Senior Vice President
Americans Abroad: The Global Market for U.S. Healthcare Executives Is Heating Up
The U.S. healthcare system has always been fairly insular. It has regulations and a reimbursement structure distinct from those in other nations, and certainly its own standards of care and quality. Its business model is driven by a strong private-public hybrid engine. For workers the money is good, especially for doctors, nurses and skilled employees; executives in the sector might not be on par with their corporate counterparts but they still do quite well for themselves. (Just ask a healthcare administrator in London, Mumbai, or Hong Kong.) Because of this, healthcare executive talent in the U.S. has tended to stay in the U.S.
Traditionally there has not been much pull from abroad for healthcare executives either. Foreign countries presented the prospect of either a socialist (i.e., lower-paying) system or one that had few modern technologies and facilities. (Exceptions were predominantly in the Middle East, where the geopolitical situation and cultural restrictions gave many U.S. executives pause about relocating.) Going abroad in many cases was literally or nominally volunteer work: executives sans frontiers.
In my recruiting work, however, I am seeing a shift in this dynamic. U.S. healthcare executives are looking more intently overseas for employment while the opportunities abroad proliferate – especially in Asia and the progressive areas of the Middle East.
Why this change? One thing is that the healthcare marketplace is truly expanding and globalizing. While the EU has been pinched and not all regions are increasing their healthcare spending, countries like India, China, South Korea, Japan, Singapore, Malaysia, and the UAE are on the build. (See Deloitte’s 2016 report on global healthcare or PwC’s recent thoughts on the impact of new entrants to the market.) Developing nations are looking to “leapfrog” others.
Say what you will about healthcare reform in the U.S. but it is not an isolated phenomenon. Other nations (China in particular) are watching the U.S. market to see how hospitals and major health systems are addressing population health, slashing costs (or at least trying) while ramping up care quality, changing reimbursement structures, testing technologies, and generally pursuing a more retail-flavored brand of medicine. As countries develop consumer-oriented models they are looking to partner with progressive U.S. providers and eyeing executives who are proven winners and change agents.
Medical travel and tourism has expanded and marketplace competition within healthcare has picked up, with “tourists” streaming in to places like Johns Hopkins, Mayo, MD Anderson, or Cleveland Clinic in the U.S. but also migrating to places like Shanghai, Singapore, and the U.A.E., hubs which are positioning themselves to compete on a world healthcare stage. Global opportunism among top “brands” is widespread, with examples like Cleveland Clinic in Abu Dhabi to Weill Cornell in China to Mayo in Singapore (partnering with Raffles Medical Group).
In short, healthcare borders are breaking down and the executive talent market is more global than it has ever been. There are more jobs than top candidates, pushing salaries and competition.
If you build it . . .
Meanwhile, U.S. healthcare execs have a cachet that is unmatched. There is the perception in the global community that American healthcare is the cream of the crop. It is hard to argue with this sentiment.
Hospital startups around the globe tend to look for a few critical leadership roles: in facilities, government relations and commissioning, chief clinical officers, chief nursing officers, and of course CEOs and COOs. More established organizations are recruiting the gamut of executives with particular needs in IT, finance, and compliance and risk management.
Are U.S. executives interested? What would prompt, say, the COO of a U.S. system to leave a good job for foreign shores? There are a number of factors at play: the complexity and uncertainty of the U.S. market; the chance to get in on the ground floor of a new or revamped venture and to be a bigger fish in a different pond; greater autonomy; a sense of mission; and good salaries and perks. Many top U.S. executives are nearing retirement, are empty nesters, and are looking for their next or last great career adventure. As noted, many U.S.-based health systems are extending their reach abroad to expand their businesses and brands, creating the prospect of executives going overseas without changing employers.
Let’s not forget that there is still a romantic pull of overseas work and living. My firm and its partner firm, Ccentric Group of Australia, recently conducted a survey of global executives about their feelings on geographic mobility. We polled more than 500 leaders in healthcare, the life sciences, and higher education, and of the hundreds who had already lived and worked overseas, every single one indicated that it was a positive experience. I find this remarkable. We also learned that, while money is important, it is not necessarily the top driver of career decisions for global-minded executives. They want a challenge and cause, something with rewards beyond monetary. Despite the inherent risks of moving one’s life to a foreign country, in almost all instances the benefits far outweigh them.
Can they go home again?
A clear concern that U.S. executives have when considering going overseas is whether they can return again. Indeed, as recently as five or 10 years ago my clients in the U.S. would look warily at the resume of an executive candidate who had been outside the U.S. for more than a year or two. This skepticism has diminished as U.S. organizations understand the benefits of recruiting executives with international experience. These individuals have a bigger-picture view, carry innovative ideas, and often have proven experience in building up programs and facilities from scratch. Physician executives are in great demand in this population health era, and with the improvement of healthcare facilities and infrastructure around the world there is no longer the stereotype that doctors lose executive or clinical skills when they work overseas – in many cases, in fact, they hone them.
While the global marketplace for healthcare executive talent is not exactly fluid and frictionless, it is very active at present. There is great demand for healthcare leaders from the U.S., and opportunities for these executives should continue to be plentiful and, increasingly, intriguing.