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'90s to be expansionary for medical management.

'90s To Be Expansionary for Medical Management

Leadership has been the operative concept for the American College of Physician Executives since its founding in 1975 as the American Academy of Medical Directors. The expressed purpose of the educational programming that initiated the College has been to provide physicians with the management knowledge and leadership skills that would allow them to seek influential roles in the health care system.

Over the years, the educational goal has been expanded and redefined in response to new needs. As new skill needs have been identified, the design of the College's curriculum has been altered to accomodate them. The goal of leadership roles for physicians in management has remained fixed.

"That purpose survives and continues to be achieved," says Dr. Lindeman, who is President and CEO of the Virginia Mason Medical Center, Seattle, Wash. Through the Physician in Management seminars, the National Conference, the National Institute, the Executive Symposium, and the many other educational programs that have been developed and presented successfully over the years, the College has established a fundamental and ongoing curriculum of learning for the physician interested in management, he says. Now, he suggests, the College will need to improve and expand its educational offerings to hone the skills of established physician executives and to encourage aspirations of leadership in them and in new groupings of physicians.

"I see 1990 and the years beyond as a time in which the College fine-tunes its mission of encouraging physicians to accept leadership positions throughout the health care system and its educational programming to ensure their success," Dr. Lindeman says. "To continue to be effective we will need to examine our curriculum and revise it as necessary. Responding to changing theories in general management and changing conditions in health care management has always been a special strength of the College. I expect the future to hold the same steady and inspired responses to environmental demands and changes."

The Physician in Management seminars, for instance, will almost certainly reflect the impact of epidemiology, outcomes research, quality improvement processes, statistical analysis, and other new topics on the medical management profession, according to Dr. Lindeman. And new developments in these areas are certain to be covered in programming for the National Conference, he says.

Pointing to the College Board's approval of new educational tracks for hospital-based chiefs of staff and other medical officers and for new board members of group practices, Dr. Lindeman says that the College Board has set the establishment kf medical management development opportunities as a major goal. "Our new courses for physicians just beginning their entry into medical management will be custom-tailored for persons whose ability to make time commitments for educational programming is limited. The learning will be just as intense, but we will design the events with both the needs and the time constraints of the audience in mind," he says. "Most important, these courses will provide the College with a mechanism for identifying potential new leadership in medical management and for encouraging these individuals to reach for the top."

Dr. Lindeman hopes that physicians completing these introductory management courses will eventually graduate to the Physician in Management seminars and then to other more advanced College offerings, becoming full-fledged members of the medical management profession. "Future growth of the College will continue to be linked closely to growth within the medical management profession. The College will serve the profession well by developing an ongoing stream of qualified physician executives."

Physician executives have traditionally come to management from clinical practice, having first served with distinction as practicing doctors. And many will continue to practice medicine, even if on a limited basis, after they have made the commitment to medical management. The important point is that most of these individuals simply do not have the desire or the ability to leave their jobs and pursue education on a full-time basis.

Dr. Lindeman does not think it likely that this situation will change. He notes that one of the things that distinguishes physician executives from other managers is their clinical expertise and health care knowledge. Medical management will always be a mid-career decision for most physicians, he says. But the College has an obligation to assist those physician executives who desire formal higher education and the resulting advanced degrees, he says.

"The educational programs of the College will be critical to the continuing development of physician executives and to the leadership that they provide the health care field," he says. "But the College must also seek new opportunities for physician executives to acquire master's degree level education and training in management. The next decade should see significant growth in both the number and the geographical spread of both residential and nonresidential master's degree programs in colleges and universities. The College will be at the forefront in the establishment of these programs on behalf of the medical management profession," Dr. Lindeman says.

For several years, the College has been struggling with the challenge of developing educational opportunities for more seasoned physician executives, for most of whom there is no longer a need for the Physician in Management seminars and bor some of whom the content of the National Institute is also too elementary. Dr. Lindeman says that the National Conference, because it provides unique opportunities for such leaders to network with both old and new medical managers, is an excellent vehicle for the more experienced executive. "There is tremendous value," he says, "for physician executives getting together and discussing the cutting edge problems that confront the profession and the health care field. We will be looking for more such opportunities in the years ahead."

At the moment, other than opportunities in traditional College educational programming, the only program designed specifically with the needs of the more seasoned executive in mind is the Summer Executive Symposium. That program will continue to be directed at the established medical manager, Dr. Lindeman says. But College staff will be asked to fine-tune the program's contents so that the program is more sharply targeted for the intended audience, he says.

Dr. Lindeman believes that the diversity of the College's membership is a key to the success of networking opportunities for members. "Our members come from every conceivable environment in the provider segment of the health care field. What is more, we have key representatives in the military, in government, and in both the buyer and the insurer segments. Our diversity is one of our most appealing features," he says. "It seems to me that all the elements of the health care field are getting closer and closer together, seeking a forum in which mutual interests can be discussed and negotiated. Our diversity makes us an ideal location for such a forum." A goal for the next few years, Dr. Lindeman says, will be for the College to begin to perform this important function, providing a forum in which health care leaders, "most notably physician executives," can meet and solve health care delivery problems.

