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Physician executives' characteristics and attitudes.

This monograph mon·o·graph  
A scholarly piece of writing of essay or book length on a specific, often limited subject.

tr.v. mon·o·graphed, mon·o·graph·ing, mon·o·graphs
To write a monograph on.
 reports on a survey of physician executives who are members of the American College American College is the name of:
  • American College Dublin, Dublin, Ireland
  • The American College in Madurai, Tamil Nadu, India
  • The American College of the Immaculate Conception, Leuven (also known as Louvain), Belgium
 of Physician Executives. The survey emphasized em·pha·size  
tr.v. em·pha·sized, em·pha·siz·ing, em·pha·siz·es
To give emphasis to; stress.

[From emphasis.]

Adj. 1.
 four areas--factors in an individual's move into management as a career choice; satisfaction with management as a career or as an element of a career; factors that prepare a physician to manage; and factors in future development of physician managers.

The number of physicians involved in management has accelerated in the past decade, and physician managers can be found in a wide range of health care and related settings. Evidence of physician interest in management as a career, or as an adjunct adjunct (aj´ungkt),
n a drug or other substance that serves a supplemental purpose in therapy.

 to a clinical career, is found in the rapid growth of the American College of Physician Executives and the continuing interest in certification for physician managers. As this new sphere sphere, in geometry, the three-dimensional analogue of a circle. The term is applied to the spherical surface, every point of which is the same distance (the radius) from a certain fixed point (the center), and also to the volume enclosed by such a surface.  of activity has emerged as a principal interest of increasing numbers of physicians, a variety of articles have appeared in the literature that comment on trends in the field, the scope of activities of such managers, their compensation, their preparation, and their attitudes and behaviour. Relatively little has appeared dealing with the reasons physicians opt for expanded management responsibilities and with how they are prepared to assume these responsibilities. Anecdotal anecdotal /an·ec·do·tal/ (an?ek-do´t'l) based on case histories rather than on controlled clinical trials.
anecdotal adjective Unsubstantiated; occurring as single or isolated event.
 reports and conventional wisdom suggest reasons such as desire to escape the rising costs of practice and an increasingly bureaucratic bu·reau·crat  
1. An official of a bureaucracy.

2. An official who is rigidly devoted to the details of administrative procedure.

 practice environment, or a desire to work more regular hours and have greater control over one's time.

Study Method

Participants in the study reported in this article were respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy.  from a random sample of 300 members of the American College of Physician Executives, supplemented by a special random sample of 60 from among female members of the organization. The basic sample represented 10 percent of the membership at the time of the survey. The separate sample of women was drawn because of the small number of women in the total membership. There were no duplicates drawn, and the total mailing sample was 360 individuals. There were 176 questionnaires returned, for a response rate of 48.8 percent. Eighty-one percent of those responding were male and 19 percent female. Thirty-two percent graduated from medical school before 1960, while only four percent graduated after 1980. Thirty-four percent graduated in the 1960s, and twenty-nine percent in the 1970s. Ninety-three percent graduated from American American, river, 30 mi (48 km) long, rising in N central Calif. in the Sierra Nevada and flowing SW into the Sacramento River at Sacramento. The discovery of gold at Sutter's Mill (see Sutter, John Augustus) along the river in 1848 led to the California gold rush of  medical schools, while seven percent graduated from foreign medical schools.

The questionnaire questionnaire,
n a series of questions used to gather information.

n a form usually filled out by patients that provides data concerning their dental and general health.
 consisted of 44 elements. Respondents were asked to indicate their responses on a five-point scale, with one representing the most negative end of the scale (e.g., "not at all important" or "strongly disagree") and five the most positive end (e.g., "very important" or strongly agree") Two types of questions were posed pose 1  
v. posed, pos·ing, pos·es

1. To assume or hold a particular position or posture, as in sitting for a portrait.

2. To affect a particular mental attitude.
. The first series consisted of statements describing factors often cited as bearing on physician decisions to enter management careers, and respondents were asked whether they agreed or disagreed with those statements as they described the respondent's own experience. The second series consisted of factors bearing on development of physician managers, and respondents were asked to scale the importance of each factor on the basis of a stated condition or conditions.

