Health system executives who keep a primary residence in one city and travel to another for work are not a new phenomenon. But as systems recruit nationally, expand across state lines and compete for high-level talent, where an executive is expected to live can become a factor in a search.
Health systems do not appear to be moving uniformly toward more or less geographic flexibility for senior executives. Instead, where leaders are expected to live and how often they need to be on site can depend on the role, the system’s geographic footprint and the circumstances of an individual search.
Stephen Davis, senior partner in the healthcare practice at WittKieffer, said his firm is not seeing a definitive trend toward looser relocation requirements. WittKieffer is an executive search and leadership advisory firm that works across healthcare, life sciences and education. In healthcare, WittKieffer works with hospitals and health systems, payers and managed care organizations, investor-backed organizations, specialty and retail providers, behavioral health organizations, federally qualified health centers, and aging services and hospice organizations.
“If anything, we’ve seen some systems tightening their requirements, wanting executives to live close to their headquarters or main hospital,” Mr. Davis said. “It’s especially important for executives of community-based and rural hospitals to be visible, to sit on local boards, to attend local events and contribute to the community.”
The reason, he said, is the nature of the work.
“Healthcare is a relationship-driven industry,” Mr. Davis said. “It starts with caregivers, but hospitals and health systems generally like to have their leaders close and visible locally, to build those relationships with colleagues at all levels of the organization as well as the patient population.”
Mr. Davis said expectations also vary by role. Systems generally want CEOs, COOs, CFOs, chief medical officers and chief nursing officers to relocate close to headquarters or the main facility, while some functional areas, including IT and HR, can offer more flexibility.
Geographic flexibility comes up often as a candidate ask, he said, and can become a deciding factor for either side.
“Candidates frequently ask about whether they might work remotely or have some kind of hybrid arrangement,” Mr. Davis said. “Some employers allow this but many do not, and it is a deal-breaker for some candidates and some employers. Our clients, when they begin a recruitment, understand there is a trade-off for expecting executive hires to relocate. In situations where there is a clear top candidate, some health systems will negotiate with that candidate on an arrangement that works for both.”
When an arrangement is reached, Mr. Davis said it typically goes into the offer letter, which his firm recommends to minimize misunderstandings later. For roles in which flexibility is available, he said it has widened the candidate pool and allowed systems to recruit nationally, though he noted this has been the case for more than a decade.
At Morgantown, W.Va.-based WVU Medicine, location expectations similarly depend on the role and, in some cases, whether an executive lives within commuting distance. Leeann Kaminsky, senior vice president and CHRO, said members of the system’s senior leadership team, including executives overseeing human resources, finance, legal, IT, compliance and marketing, are expected to be visible, available for on-site meetings and able to travel throughout the service area.
That does not necessarily mean living in Morgantown. Ms. Kaminsky said several senior leaders commute daily from outside the city where the system’s corporate headquarters is located and described the commute as reasonable. She said those leaders are also available to travel to locations across WVU Medicine’s three-state system.
Physician executives and clinical leaders generally relocate to the area, she said. Within HR, however, WVU Medicine’s system HR team has operated remotely since March 2020 and has leaders working from several states, while local HR teams work on site at their hospitals. The system gave up leased office space and has not required system HR employees to return.
“It really has opened up our talent pool,” Ms. Kaminsky said. “We’ve been able to get really skilled, experienced people to work for us because they’ve not had to relocate.”
Ms. Kaminsky works on site several days a week, though that can vary depending on business needs and may require her to be on site every day during a particular week. When it comes to determining which positions can have that flexibility, she said the role remains the primary consideration.
Expansion into new markets can add another element. WVU Medicine expects to acquire six hospitals by Jan. 1, five of them through its pending acquisition of Independence Health System in Western Pennsylvania.
Ms. Kaminsky said that if WVU Medicine hires new leaders for new clinical locations or hospitals, those leaders would be expected to relocate because of the expectations around hospital operations and community work.
Mr. Davis said mergers and acquisitions can create similar questions for other systems, particularly when organizations add facilities in new states and have to balance retaining existing executives with determining where leaders need to be based.
More broadly, he said location is one of several areas in which health systems are becoming more creative as they compete for leadership talent.
“In general, health systems are getting much more creative around their recruiting efforts to get the leadership they need,” he said. “This can include hiring interim and on-demand executives (who may relocate for a short tenure), forming strategic partnerships and more. In situations where there’s a merger or acquisition or major transformation, systems will have to balance wanting to retain executives with asking some of them to relocate. As such, location/relocation expectations can differ from one organization to the next and industrywide patterns are harder to identify.”
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