Dr. Lindeman believes that this national forum can come from mechanisms that are already in place within the College. "The Societies and Forums set the stage for such a gathering," he says. "The Roundtable could easily become an initiating mechanism. In this group and in the Societies and Forums themselves, we already have most of the groups that will have to be gathered for a national discussion. Our own members could be the organizers of this unique effort."

During its annual meeting at the National Conference, the College Board approved the establishment of a Forum on International Medicine and Health Care. Dr. Lindeman sees the Forum as an extension of the College's drive for leadership for medical management within the health care field.

"Many in policy-making positions are looking closely at the efforts of health care professionals in other parts of the world. There is much that we can learn from the health care systems and practices of other countries," he says. "And it is clear that there is much that we can share with our professional colleagues abroad. This new forum will be an important conduit for the exchange of ideas and knowledge that can improve health care delivery on a global basis."

The theme of the 1990 ACPE National Conference was medical care quality, and all of the questions that surround that issue were addressed during the Conference. Dr. Lindeman believes that resolution of quality issues will need the special skills and attributes that physician executives bring to the discussion. "The clinical background of physician executives, combined with their management skills, uniquely positions them to address medical quality. In fact, medical quality management cannot be accomplished in the absence of strong physician executive involvement."

Dr. Lindeman sees quality, its definition, measurement, and evaluation, as a continuing part of the leadership role for physician executives. "I see a role for the College in helping physician executives not only to stand for and understand quality but also to be committed to its continuous improvement in the organizations they represent. A self-satisfied attitude will not be acceptable," he says. "Physician executives will have to take a leadership position in demanding that quality be examined routinely and improved as a matter of course."

Dr. Lindeman believes that too much attention continues to be paid by organizations to the notion of "bad apples" in the drive to improve quality. He says that quality improvement must be an overall effort. "If everyone in an organization improved performance by, say, 3 or 4 percent, the organization would undoubtedly deliver a better product to the patient. We would make bigger gains for more people if everyone improved a few percentage points each year rather than have all our energies concentrated on trying to sead out a couple of bad performers."

Just as important as quality, according to Dr. Lindeman, is service. "As I deal with patients, it doesn't seem to me that they have a bone to pick with us on the quality of our performance. Where the pubic has access to care, it seems satisfied with the quality of the care provided. Where patients do get on us is that we cure but we don't care. I think that doctors, most especially physician executives, can take a leadership role in delivering, interpreting and managing the process by which we deliver services to patients. Call it service or call it patient advocacy, but it's all the little things that make things easier and more pleasant for patients."

Dr. Lindeman says that the answer may be to insist, and operate on the premise, that quality subsumes service. "The final definition of quality will have to encompass the patients' perception of the services he or she receives," he says.

The medical management profession, then, has the capacity to serve as a unifying force for the health care field. "The profession and the College, because of the success of their efforts to handle diversity, can serve as both a model and a forum for gaining appreciation for the commonality that characterizes the health care field. An understanding of that commonality," he says, "can lead to more timely and more effective solutions to the difficult problems that beset the health care delivery system." Dr. Lindeman says that the '90s will be a critical period in developing those solutions. And he expects the medical management profession to be at the head of the charge.

"The seeds of ongoing success are already planted," Dr. Lindeman says. In its first 15 years, the American College of Physician Executives "has developed educational programming of national stature for physicians moving into management roles. The high quality of that programming, and the intensity of the College's overall efforts to elevate the status of the medical management profession, has attracted a broad-based membership. The medical management profession," he says, "has arrived. Now the nuturing must begin in earnest."

Dr. Lindeman sees growth for both the profession and the College in the years ahead. "All the initiatives I have mentioned--the new educational programming, the Forum on International Medicine and Health Care, etc.--are important elements in the nurturing of the profession. In the not too distant future, I expect that we will achieve formal recognition as a medical specialty through the work of the American Board of Medical Management. That will contribute more growth.

"An already large and growing cadre of well-trained and dedicated physician executives will become a source of leadership for a health care system in real need of the physician's hand. It is easy to be optimistic about the College. The base is solid, and the planning is sound," Dr. Lindeman says.

And that returns the conversation to its beginning point. Leadership. "No objective is as critical in the College's planning and programming as the continued development of physician leaders."

Wesley Curry is Editorial Director of the American College of Physician Executives.
COPYRIGHT 1990 American College of Physician Executives
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Copyright 1990, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Title Annotation:conversation with American College of Physician Executives' president Roger C. Lindeman
Author:Curry, Wesley
Publication:Physician Executive
Article Type:interview
Date:May 1, 1990
Previous Article:Not different, just bigger.
Next Article:Why physician managers fail - part one.

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