Why MDs Become Managers

Do physicians enter management to escape the increasingly regulated reg·u·late  
tr.v. reg·u·lat·ed, reg·u·lat·ing, reg·u·lates
1. To control or direct according to rule, principle, or law.

 practice environment? Forty-three percent of respondents indicated that this was an important factor in their moves toward management careers, while 32 percent minimized min·i·mize  
tr.v. min·i·mized, min·i·miz·ing, min·i·miz·es
a. To reduce to the smallest possible amount, extent, size, or degree.

b. Usage Problem To reduce. See Usage Note at minimal.
 the importance of this factor. Overall, this motivation does not appear to be a significant one for the physician managers in the sample, nor are there differences among respondents based on year of graduation Graduation is the action of receiving or conferring an academic degree or the associated ceremony. The date of event is often called degree day. The event itself is also called commencement, convocation or invocation.  or sex.

Increased regulation and complexity of medical practice influenced me to become more involved in management and less involved in clinical practice.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean

17%     15%   25%     25%   18%   3.1

Two other factors that conventional wisdom suggests might be important in physician decisions to move away from clinical activities to administration were not significant to the respondents. Only a third of those responding to the survey gave weight to a desire to gain better control over time (e.g., regular hours) as a factor in their expansion of management responsibilities. The number influenced significantly by the rising costs of medical practice was even smaller, with 17.1 percent reporting this factor as important. At the same time, nearly half (44.5 percent) of respondents did cite "quality of life" considerations (family time, stress levels) as important in their decisions to increase the percentage of their time devoted to management.

A desire to make my hours more regular and to gain better control over demands on my time influenced me to become more actively involved in management.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
22%     23%   19%     25%   11%   2.8

The rising costs of operating a medical practice influenced my desision to become more active in management and less active in clinical practice.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
34%     29%   20%     12%    5%   2.2

Financial considerations, such as salary and fringe benefits fringe benefits, the benefits, other than wages or salary, provided by an employer for employees (e.g., health insurance, vacation time, disability income).
, were important influences on less than a third of those responding to this survey.

Economic considerations (e.g., income, fringe benefits, retirement plans) were: Not at all Important Very Important
 1       2     3       4     5   Mean
24%     19%   25%     22%   10%   2.8

The single most important factor influencing these physician executives in choosing a management career was the perceived per·ceive  
tr.v. per·ceived, per·ceiv·ing, per·ceives
1. To become aware of directly through any of the senses, especially sight or hearing.

2. To achieve understanding of; apprehend.
 opportunity for leadership to a medical organization, highly valued by 87.6 percent of those responding to the survey.

Opportunity to exercise leadership in organization was: Not at all Important Very Important
 1       2     3       4     5   Mean
2%      3%    8%      37%   50%   4.3

The majority of the respondents (63.5 percent) indicated that they had enjoyed the management aspects of clinical practice, such as serving on medical staff committees or financial management, and that this led them to seek a larger management component in their activities.

I enjoyed the management aspects of my clinical practice (e.g., serving on medical staff committees, managing the financial aspects of my practice, and so forth) and wanted to spend more time on management activities.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
7%      8%    22%     38%   25%   3.6

An even larger proportion of those responding to the survey (69.8 percent) identified a need for more physician-centered direction in the management of medical organizations as a factor in their decisions to expand their management activities.

My move into a management role came with my recognition of a need for more physician-centered direction in my organization.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
5%      7%    19%     38%   31%   3.9

Similarly, 78.9 percent of respondents cited a desire to have an impact on organizational policies governing gov·ern  
v. gov·erned, gov·ern·ing, gov·erns
1. To make and administer the public policy and affairs of; exercise sovereign authority in.

 medical care as a factor in their career decision to participate in management.

