Physician executives in the 21st century: new realities, roles, and responsibilities. (The Evolving Role of the Physician Executive).

As PHYSICIAN GROUPS [and hospitals] merge into even larger entities, the opportunity for a new type of physician executive is likely to emerge-one who is sought after for his or her leadership and organizational abilities first and clinical experience second.

George F. Longshore, Top Docs: Managing the Search for Physician Leaders (1)

A growing number of physician executives will find themselves at the top of their careers in the next decade. What will they do when they get there? The physician executive of the future will have a broad array of management opportunities and career choices. More doctors will be managers in the future. As many as 25 percent of America's 620,000 practicing physicians may be holding at least part-time, paid administrative positions in the next ten years, providing leadership for a wide array of management and clinical processes. Physician executives will work at every level of health care organizations, across the continuum of care, from large complex urban systems to small rural settings.

Assumptions about the future are changing

Today's assumptions about the health care environment can be expected to shift rapidly, and some will change radically in the coming millennium. The clinical workforce may experience one of the biggest demographic shifts (please see Table 1). A new set of market conditions will shape the management challenges that physician executives will face in the 21st century: (2)

* Aging of America as the Baby Boom reaches senior status

* New clinical technology, for example, genetic therapy and stem cell transplants

* Consolidation of health care organizations into dominant regional integrated systems

* Massive market clout of national managed care plans

* Labor shortages of nurses and other key caregivers

* Restrictive federal payments as Medicare becomes the number one government program

* "Report cards" on the performance of physicians, hospitals, and health plans

* Internet-Informed consumers armed with the latest medical literature

* Computer-assisted care coordination and disease management systems

* Telemedicine and the Internet transform health care into a 24-hour, global enterprise

* Disgruntled physicians in unions and large economic organizations

* Entrepreneurial competition from clinical 'niche' players backed by Wall Street

* Constant financial pressures to keep health costs down

* Tough ethical choices at the intersection of aging, technology, and economics

Technology will reshape the health care environment

Technology will fundamentally alter how health care is organized and delivered (please see Table 2). Personal computers are likely to be as prevalent for physicians as stethoscopes. Physicians and care managers will plan and monitor patient care, utilizing rich data warehouses of patient outcomes and treatment costs. Vast libraries of medical research will be accessible to providers and patients, with searches taking seconds. Provider skills can be updated as fast as the knowledge base expands. The Internet and telecommunications will provide new media for continuing education and management training. Companies like WebMD will link physicians into global networks for disseminating research findings and conducting Internet grand rounds. 'Virtual patients" will receive telemedicine in home settings and remote locations. Many patients will carry their medical history with them on "smart cards."

The business of medicine will be reshaped by technology. Clinicians and IT (information technology) professionals will work together frequently and collaboratively. All claims processing and payment will be online. Verifying insurance eligibility will be instantaneous. High-performance work teams will collaborate in cyberspace across regions served by large health care enterprises. E-work can be done on- or off-line, 24-hours a day, seven days a week, across time zones and spanning all geographic boundaries. Net-enabled processes, such as rapid-turnaround lab results, have the potential to take costs permanently out of clinical practices, which can boost productivity and allow doctors to spend more time with patients. But will they? More time with patients may not occur if fee-for-service physicians choose to use their improved productivity to see more patients and make more money.

New careers, roles, and responsibilities

Don't get comfortable with your job description. Tomorrow's physician executives will take on expanding sets of career opportunities and leadership roles, including:

* Chief executive officer--Large hospitals and health systems are searching for high-trust physician executives with business skills and demonstrated leadership abilities. What is needed are physician executives who can reunite warring medical groups and shift their organizations back to a patient care and quality emphasis. Stakes will be high, but so will compensation. These high-visibility physician CEOs will walk a tightrope between the patients' first demands of their professional colleagues and board requirements for economic performance. Those who can get the mix right will be among the vanguard of health care CEOs in the next decade.

* Chief operations officer--Moving into the COO role is a major expansion of responsibility for many chief medical officers. The COO will drive the organizations core business--patient care--but will also oversee many other clinical and administrative support functions. Business skills are important, but people skills may be even more critical. Achieving financial and clinical service goals will rely on motivating and coaching others, in what will seem to be endless meetings. Not all physician executives may have the patience--or personal leadership skills--to be effective COOs. A critical challenge will be developing a close working relationship with nursing executives who directly manage patient care services. Nursing may resent not having an RN in the chief operating officer position.

* Chief medical officer--The OMO is a diplomat, first and foremost, providing liaison and representation between the provider organization and the community's physicians and medical groups. Serving as a "minister without portfolio"--with no operational responsibilities--may be one of the toughest assignments for any physician executive. Trust is the essential requirement for this job. The CMO will be engaged in endless negotiations over some of the most sensitive issues that could divide hospitals and their physicians. CMO job descriptions will be broad and vague, at least in the near future. The emphasis on diplomacy may shift in the coming decade to include more operational roles, such as managing a medical division or taking on the oversight of quality.

