A student's view.

A Student's View

As the profession of medicine is swept and altered by the issues of diminishing resources, limited access, advancing technology, and assuring quality, clinicians are increasingly called, sometimes pulled, into medical management. Elemental to the paradigmatic shift in the medical profession that the addition of management responsibilities entails is recognition and acceptance of medical management as a specialty of medicine. This article describes the journey of one physician in the acquisition of management credentials.

My involvement with management began with direction of a medical school program in internal medicine while simultaneously conducting a consultative practice. Over the ensuing six years, management skills--developing strategic plans, initiating structure, managing interpersonal relationships, and problem solving, among others--were learned on the job. Measuring and improving the quality of patient care and of the educational experience for new physicians were essential parts of my responsibility. The emerging fields of quality and utilization management and medical staff affairs provided the next administrative way station for me. I worked as a consultant in a loosely bound consortium of regional health care institutions, where the managerial issues of quality, accreditation, medical staff affairs, and clinical information systems provided a fertile environment for a transition from clinical epidemiology to the management of health care quality. While hospitals are extremely diverse in their approaches,[1] the need for a managerial resource at the physician level is becoming recognized by many, especially smaller, health care organizations. The medical director, relying on administrative knowledge, managerial skills, and clinical understanding, has assumed a "boundary-spanning" role.[2] Medicine is a categorizing discipline. Through the credentialing process, we attempt to clearly define areas of competence. This rationale also holds true for the physician manager, who acquires the fundamental skills and knowledge required for administrative medicine through clinical expertise and experience. Credibility, however, must be earned and is based on three characteristics: participation and leadership in the medical community, capability in the establishment of standards of care, and training in management theory and practice.[3] Management training and education programs, to be successful, must accommodate individuals with job and home responsibilities. At the University of Wisconsin Program in Administrative Medicine, adult learning tools and nonresidential coursework make possible a degree program with day-to-day applications integrated into the core curriculum. The members of a class, because of their experience and expertise, contribute to the knowledge-acquisition process as much as does the faculty instructor. In this collaborative mode, a network of student contacts allows comparisons of regional or national trends, as well as development of future resources from which the members of the class may draw. Such interaction also augments areas of research, collaborative studies, and dissemination of newer concepts. The preceptor aspect of the University of Wisconsin program further enhances network opportunities, collaborative projects, and multi-institutional approaches. Following the principles of quality improvement,[4] such training is an asset on the ledger sheet of the institution as well as the individual. However, the opportunity costs for the student can be great. The amount of time required for study and project preparation is easily underestimated. Co-workers and superiors need to be understanding of lesson deadlines as well as of the time required for teleconferencing. Stresses on the family may also be underestimated, as evenings and weekends are cluttered with homework assignments. On-campus residential work subtracts from vacation time, and the intensity of coursework may lead to burnout. A sincere personal commitment is required, and sacrifices must be made. The importance of a supportive family and work environment is clear and vital. My interest in medical informatics, epidemiology, and quality assurance, coupled with experience in medical education and entrepreneurship, was focused by the pursuit of a graduate degree in administrative medicine. The University of Wisconsin program has been key to the assumption of a new role in senior management of a health care system.[5] Without doubt, this career path was influenced by an apprenticeship with a visionary in the field of medical management, but the transition also required the skills and knowledge developed from past clinical-practice experiences and previous educational programs,[6] a significant portion of which could not have been gleaned from on-the-job training. As changes in health care systems increase in speed and intensity, clinicians in management will rely more and more heavily on advancing their skills and knowledge through graduate education. Additional recognition will come through credentialing, and continued research will multiply the impact that trained physician managers will have in guiding the health care system into the future.

References

[1].Acree, P. "Differences Characterize Utilization Review, Quality AssuranceActivities." Physician Executive 14(6):29, Nov.-Dec. 1988. [2].Kindig, D., and others. "The Changing Managerial Roles of Physician Executives." Journal of Health Administration Education 7(1):33-46, Winter 1989. [3].Burns, J. "The Credibility of the Physician Executive" in New Leadership in Health Care Management: The Physician Executive. Tampa, Fla.: American Academy of MedicalDirectors, 1988, pp. 74-77. [4].Deming, W. Out of Crisis. Cambridge, Mass.: MIT Center for Advance Engineering Study, 1986. [5].Matheson, G., and others. "Good Management for Good Medicine: The Role ofthe Vice President of Medical Affairs." Healthcare Executive 3(5):31-3, Sept.-Oct. 1988. [6].Ottensmeyer, D., and others. "Mining Physician Potential: The Physician as Hospital Executive." Healthcare Executive 4(5):24-6, Sept.-Oct. 1989.

B. Eugene Beyt Jr., MD, is Vice President for Medical Affairs, General Health, Inc., Baton Rouge, La. The author acknowledges the support, guidance, and encouragement of Page Acree, MD, and Perry Chesney, MD.