The changing managerial role of physician executives

A survey of tasks performed by a sample of 517 physician executives from the AMA Masterfile was carried out to determine the role played by this group of administrators in health care organizations. In contrast to the findings of previous studies, physician executives appear to have responsibilities in general management as well as clinical management and do not focus primarily on physician and medical staff issues. No significant differences were found among respondents from hospitals, government, academic organizations, group practices/HMOs, and physician executives who spend more than 90 percent of their time in administration. Tasks identified as important for the future but not currently being done were primarily in the category of external activities such as "changing regulations and legislation" and "communicating goals to the public." These results identify an important boundary-spanning role for physician executives in balancing managerial and professional issues of cost, quality, and access in health care organizations. The implications of these findings for the educational needs of physician executives are discussed.     

Exploring dual commitment among physician executives in managed care

The growth of a medical management specialty is a significant event associated with managed care. Physician executives are lauded for their potential in bridging the clinical and managerial realms. They also serve as a countervailing force to help the medical profession and patients maintain a strong voice in healthcare decision making at the strategic level. However, little is known about their work loyalties. These attitudes are important to explore because they speak to whose interests physician executives consider and represent in their everyday management roles. If physician executives are to maximize their effectiveness in the healthcare workplace, both physicians and organizations must view them as credible sources of authority. This study examines organizational and professional commitment among a national sample of physician executives employed in managed care settings. Data used for the analysis come from a national survey conducted through the American College of Physician Executives in 1996. The findings support the notion that physician executives can and do express simultaneous loyalty to organizational and professional interests. This dual commitment is related to other work attitudes that contribute to success in the management role. In addition, it appears that situational factors increase the chances for dual commitment. These factors derive from a favorable work environment that includes both organizational and professional socialization in the management role. The results of the study are useful in specifying the training and socialization needs of physicians who wish to do management work. They also provide a rationale for collaboration between healthcare organizations and rank-and-file physicians aimed at cultivating physician executives who are credible leaders within the healthcare system.     

Defining Competencies and Performance Indicators for Physicians in Medical Management

The recent and profound changes in the American health care delivery system have created a need for physicians who are trained and willing to assume a high level of responsibility for managing evolving health care organizations. Yet most physicians receive no formal training in medical administration and management because changes in medical school and residency education have lagged behind changes in clinical practice and reimbursement. To avoid haphazard approaches and unnecessary duplication of resources, it is important for physicians involved in managerial medicine to collectively identify competencies in this area needed in the marketplace. The American College of Preventive Medicine (ACPM), with funding from the Health Resources and Services Administration (HRSA), undertook an effort to identify competencies essential for physicians who will fill leadership roles in medical management. Like ACPM’s earlier effort to develop core competencies in preventive medicine, this project drew upon the theoretical model of competency-based education. This article describes the strategy we followed in reaching consensus among a diverse group of physician executives and preventive medicine residency program directors, and includes the list of medical management competencies and performance indicators developed. Recurrent issues that can sidetrack competency development projects are also presented as well as suggestions for overcoming them. The competencies can serve as a framework for expanding current core preventive medicine training in management and administration and for developing new training programs to equip physicians with the special expertise they will need to provide management leadership within the changing landscape of health care delivery.     

Physician executives in managed care: characteristics and job involvement across two career stages.

This paper examines characteristics, job involvement, and career stage differences among 294 physician executives working in managed care settings. The following research questions guide the study: What types of physicians are currently in managerial roles in these settings? What role (if any) does medical career stage play in physician executives' professional and job-related attitudes? What factors are related to physician executives' involvement in their management roles? Several observations are made from the findings. First, contemporary physician executives see management as an exciting alternative career that involves multiple work loyalties, weaker beliefs in traditional professional values, and the sacrifice of significant amounts of clinical for management work. Second, these trends are more pronounced for physician executives at earlier points in their medical careers, although their work loyalties to profession and employing organization are weaker than older physician executives' loyalties. Younger individuals' involvement in management work, more than older individuals' involvement, appears to depend upon the surrounding work climate within the organization. Finally, the amount of time spent by physician executives as clinicians is inversely related to how psychologically attached they are to management, regardless of career stage.     