* Chief technology officer--This "senior scientist" position will be based in large health systems, academic medical centers, pharmaceutical manufacturers, and other health industry suppliers. CTOs will have a research background and may manage research institutes. Their primary role will be to scan the technology horizon for promising R & D that could enhance their organization's clinical services or provide an opportunity for product development.

* Vice president for quality--Physician-managed quality programs are the province of these vice presidents for quality oversight. A strong research orientation and analytic skills are prerequisites for this position. Some VPs for quality will be epidemiologists. In their role as quality managers, these physician executives will report regularly to the senior management team and the board on clinical performance. They will lead quality improvement and clinical pathway initiatives, and conduct studies of their organization's outcome and cost data.

* Managed care medical director--Providing medical leadership for managed care organizations is already a widely established position. The number of these medical managed care executives is likely to expand further, as almost 30 percent of the U.S. population is enrolled in an HMO. Managed care medical directors will work on the plan side for HMOs, insurance companies, preferred provider organizations. as well as on the provider side for provider-sponsored managed care organizations. The role of managed care medical directors is changing. Their primary role as utilization manager will be broadened to include more analysis of variations in medical care and outcomes within their enrolled populations, applying sophisticated techniques of data analysis to "mine" their data warehouses for opportunities for quality and cost improvement.

* Medical division vice president/MSO executive--Physician executives will manage the growing number of provider-owned physician practices among the nation's 20,000 medical groups. More than 60 percent of U.S. hospitals and health systems have acquired physician practices, and have created medical divisions or MSOs (management service organizations) to provide practice management services. Heading a provider-sponsored medical division or MSO will be a challenge. Many hospitals and health systems have lost $50,000-$100,000 per doctor in annual subsidies, and are restructuring the practices to improve productivity and reduce expenses. (3) In many markets, the acquired physicians have really not been consolidated into an integrated group practice. The recent market collapse of Wail Street-backed MSOs like MedPartners and FPA is likely to drive many of their acquired physicians back into MSO arrangements with local hospitals and health systems. This is an expanding field that will reward physician executives who can successfully generate a bottom-line from these medical groups.

* Service-line manager--Today's clinical program medical directors will be the service-line managers of tomorrow. These physician executives will combine clinical expertise with marketing and business management skills. Niche players In health care like MedCath and HealthSouth are driving adoption of service-line management by many hospitals, health systems, and large medical groups. The most popular specialty niches are cardiovascular, oncology, and women's health, but many other clinical services lend themselves to a service-line management approach.

Managing medicine will put physician executives in the middle

As more physicians become involved in administrative roles, the business of medicine will pose professional challenges. Physician executives will find themselves at the center of controversies about ethical and economic choices. Some choices will involve competing investments, for example, putting capital into marketing campaigns versus acquiring new clinical technologies. Life-extending genetic therapies may pose difficult dilemmas for physicians treating older patients. At what age should older patients be considered suitable for investments in costly treatments.

More physician executives are likely to be involved in risk-assuming arrangements with managed care plans. This will create complex dilemmas, where controlling utilization and costs may compete with the physician's professional duty to put patients first. These millennium challenges will come with the rapidly expanding management opportunities to tomorrow's physician executives.

TABLE 1

THE FUTURE CLINICAL WORKFORCE

WORKFORCE DEMOGRAPHICS          % IN THE FUTURE

U.S. trained male physicians                46%
U.S. trained female physicians              25%
Foreign medical graduates                    1%
Physician extenders                         26%
Others                                       3%

Future of Health Care Delivery. Quick Tally electrionic poll. American
College of Physician Executives, 1999 Spring Institute.

Las Vegas, Nevada, May 13, 1999

Table 2

THE FUTURE OF TECHNOLOGY

TECHNOLOGY PREDICTION                      TRUE %  FALSE %  NOT SURE %

* Personal computers are as prevalent       94%      6%         0%
  for physicians as stethoscopes

* Cliniccians and IT professionals are      62%     30%         8%
  intimately linked

* All patients will carry their medical     47%     42%        11%
  history around with them on Smart Cards

* Telemedicine will reach a point when      58%     33%         9%
  the physician and the patient do not
  have to be in the same physical space

* Artificial/synthetic replacement          35%     52%        13%
  body parts will be as commonplace
  as contact lenses

Future of Health Care Delivery. Quick Tally electronic poll. American
College of Physician Executives, 1999 Spring Institute. Las Vegas,
Nevada, May 13, 1999

References

(1.) Longshore, G.F. Top docs: managing the search for physician leaders. Tampa. Florida: American College of Physician Executives. 1992, p. 87.

