] a bigger laboratory and bigger test tubes to create an exponentially significant impact.
Ms. Martin: I see the biggest difference is the face-to-face interchange with physicians and staff. The administrator is on-site daily and has to be the first line of interaction with angry physicians, or difficult issues that arise. I don't get involved with those unless they escalate to a point where the administrator can't handle them. Also, the accountability is certainly increased, as I am required to ensure that all facilities are successful in all areas of the operations.
Dr. Welti: Going back to the transition from being a physician to administrator, what I learned is that when physicians come into a center, do their cases and leave, it's very rare for a physician to have any idea of how much it really takes to run an ASC. They come in, do a case and get that snapshot view, but they have no idea how much it takes to run the center in terms of regulatory issues, clinical issues, supply issues, labor issues. Having held both the role of physician and administrator, I thought I was in a pretty good position to understand these organizations from the ground up, but what I needed was then financial education that a company like Regent could give me.
Funny thing I learned was that I thought that going to the executive position would be more relaxing than being in the trenches as a practitioner/administrator, but in reality it's just multiplied by six (for the six ASCs he oversees) and I end up working harder and more hours (factoring in the travel as well) then even when I was practicing full-time anesthesia. It's a seven-day-a-week job.
Q: What do you miss about working as an administrator?
Ms. Baber: Patient contact. As an RN, patient care is always at the forefront of my mind. As an administrator, I found that daily contact is an essential component of management.
Ms. Kizirian: Patient care and mentoring new employees fresh out of school.
Ms. Martin: Working with patients. When there were staffing shortages, I would jump in and help and that always gave me the personal touch "fix" working with patients gives me. It also reminded me of how hard my staff work and gave me a renewed appreciation of their work ethic. It was also fun working in my hometown and being able to see and take care of friends and family when they were having surgery. Now that I travel, that aspect is gone.
Dr. Welti: When I was administrator, you really did create a sense of a family. I would know the nursing staff, the business staff, and having worked for 27 years as a physician in the community, we were really a close-knit family. It takes awhile to penetrate the culture of each new center and to be accepted as not an outsider. I do miss really knowing the people on a day-to-day basis.
Q: For individuals working in surgery centers considering this career change, what advice or recommendations would you offer them?
Ms. Baber: Making the transition from a clinical mindset to a business mindset is often challenging. I recommend that they find a mentor and learn as much as they can. Don't be afraid to ask questions. The ASC business changes rapidly and it is extremely important to keep up with all of the new regulations. Keep the old motto "never stop learning" in mind.
Ms. Kizirian: Once you have gotten your ASC as good as it can get, then this is the next step. Master's degree preparation in business is an enormous advantage. Participation in industry associations on the state and national level, pursuing public speaking on ASC specific topics and writing for ASC publications are all excellent stepping stones to expanding ones horizon from one facility and the day-to-day to a much bigger forum. You have to like confrontation and conflict management. And you have to thrive on new and different. To get to this next step it is about successfully motivating others and creating and implementing fast and efficient protocols to achieve all goals en masse.
Ms. Martin: Develop your time management skills so that you will be able to handle multiple facilities. Focus on details, as many times the new centers I am introduced to are mature and well run, but can still use my experience and knowledge of where to look for money-saving opportunities or how to implement clinical best practices. Conversely, I have also had to go into centers and make many corrections, so learn everything you can about your business when an administrator from how to use your software system in all modules to performing life safety checks in your facility. Last, but not least, look for opportunities to learn new things and help other centers within your organization. This exposes you to your executive management team more and you get to observe how other facilities are run. One thing that changes once you step into an executive role is you learn that there are many ways to run facilities and you need to have an open mind to this. Be open to constructive criticism.
Dr. Welti: I think you have to have — and you probably already do if you're an administrator — excellent organizational skills because now you're trying to keep up with handling the information of not just one center, but you're trying to keep on top of multiple centers.
I think you need to really like people because you're constantly meeting new and diverse people you may have never met in your old center. You just have to know the business inside out so you can walk into a new place and convey the confidence that you're really there with the knowledge to help them develop the center. The travel from covering multiple centers can be exhausting. I could not have done this when I had small kids. You better not [dislike] like travel.