Tolerance of ambiguity among MD/MBA students: implications for management potential.

BACKGROUND: Health care is increasingly characterized by uncertainty and turbulence. In an environment of rapid change, flexibility is critical to the success of managers and organizations. Future physician executives must also be open to change and must be able to deal with the uncertainties of management; they must be able to tolerate the ambiguity in management situations. METHOD: This study uses tolerance of ambiguity measures to analyze students at six medical schools offering dual-degree (MD/MBA) programs. Students enrolled in dual-degree programs were assessed and compared with a control group of traditional medical students. RESULTS: MD/MBA students exhibit a higher tolerance of ambiguity than traditional medical students. FINDINGS: As a characteristic associated with leadership ability, tolerance of ambiguity offers a potential indicator of future success as a physician executive. As such, tolerance of ambiguity might be used for selective admissions to medical school and as an indicator of a student's potential to transition between clinical and management functions. As students match personality traits with career choices, those who serve their learning needs must anticipate differences across selected disciplines, roles, and responsibilities.     

Professional commitment among US physician executives in managed care

This paper examines professional commitment among physician executives working in managed care settings in the United States. The rise of an 'administrative elite' in medicine is central to the notion that physicians preserve their professional dominance despite changes in their prestige, work and employment status. Implicit in the notion of Freidson's restructuring perspective, physician executives presumably remain dedicated to professional interests in their management roles. The findings of a national survey support this assumption. Physician executives maintain meaningful, stable levels of professional commitment over time in management and the organization. This commitment is positively related to work-related characteristics involving favorable perceptions of the management job and physical and mental 'connection' to the practice of medicine. Belief in one's ability to successfully deliver appropriate clinical care, however, moderates the positive association between involvement in the management job and professional commitment. The findings provide a rationale for the maintenance of professional loyalty among physicians in management rooted in the work-related perceptions and activities of the individual physician executive.     

Perceptions of management development in selected hospitals

Today health care executives are managing organizations that are complex and require a higher degree of financial management, medical knowledge, and general business skills. The skills and academic background required to manage health care facilities have been debated by practitioners and academicians over the years. This study will examine executives' perceptions of management development activities in their organizations. To assess these perceptions, an eight-item questionnaire was mailed to 587 executives. Forty-two percent were returned. The data showed that a majority of the respondents indicated that the management development programs in their organizations were well received and that the morale of managers had improved. The pressures and challenges facing health care organizations will require managers and executives to make use of a wide range of skills if they are to be successful.     

The leadership and executive potential of physicians in an era of managed care systems

The emergence of managed care signals a need for an expanded role for physicians. Physician executives, trained in management, have the potential to become champions of clinical integrity, negotiators with patient agent organizations, public interpreters of hospital performance data, consultants to the profession, and designers of health care systems. Nonclinically trained administrators have been slow to recognize the unique skills and perspective that physicians bring to the managerial suite. The clash of professional and managerial cultures has often been perceived as precluding a strong working alliance between physician and nonphysician executives. As hospital margins are threatened, decision protocols must not be designed to incorporate teams of leaders who are able to overcome the managerial/clinical divide. The management of this interface will demand the attention of both administration and boards and may require the establishment of new structures in health care organizations.     

Emerging state policy trends related to medical group practice: Alpha Center

This article examines how state health care policy affects new ventures involving medical group practices. It will review briefly traditional state authorities related to the health care sector in general and physician organizations in particular. The article will then discuss state policies related to a range of physician organizations, including those aligned with larger provider systems. State policies related to physician organization in the competitive marketplace include several topics: referral practices, tax exemption, corporate practice of medicine, and antitrust and insurance regulation. Finally, it will discuss the implications of these trends for future enterprises undertaken by medical group practices.     