My decision to move into a more active role in management resulted from a desire to have an impact on the organizational policies governing medical care.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
5%      3%    13%     39%   40%   4.0

Participants were asked whether they were sought out by organizational management to become involved as physician executives. Nearly half of the respondents reported that they entered management in this way. It is interesting to note that a significantly higher proportion of physician managers who graduated from medical school prior to 1960 were approached by their organization to assume management responsibilities.

My move into a management role came when executives in my organization recognized the need for more physician-centered management in the organization and approached me to fill that role.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean


14% 13% 26% 19% 29% 3.3

Graduated before 1960

9% 6% 23% 13% 49% 3.9

Graduated after 1960

15% 16% 27% 21% 19% 3.1

Satisfaction with Management Career

Physician executives responding to this survey are highly satisfied with their choice to enter management. This is true on both absolute and relative scales. More than 85 percent of respondents reported a high level of satisfaction with their roles as a physician executives, and only 17 percent consider their management responsibilities relatively less satisfying than clinical practice. Nearly three-fourths Noun 1. three-fourths - three of four equal parts; "three-fourths of a pound"

common fraction, simple fraction - the quotient of two integers
 of the physician executives agreed that their management activities provided them with a strong sense of accomplishment.

I have found my role as a physician executive very satisfying to me as a professional.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
2%      3%    10%     44%   42%   4.2

I have found the management portion of my career to be relatively less satisfying than the clinical portion of my career.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
24%     33%   26%     12%   5%    2.4

My role as a physician executive gives me a strong sense of accomplishment.
Strongly Disagree       Strongly Agree
 1       2     3       4     5   Mean
1%      2%    14%     45%   32%   3.9

Although there were no significant differences among respondents on the latter two factors, physicians who graduated prior to 1960 reported significantly less satisfaction with their roles as physician executives (the first of these three items) than those who graduated after 1960.

Factors in Development of MD Managers

A second area examined in the survey was the importance that physician executives attach TO ATTACH, crim. law, practice. To an attachment for contempt for the non- take or apprehend by virtue of the order of a writ or precept, commonly called an attachment. It differs from an arrest in this, that he who arrests a man, takes him to a person of higher power to be disposed of;  to various experience and educational factors in preparing them for management responsibilities. This was examined in two contexts--the factors the respondents felt had been important to their development as physician executives and those seen as important to development of such executives in the future.


The responses show that service on medical staff committees or in medical staff governance Governance makes decisions that define expectations, grant power, or verify performance. It consists either of a separate process or of a specific part of management or leadership processes. Sometimes people set up a government to administer these processes and systems.  and participation in practice management were much more highly valued than were experiences in medical society activities, non-medical community organizations, or the military. Respondents also rated service in medical staff committee work and governance highly for development of future physician managers. In all other experience areas, there were statistically significant differences between the factors rated important to their personal development and those that they see as important for future generations of physician executives. In each case, the respondents felt that the factors were more important to future managers than they had been to their generation of managers.

Education Factor Considered Self Others

Formal management training leading to a management degree

2.3 3.6

Formal management training leading to a certificate or other nondegree recognition 2.7 3.8

Continuing education continuing education: see adult education.
continuing education
 or adult education

Any form of learning provided for adults. In the U.S. the University of Wisconsin was the first academic institution to offer such programs (1904).
 programs in management (e.g., short courses correspondence courses) 3.8 4.3


For this group of executives, formal training in management through continuing education was a much more important factor than formal graduate education leading to a management degree or a certificate. However, their view of the relative importance of formal education for future physician executives was quite different.

Physician executives' view of the importance of education varied with year of graduation from medical school. Those who graduated prior to 1960 placed less value on formal education leading to a degree or certificate, either as important to themselves or to development of physician executives in the future. The differences between the two groups of respondents were significant.

Importance of formal management training leading to a management degree (e.g., MBA MBA
Master of Business Administration

Noun 1. MBA - a master's degree in business
Master in Business, Master in Business Administration

microangiopathic hemolytic anemia.
, MPG The extension used on the MPEG file format. See MPEG.

