Congratulations ... you're fired!

Being fired as a physician executive is the dark side of burgeoning opportunities for health care leadership. The risk of termination is 20 to 40 times higher than for clinicians. Several approaches to calculating and predicting the probability of being fired are presented, based on a recent survey of American College of Physician Executives members and the author's professional observations. The survey identified several factors that are associated with a higher risk of being fired. These include structural conditions like organizational type and position, as well as factors ranging from being the first person in a new or unclear job to working for an entity with two or more years of significant financial losses. Persistent conflict with a boss or board member--concerning personal style or organizational strategy--is another commonly present danger signal. Additional predictive variables include recent termination or departure of a boss, recent merger, and widespread organizational downsizing or re-engineering. This article suggests strategies to better predict high-risk situations, to prevent termination, and to increase the likelihood of your professional and personal well-being when termination becomes inevitable.