Physician executives share insights.

What do physician executives see as the skills necessary for success? How have their jobs changed over the years Have the made the right choice in pursuing medical management careers. The Physician Executive Management Center, a Tampa, Florida-based search firm, recently surveyed physician executives in hospitals, managed care organizations, and group practices and their responses provide an excellent picture of the growth of the profession, as well as a broad perspective of anticipated changes for the future of medical management.

Skills needed to succeed

Physician managers are being asked to bridge the gap between administration and the medical staff. Often, it is the physician leader, in the organization who acts as the "messenger" for each side. The ability to see the "big picture" and move others in that direction is critical.

Skills cited as necessary for success in management listed in rank order are:

* Effective communicator

* The ability to persuade, motivate,

or influence others

* Effective written communication,

* Strategic planning 

Changes over the past decade

Physicians were asked to what degree their current positions have changed over the years, the manner in which the change occurred, and what they thought were the reasons. Hospital physician executives indicated that changes in their roles began with the onset of managed care and system integration, plus their need to assume system responsibilities. Managed care physician executives suggested that changes in their roles happened as a result of reorganization, adding a broader scope of duties and expanding geographic regions. In groups, where the highest percentage of change was reported, complexity, increased managed care, and expanded duties were cited as reasons.

Eighty-seven percent of physicians serving in senior management positions have no clinical responsibilities. This is a dramatic change from 10 years ago, when half of these managers had clinical duties. The concept of physician executives continuing to do some hands-on clinical work as a means of establishing credibility is fading.

Career satisfaction

Physicians were asked if they were satisfied with their career choice. More than 99 percent of respondents in each category indicated the were glad they had made a career move into management. Not only do they feel it was a good move for them, they would recommend it to colleagues.

When asked what they have learned over the years, physician executives indicated the art of patience in making a career change physicians have had to learn to deal with large corporate structures where decisions require teamwork and consensus. They have found that is it no longer a physician-controlled environment, as in clinical practice where decisions might be made quickly and autocratically.

A change in responsibilities

Survey respondents were asked to indicate whether each of nine specific responsibilities was included in their job functions - liaison with medical staff and administration, quality management, credentialing, supervision of physicians, strategic planning, education, external relations, recruitment, and compliance with licensing and regulatory agencies. Physician managers were also asked to specify the percentage of their time spent in each area, its perceived value to the organization, and which was the most rewarding.

Unexpectedly, quality management duties and strategic planning responsibilities were ranked equally as the prime responsibilities for physician executives in all organizations. Clearly, quality management continues to be a key duty of these managers; however, this responsibility is giving way to an equal involvement in strategic planning issues, including budgeting and program development. Physicians are transitioning from technicians to managers, from the doctor managers to the executives who have medicine as a specialty area, not unlike other managers. such as finance and engineering directors.

The percentage of respondents with selected duties is indicated in Figure 1. including the percent of time spent in each noted category (indicated) in parentheses. While the majority of time is spent in liaison between administration and medical staff for hospital and group managers, managed care physician managers spend most of their time in quality management activities.

Liaison between medical staff and administration and quality-management were perceived by these physician executives as their most important and valued contributions to their organizations. Similarly, duties in education and as a liaison between medical staff and administration were cited as the responsibilities enjoyed the most.

In contrast, hospital physician managers in the 1990 survey indicated that their greatest value to the organization was in strategic planning and indicated that those activities were also enjoyed the most. Group practice physician managers indicated that supervising physicians was their greatest value to their organizations, but strategic planning was what they favored most. Managed care physician managers cited quality assurance activities as having the greatest value and also the responsibilities they enjoyed the most.

Ten year findings - hospitals

Fifty-one percent of respondents were full-time Senior Medical Managers in hospitals. Average total compensation levels continue to rise well above the rates of inflationary change in all organizational types. of the three categories, hospital physician executives reported the highest percent increase in total compensation in 10 years, but continue to be paid less in total compensation than those in group practice and managed care.

* During the past 10 years, the differential

in compensation levels from

younger physicians to

older physicians has

been reduced.

Although 50-59 years

of age continues to

represent peak earning

years, younger

physicians entering

management have

received more competitive

compensation

packages in recent

years.

* Hospital senior physician executives

continue to be mostly men. While

our search activity suggests an

increase in acceptance of women in

senior positions, the data do not

reflect this change.

* The percentage of physicians who

continue to have clinical practice

responsibilities has decreased.

Clinical practice at this level is no

longer critical for success, given the

limited amount of time available for

such duties.

* The percentage of physician executives

who receive a

bonus or incentive

in addition to base

salary and benefits,

has increase 25

percent in 10 years. * Primary care specialty

physicians

(family practice,

pediatrics, and

internal medicine)

in these roles have

increased to 62

percent from 40

percent in the mid

'80s.

* Twenty-one percent

of these physicians

expect to be

in a new management position in a

new organization within the next five

years.

Ten year findings - groups

Full-time Senior Medical Managers in groups continue to be paid more total compensation than their counterparts in hospitals and managed care. Average total compensation levels continue to rise, but at a level only slightly above the inflation rate.

* The percentage of medical directors,

who are specialists in family practice

or internal medicine, increased twofold

in 10 years.

* The percentage of group medical

directors with written employment

contracts has increased significantly,

higher than those in either hospitals

or managed care.

* Female medical directors in groups

seem to be making some inroads 

into part-time positions@ otherwise,

management positions in group practice

continue to be male-dominated.

* Physician executives in senior manager

positions who maintain a clinical

practice have decreased by more

than half.

* Physicians in these positions as their

first management position has

decreased dramatically, suggesting

the importance of prior management

experience for the successful

group manager.

* Over the next five years, 51 percent

of these physicians expect to remain

in their current organization but have

new or different duties.

Ten year findings - managed care

Total compensation for Senior Medical Managers in managed care continues to be on the rise, at a level double the inflationary rate.

* Managed care continues to be the

place where, on the average, we

found the youngest physician executives,

although ages are similar to

those in group practice.

* The percentage of managers having

clinical duties has dropped significantly

and clinical practice is only a

small part of their daily duties.

* The percentage of organizations that

provided bonuses or incentives to

physician executives

increased to 76.2

percent, suggesting

the necessity of

these payments for

successful recruiting

of these executives.

* Within five years,

30 percent of these

physician executives

expect to be in new

management positions

in new organizations.

Compensation Levels

Average total compensation, which includes cash compensation of salary and bonuses or incentives in each health care organization type, is illustrated in Figure 2.

Physician managers in groups reported the lowest compensation levels in 1986 but the highest level in 1995, which could account for the portion of physician managers who continue to have clinical duties. Hospitals and managed care physician managers, total compensation have been competitive throughout the 10-year span, with each category reporting total compensation well above the aggregate for each year.

Conclusion

It is not so surprising that change continues to be the future for physician executives. While trends over the 10 year period are moving in a positive direction for physician executives in compensation, benefits, and attitudes, we expect even with the many changes the health care field is experiencing that it will continue. As the industry continues to evolve and take shape, physician executives will play an increasingly important part in its dynamics.

Organizations are realizing the value of a physician leader and physician input on clinical and management issues. In addition, we expect the physician executive role in practice management and managed care to increase significantly as proven by our increase in search activity in these areas. Patience, teamwork, and listening skills will help physician managers find their success along the way.