How do physician executives view themselves?
The changes run deep. Most physician executives today have acquired substantial management training and experience, and many have worked with and relied on the expertise of physician executive mentors for their career guidance and development. In other words, we are seeing physician executives actually becoming executives who happen to be physicians. And they see it that way, too.
To chronicle this process, Witt/Kieffer, Ford, Hadelman & Lloyd conducted a national survey this spring among senior physician executives in both payer and provider organizations who are members of ACPE. (The survey yielded a 30 percent response rate, providing career/position data from physician executives in hospitals, health care systems, medical group practices, insurance companies, and managed care organizations throughout the country.) The data provide a "snapshot" of their role, and may also suggest some future scenarios for the industry.
Increasingly, sophisticated physician managers are undertaking and succeeding in roles for which their medical school backgrounds did not prepare them. These individuals are essentially reinventing themselves through a career change - rising successfully to meet the challenge of health care management, and finding they have a flair for it, even getting a kick out of it, at a time when there may be little reason for joy to be found in many health care executive suites.
The CEO Perspective
In addition, we also conducted a brief companion survey of health care CEOs, asking a few key questions about the physician executive role and giving the CEOs a chance to offer career advice and counsel to them as a group. The results were enlightening and, to a considerable extent, heartening. CEOs overall are pleased with the contributions made by the physician executive role, but they want more. They want physician executives to continue to expand and enhance their management skills, through advanced education and broader experience with the varieties of health care organization styles of operation.
Some findings from the survey deserve a closer look, as they point out positive directions in which the profession is heading, as well as pitfalls that might be avoided.
Provider CEOs told us they actively encourage their physician executives to acquire further formal education: 63 percent of the hospital/system CEOs surveyed claim to pay for or require their physician executives to attend ACPE's Physician in Management programs; 40 percent said they will provide tuition reimbursement for MBA or other master's programs. A smaller percentage said they prefer Harvard-type management short courses for their physician executives, while many said they provide custom-tailored, in-house training. One clearly disgruntled CEO commented: "I would pay for any of it - if they would do it!"
No magic in the MBA
Management degrees may open opportunities for greater success for many physician executives, but the ABA does not possess magical properties. An MBA cannot guarantee spectacular results in the short-term. We hear every week from physician executives who say to us, in effect: "I have just completed my MBA - now, where's the great job with a great salary?" We have to let them down, gently but candidly. The great job/great salary opportunity will probably come, but often not until executive seasoning has been acquired and honed.
Degrees less common
in provider respondents
Overall, 18 percent of the physician respondents said they have completed a management degree, while 76 percent said they have taken one or more management courses to develop their skills. Respondents who work for providers are only half as likely to have completed a management degree as those with payers, but there is wide acceptance of educational preparation in other, non-degree-granting forums.
Physician executives with a completed management degree program are, according to the survey, more likely to:
* Have been in their organization less
time than the average overall * Have been promoted from within
that organization * Have worked as a physician executive
in at least one other payer or
provider organization * Have had a mentor * Have mentored others * Currently not practicing medicine
Those with payer organizations (managed care and insurance companies, in particular) account for the highest percentage of completed degrees, and these organizations report lower base salaries at the middle management level overall than do providers, although payers are far more likely to have incentive award eligibility.
The role of mentors
in career success
Mentors - most often themselves physician executives (74 percent) - play an important role in the success of physician executives. Overall, 42 percent said a mentor has played "a pivotal role" in their executive careers. Those with providers (40 percent) are a little less likely than those in payer organizations (46 percent) to claim the experience of having a mentor. Physician executives say mentors provide them with these benefits:
* Awareness of educational
opportunities and career
* An example/model of executive
behavior and leadership
* Direction/guidance at decision
* Development through personal/
Average salaries - but who's average?
The average salary of all the physician executives participating in the survey was $172,000. In providers, the average ($183,000) is considerably higher than the average in payers ($153,000). It should be stressed that these are average amounts; replacement costs for a physician executive would be far higher. CEOs often experience "sticker shock" when their physician executive must be replaced. In addition, exceptional performers will earn far more than average. The survey allowed us to analyze base salary data by a number of factors to define average salaries for physician executives - by tenure and promotion history, by work and mentoring experience, and by whether currently in medical practice, as well as by organization types.
The primary reasons for choosing to pursue a management role noted by most participants are proactive, positive, and optimistic. Response were about the same for both provider and payer groups. They include:
* Desire to be part of the health care solution (45 percent) * An interest in management and leadership challenges (37
percent) * Other reasons - post-retirement opportunity, curtailment of
medical career by physical or health disabilities, better hours,
predictable schedule, higher income, practice frustrations,
loss of interest in medical challenges (18 percent).
Aspirations for the future
Although they appear to be even better prepared to assume the reins of leadership than in the past, only 27 percent of respondents overall said their "ideal professional role" in five years would be CEO or President of a health system, hospital, managed care company, or medical group practice. In a similar survey by the firm two years ago, almost all of the physician executive respondents reported aspiring to a CEO role. Most (40 percent) envision themselves in a senior management role, but not the top spot. Another 15 percent said they would like to be right where they are now, and 10 percent said they would be cutting back or retired. The remainder were not sure or expect to leave the health care field for another area.
Interestingly, there is not notable rush to relocate in the other's venue; neither provides nor payers indicated any strong expectation of movement over to the other's environment in the coming years. The distinct physician executive profiles that have begun to emerge from those in payers and in providers will be interesting to track. At some point, will "crossovers" be plausible?
What does it all add up to? The bottom lines...
* Physician executives in payer and provider organizations
may have similar titles but they are developing very different
profiles - not only in what they do and earn, but in
how they perceive the health care field. Payer-based physician
executives look more business-like; they are more
likely to have business degrees; and to have more income
* A revolution is stirring. Many physician executives are in
truth becoming executives who happen to be physicians - they
view themselves first as leaders, then as physicians.
Along with their personal perceptions, a decline in the numbers
of those who maintain a medical practice reinforces the depth of that professional shift.
* CEOs are actively encouraging their physician executives to acquire more formal education. Physician executives are pursuing both degree and non-degree programs. A management degree, however, does not give instant entree to the best jobs.
* Obviously, merely having a mentor will not ensure the physician executive's success; one must heed the mentor's advice and act on the mentor's guidance for the experience to be meaningful. Interestingly, being a mentor also has a favorable influence on success.
* Highest salaries are paid to senior physician executives in hospitals and systems, particularly to those who have been promoted through the ranks, those who have had a mentor and who have, in turn, mentored others. Although average salaries are lower in payer organizations, 88 percent are eligible for incentive awards; only 52 percent of those in provider organizations are eligible for incentives.
TABLE I PURSUIT OF FORMAL MANAGEMENT TRAINING Training Total resps. Payers Providers Management 76% 69% 80% courses Management 18% 26% 13% degree Other 18% 14% 20% TABLE 2 AVERAGE SALARY RELATED TO MANAGEMENT DEGREE $150,000 or less $151,000- $200,000+ $199,000 Providers with 33% 33% 34% management degree Payers with 43% 20% 37% management degree
[TABULAR DATA OMITTED]
The authors are all physician executive search consultants with Witt/Kieffer, Ford, Hadelman & Lloyd, an executive search firm serving the health care industry founded in 1969.
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|Title Annotation:||physicians as leaders, doctors and managers|
|Author:||Singer, Glenn R.|
|Date:||Sep 1, 1996|
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