Managing managed care. The task calls for an integrated management team

Healthcare providers must learn the art of "managing care," a concept integral to but broader than managed care. Managing care has four dimensions: recruiting skilled operations managers; developing systems, procedures, practices, and protocols that meet the demands of capitation and risk management; fully integrating physician leaders; and preserving society's resources by providing care on the wellness, rather than the sickness, model. Managing managed care, which is now usually the task of a single executive, will tomorrow require a team comprising these four roles: The CEO articulates the system's vision, helps develop its strategic plan, and leads the effort to educate all its associates and employees about managed care. The operations leader (which may in fact be a group of operations executives) redesigns the systems organizations, redeploys its managers, and dismantles its obsolete methods. The physician leader (which may also be a group, rather than an individual) helps retool the system's practices and protocols in a way that enables it to deliver the highest quality of care at the lowest possible cost. The managed care executive acts as the broker between the system and insurance firms. In larger systems, this executive designs long-term partnerships between the system and insurers.     

Is a management degree worth the investment for physicians? A survey of members of the American College of Physician Executives

In a survey of 568 physician members of the American College of Physician Executives (ACPE), most of whom had advanced management degrees (MBA, MMM, MPH), approximately 90% of respondents reported that their investment in the education was "worth it." The return on investment was independent of the quality of the academic institution, although primary care physicians stood to gain more relative to specialists. Salary comparisons showed that female physicians had approximately 20% lower incomes than male physicians, confirming the presence of a "glass ceiling" for female physician executives as seen in other medical specialties. These findings have implications for early and mid-career physicians and physician recruiters.     

Lessons of experience: Key events and lessons learned of effective chief medical officers at freestanding children's hospitals

As the healthcare environment changes, physician executives who are effective leaders and agents of change are needed. Healthcare organizations that are successful at developing effective physician leaders will be at an advantage. This article examines how physician leaders develop on the job. Such knowledge and insight can be useful to healthcare systems looking to develop a new physician leadership development program or improve an existing one. This study identified that learning from other people (e.g., mentors, role models, bosses) and key events involving hardships are valuable means in developing leadership acumen for chief medical officers (CMOs) at freestanding children's hospitals. Most of the hardships CMOs reported were a result of mistakes made when they were trying to institute change. CMOs reported a disproportionately low number of learning events from developmental job assignments. This finding may indicate a lost opportunity on the part of healthcare organizations in developing leaders. The most frequent lessons learned pertained to handling relationships, interpersonal skills, and executive temperament. Skills in handling relationships and interpersonal skills were best learned through business mistakes made in dealing with others. Lessons in executive temperament, self confidence, and handling adversity were most often learned from role models and bosses. These findings indicate that physician leadership development initiatives should intentionally and systematically incorporate job assignments, role models, and mentors.     

Implementing a physician leader compensation program at a major community hospital

The roles of physician leaders in Canadian hospitals and health regions are becoming more complex and time consuming. Physician leaders are increasingly being seen by hospital boards and executives as key to achieving strategic and operational outcomes. Given the growing importance of these roles and the increasing performance expectations being placed on physician leaders, it is critical that organizations are able to recruit and retain individuals who demonstrate the skills required to fulfill these critical roles or commit themselves to acquiring them.     

The role of the principal clinical coordinator in the Health Care Financing Administration's Health Care Quality Improvement Initiative

The Health Care Quality Improvement Initiative (HCQII) is the Health Care Financing Administration's latest approach to quality management by peer review organizations (PROs) of the health care delivered to Medicare beneficiaries. The principal clinical coordinator (PCC) of each PRO, a physician with both clinical and methodological expertise, has the overall responsibility for all HCQII-related activities. The PCC works with a clinical coordinating team to analyze patterns of care and provide feedback about these patterns to the medical community for the purpose of improving the quality of care. Each PRO provides its PCC with the necessary infrastructure and expertise to conduct pattern analyses and implement the dissemination process. However, the effectiveness of the HCQII will depend largely on the PCC's ability to maintain the full support and cooperation of the local medical community. The success of the PCC role under the HCQII may enable it to serve as a useful model of physician leadership in the quality oversight organizations that will accompany national health care reform.     