1. (jargon) MPG - Miles per gallon, as in "Your MPG may vary", i.e. "Your mileage may vary".
2. (filename extension) mpg - A filename extension for a file in MPEG format.
, etc.) to my development Not at all Important Very Important 1 2 3 4 5 Mean


42% 16% 19% 14% 9% 2.2

Graduated before 1960

33% 28% 24% 12% 4% 2.2

Graduated after 1960

46% 10% 17% 15% 11% 2.3

Importance of formal management training leading to a management degree (e.g., MBA, MHA, MPH MPH Master of Public Health.
MPH Master's Degree in Public Health
, etc.) to others' development Not at all Important Very Important 1 2 3 4 5 Mean


2% 9% 27% 46% 16% 3.6

Graduated before 1960

2% 17% 36% 34% 11% 3.8

Graduated after 1960

2% 6% 23% 52% 18% 3.4

Future Development of Field

The survey asked participants to weight the importance of several factors to the future development of management as a medical specialty medical specialty Any specialty that provides non-interventional Pt management, ie with drugs, or with minimum intervention–eg, balloon catheterization Examples Internal medicine–allergy and immunology, cardiology, gastroenterology, hematology/oncology, . Of eight factors assessed, the respondents rated the existence of opportunities for promotion and wider responsibilities highest as a factor in the future development of the field. Also highly rated were the increasing importance of managers who are technically competent Possessing the necessary reasoning abilities or legal qualifications; qualified; capable; sufficient.

A court is competent if it has been given jurisdiction, by statute or constitution, to hear particular types of lawsuits.
 individuals in health management positions; the need for physician involvement in management in a system increasingly concerned with quality; increased availability of graduate programs in management tailored to needs and interests of physicians; and appropriate levels of compensation for physician managers. Recognition of medical management as a medical specialty was highly regarded as a factor in future growth of the field by 69 percent of respondents.

A reduction in clinical opportunities as a result of increased competition was considered important to the future development of the field by only 19.4 percent of respondents. Again, despite anecdotal evidence anecdotal evidence,
n information obtained from personal accounts, examples, and observations. Usually not considered scientifically valid but may indicate areas for further investigation and research.
 that physicians are "fed up" with regulation and the business aspects of practice, only 22.8 percent of respondents rated that factor as important in determining the future development of the medical management field.


Despite a wide range of differences among the respondents in age, sex, background, and current employment, there were relatively few significant differences in responses based on any subgroup sub·group  
1. A distinct group within a group; a subdivision of a group.

2. A subordinate group.

3. Mathematics A group that is a subset of a group.

 characteristics. The exception was year of graduation from medical school. Respondents who graduated before 1960 did show statistically significant differences in their responses on several survey questions. These differences showed no pattern that suggests any real difference that might guide future development of the field.

Physician executives responding to this survey are remarkably consistent in their responses concerning the reasons they have moved into management roles. They assumed larger roles in management because of a desire to have greater influence on organizational policies and because they perceived a need for more physician direction in the organization. Factors often suggested as bearing on physicians' move into management--rising costs and bureaucratization of practice or a desire to control time better--were not significant influences among this sample of respondents, nor were economic considerations.

Physician executives find their role as managers satisfying and experience a strong sense of accomplishment from their executive responsibilities and indicate that more satisfaction is derived de·rive  
v. de·rived, de·riv·ing, de·rives
1. To obtain or receive from a source.

 from these activities when compared to clinical activities.

The participants in this survey see the development of wider opportunities for promotion and assumption of a wider range of responsibilities as a major factor in the future development of the physician executive career path. Similarly, they expect that technological developments in medicine requiring increasingly technically sophisticated managers will positively influence demand for medically trained managers. Conversely con·verse 1  
intr.v. con·versed, con·vers·ing, con·vers·es
1. To engage in a spoken exchange of thoughts, ideas, or feelings; talk. See Synonyms at speak.

, they do not expect that physician disillusionment Disillusionment
Adams, Nick

loses innocence through WWI experience. [Am. Lit.: “The Killers”]

Angry Young Men

disillusioned postwar writers of Britain, such as Osborne and Amis. [Br. Lit.
 with the practice environment or constriction constriction /con·stric·tion/ (kon-strik´shun)
1. a narrowing or compression of a part; a stricture.constric´tive

2. a diminution in range of thinking or feeling, associated with diminished spontaneity.
 of clinical opportunities will have strong effects on the future of the field.