(2.) Coile, Jr., R.C. Beyond managed care: challenges for physician executives in the millennium marketplace. The Physician Executive. 25(1):8-13. Jan., 1999.

(3.) Coile, Jr., R.C. and Kaufman, N. Unpublished national survey on hospital-acquired physicians, based on survey responses from 140 hospitals and health systems. Superior Consultant, Southfield, Michigan, 1999.

RELATED ARTICLE: INTERACTIVE DISCUSSION OF FUTURE TRENDS

This article is based in part on responses from 150 physician executives who participated in an interactive discussion of future trends at the American College of Physician Executives Spring Institute and Senior Executive Focus, in Las Vegas, Nevada, on May 13, 1999. The session included electronic polling on 40 predictions that were analyzed by Quick Tally, a decision-support system that can assist groups of up to 5,000 participants to rate issues and rank choices. Tabulations are instantaneous and responses can be analyzed by subgroups. Used frequently by the entertainment industry to rate commercials and moves, as well as for market research, the system generates computer printouts and as ASCII file for statistical analysis. Further information can be obtained by calling 323/653-5303 or via email at [e-mail].

RECOMMENDED RESOURCES

The following books are recommended reading for further information on the evolving role of physician executives.

ACPE books

Cultureshift: A Leader s Guide to Managing Change in Health Care

edited by Joan E. Lowery, 1997

This book is a manual of techniques for dealing effectively with health care system change.

Designing 21st Century Healthcare: Leadership in Hospitals and Healthcare Systems

by John R. Griffith, 1998

The author explores five critical dimensions of integrated delivery systems, using the experiences of three successful systems.

In Search of Physician Leadership

edited by Barbara LeTourneau, MD, MBA, CPE, FACEPE, and Wesley Curry, 1998

This book explores new physician leadership roles in terms of the benefits of shared physician/nonphysician management of health care organizations.

MD/MBA: Physicians on the New Frontier of Medical Management

edited by Arthur Lazarus, MD, MBA, 1998

This helps physicians assess their professional and personal strengths in terms of the options that they have in moving into and progressing in the medical management profession.

The Physician Leader s Guide, Second Edition

edited by Richard Burton, MD, MBA, 1998

This book helps physicians assess their professional and personal strengths in terms of the options that they have in moving into and progressing in the medical management profession.

The Physician Leader s Guide, Second Edition

edited by Richard Burton, MD, MBA, 1998

This new edition guides the reader through opportunities in managed care and integrated delivery systems and analyzes electronic communication and information processing techniques that are revolutionizing the health care field.

Physicians in Managed Care: A Career Guide

edited by Mark A. Bloomberg, MD, FACPE, and Steven R. Mohlie, MD, MBA, 1994

This book offers solid advice for the physician seeking management opportunities in managed care. It thoroughly explains managed care roles in terms of their fit for physicians.

Women in Medicine and Management: A Mentoring Guide

edited by Deborah Shlian, MD, MBA, 1995

In individual accounts, women physicians describe their entry into medicine and their moves to medical management. The accounts focus on the mentoring process to demonstrate the scope of achievement that is possible in this growing profession.

Other books

The Challenge of Health Care Leadership: Executive Strategies for Managing Responsible change

edited by Earl A. Simendinger American Hospital Publishing, 1997

Facing Change in Health Care: Learning Faster in Tough Times

by W innie Schmeling, PhD American Hospital Publishing, 1996

Millennium Management: Better Faster Cheaper Strategies for 21st Century Healthcare Organizations

by Russell C. Coile, Jr. Health Administration Press, 1998

The New Health Partners: Renewing the Leardership of Physician Practice

by Stephen E. Prather

Jossey-Bass Publishers, 1999

The Physician-Manager Alliance:
Building the Healthy Health Care Organization

by Stephen M. Davidson, Marion McCollum, Janelle N. Eeineke,
McCollom, Marion MoCollom, Jossey-Bass Publishers, 1996

Rethinking Health Care:
Innovation and Change in America

by Max Heirich, Westview Press, 1998

Thriving in an Age of Change:
Practical Strategies for Health Care Leaders

by Donald N. Lombardi, Health Administration Press, 1996

Wesley Curry

Russell C. Coile, Jr., is Vice President and National Strategy Advisor for Superior Consultant, a national health information systems and management consulting firm in Southfield, Michigan. He is the author of six books on the future of health care and medicine, including Millennium Management (1998), and the editor of "Russ Coile's Health Trends," a monthly health industry newsletter. He resides in Dallas, Texas and can be reached by calling 972/403-1945 or via email at [e-mail].