The new obstetrics: strategic implications for hospitals.

In brief, Obstetrics, like many other medical specialties, is experiencing the convergence of a number of diverse medical, social and economic trends. As a result there is increasingly intense turmoil in how these services are clinically delivered and in how they are managed--with a profound shift from basically inpatient, institutional care to outpatient care. Hospital executives must be alert to these changes if they expect their clinics and inpatient facilities to remain competitive and to deliver the best possible care under a rapidly changing set of expectations. If executives fail to recognize these pressures and thereby fail to create timely strategic reactions, their organizations may subsequently experience poor long run performance. The issue in obstetrics is not merely one of determining how best to manage obstetrics-related clinics, programs or departments; although this is a significant hospital management problem, it is important to recognize the changes and prevalent patterns, and to begin devising responsive management strategies. See strategies below.     

Physician executives strive for balance in their changing roles

Many physicians are apprehensive about healthcare reform and what it will mean for them. As physician executives, our job is to help construct systems that cost-effectively deliver high-quality services and achieve positive outcomes in a competitive environment. To this end, we must understand management and all of its ramifications--from finance to organizational dynamics to marketing to systems thinking and information management.     

Managing diversity: a senior management perspective

Diversity and managing diverse workgroups have become strategic imperatives for many organizations. Corporations are developing programs and opportunities to increase the participation of their employees, especially those who have not been previously included in the mainstream of their organizations. Many health care institutions are also focusing on diversity management. This study was designed to examine the manner in which diversity management is perceived and implemented by hospital executives. To determine the perception of executives, a 16-item questionnaire was developed and distributed to hospital executives. The data showed that executives in urban teaching hospitals considered their workforce diverse, and many of these organizations had implemented diversity management programs in their facilities. Surprisingly, this study found that although most executives (68 percent) agreed they had a diverse workforce, less than one-third (30 percent) of these executives had specifically developed diversity management programs in their hospitals.     

Large medical group-practice organizations and employed physicians: a relationship in transition

Out of the revolution in medical practice is being forged a new type of group-practice organization--larger and more complex, more tightly administered, and more strategically aware than its antecedents. A typology is offered to contribute to an understanding of the changing physician/group-practice relationship. Drawing upon historical and contemporary literature, initial and following-up field observations, and extensive interviews, large medical group-practice organizations are analyzed according to basic orientation toward the health care market, and to a belief in how medical practice should be organized. The revolution in practice will be stamped on future health care arrangements, and will be transmitted into the professional culture of medicine.     

A 10-Point Strategic Checklist for Rural Health Care Systems

A checklist format is used to provide a framework for rural hospital executives and community members for gauging the health and stability of rural hospitals and rural hospital systems. Benchmarks are provided for financial and operational performance and emphasis is placed on medical staff size and physician recruitment. Physician/hospital organizations and regional partnerships are used as examples of strategies available to rural providers. The importance of market knowledge and regional strategic alliances also is stressed. In an era of dwindling resources and tight reimbursement, rural providers are encouraged to consider cooperative clinical programming and technology consolidation.     

What are we without risk? The physician organization at a crossroads

The managed care market in Chicago is experiencing rapid change. As health maintenance organization (HMO) enrollment flattens or even declines, and capitation becomes less sustainable for many, physician organizations are reevaluating their continued participation in risk-based contracts and are struggling to define their future roles. Physician organizations are looking for new ways to provide value to their physician members. Physician hospital organizations (PHOs) in particular are reassessing how the organization can continue to serve the interests of both the physicians and their hospital partners. To better understand the concerns of physician organizations, The Lowell Group surveyed Chicago area provider executives on their top issues. Three major concerns emerged: (1) protecting the financial health of the organization; (2) predicting the future of the managed care industry; and (3) evolving the physician organization to meet changing market conditions. Ultimately, physician organizations must make business decisions that support their true goals-serving patients and purchasers of care, physician members, and the organization's owners.