The most interesting results of this survey fall in the area of physician preparation for careers in management. Reflecting the relatively short time since the resurgence re·sur·gence  
1. A continuing after interruption; a renewal.

2. A restoration to use, acceptance, activity, or vigor; a revival.
 of interest in management among physicians, relatively few of the respondents valued formal degree or certificate education highly in their personal development as managers, while continuing education was a significant factor. When the respondents turn to the matter of future managers, however, they rate the need for formal education in management much higher, while maintaining a priority for continuing education. One can speculate that the difference as regards formal management education reflects a perception that future physician executives will carry broader responsibilities in a more complex environment, requiring broader educational preparation in management. The priority accorded continuing education as a factor in development of physician executives reflects respondents' experience in medical education, where formal education is limited to a discrete A component or device that is separate and distinct and treated as a singular unit.  period, with extensive dependence on continuing medical education continuing medical education See CME.  for maintaining currency.

Given the growing trend toward full- and part-time part-time
For or during less than the customary or standard time: a part-time job.

 management careers among physicians, the results of this survey provide several interesting conclusions. Clearly, this sample of physician executives sees management as a desirable and fulfilling career choice. Their motivations are drawn from a perception of need for more physician leadership in an increasingly technologically complex health system rather than from disaffection with medicine and the practice environment. The route to expanded involvement in management most frequently is through participation in medical staff governance and practice management activities, and continuing education has been the most frequent source of specialized spe·cial·ize  
v. spe·cial·ized, spe·cial·iz·ing, spe·cial·iz·es

1. To pursue a special activity, occupation, or field of study.

 management knowledge for today's active physician executives. When these managers look ahead, however, they see a much more important role for formal management education for physician executives.

Looking to the future development of the field, a clear majority of these physician executives see development of expanded opportunities for leadership as a key factor in growth of the field. The increasing emphasis on quality in health services health services Managed care The benefits covered under a health contract  will require more physician participation in management of health care enterprises in the future. They conclude that availability of graduate education programs "tailored to physician executives' needs and interests" is an important factor in the future development, as is recognition of medical management as a medical specialty.

(1.) Curry, W. '"90s to be Expansionary ex·pan·sion·ar·y  
Tending toward or causing expansion: the empire's expansionary policies in Asia. 
 for Medical Management." Physician Executive 16(3):2-5, May-June 1990.

(2.) Tabenkin, T., and others. "Physician Managers: Personal Characteristics Versus Institutional Demands." Health Care Management Review 14(2):7-12, Spring 1989.

(3.) Kindig, D., and Lastiri-Quiros, S. "The Changing Managerial Role of Physician Executives." Journal of Health Administration Education 7(1):33-46, Winter 1989.

(4.) Irwin IRWIN are a collective of Slovene artists, primarily painters, part of Neue Slowenische Kunst (NSK). They describe their own work as "retro-principle" or "retro-avant-garde".[1]

The group is emphatic about their work being collective rather than individual.
, B., and Harvey Harvey, city (1990 pop. 29,771), Cook co., NE Ill., a suburb S of Chicago; inc. 1895. Its manufactures include steel castings, metal products, chemicals, machinery, and electronic equipment. Harvey has an oil research center. The city was founded by Turlington W. , N. "The New Physician Executive: The Next Decade." Healthcare Executive 1(2):21-3, Jan.-Feb. 1986.

(5.) Wallace Wal·lace , Alfred Russel 1823-1913.

British naturalist who developed a concept of evolution that paralleled the work of Charles Darwin.
, C. "Physicians Leaving Their Practices for Hospital Jobs." Modern Healthcare 17(10):40-1,44,48,55-6, May 8, 1987.
COPYRIGHT 1992 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Career Development
Author:Haddock, Cynthia Carter
Publication:Physician Executive
Date:May 1, 1992
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