Quality management remains top medical manager responsibility.

Early in 1992, a survey questionnaire was mailed to physician executives in hospitals, managed care organizations, group practices, and selected other organizations. The survey instrument sought information on a wide range of compensation and compensation-related issues as they affect senior medical management in those organizations. A complete breakdown of the results of the survey is included in Physician Executive Compensation Report: A 1991 Survey of Medical Directors. In this brief article, we describe some of the findings in the survey relative to the roles and responsibilities of senior medical managers.

Respondents were asked to indicate whether each of nine specific responsibilities was included in their job functions-medical staff/administration liaison, quality management, credentialing, supervision of physicians, strategic planning, education, external relations, recruitment, and compliance with the requirements of licensing and regulatory agencies. In addition, they were asked to specify the percentage of their time that was spent in each of the areas of responsibility.

Not unexpectedly, quality management (quality assurance, utilization review, and risk management) ranked as a prime responsibility for physician executives in all organizations. Also receiving high rankings were liaison between administration and the medical staff and strategic planning. These two functions required most of the physician executives' time and gave them the most enjoyment.

In the following sections, we will discuss the separate findings for fulltime and part-time positions. We will also compare the findings, pointing out similarities and differences.

Full-Time Managers

Overall, quality management and strategic planning are the most frequently mentioned functions of fulltime senior medical managers (table 1, page 43). Medical staff/administration Haison and credentialing were mentioned next, followed by external relations. Least mentioned of the nine functions was education. Only in hospitals was the quality management function outscored by another function, liaison between administration and the medical staff in that case. The largest percentage of working time is spent on liaison in all cases except managed care organizations, where quality management takes more than 50 percent more of the manager's time.

Clearly, the role of medical directors is to deal with issues related to the care provided by their organizations. These issues first and foremost include management of the quality of care as it relates to the appropriate utilization of health care resources. Credentialing is also an important function to ensure that practitioners are meeting expectations for quality of patient care set by the organization. In order for a medical director to be successful in meeting quality of care responsibilities, he or she must be able to effectively communicate with practitioners on the medical staff (or with contracted physicians). The liaison function (medical staff/administration liaison) is therefore a critical duty for the medical director. This liaison role requires walking a line between the two groups, working with issues that affect the care rendered and the relative satisfaction of both groups with the process.

All of the nine functions found favor with large percentages of respondents in all three provider environments. Overall, involvement ranged from 93 percent (quality man- agement) to 62 percent (education). For hospitals, the range in involvement was from 98 percent (liaison) to 62 percent (supervision of physicians). In group practices, the range was from 90 percent (quality management, supervision of physicians, and recruitment) to 55 percent (compliance with licensing and regulatory agencies). Finally, in managed care organizations, the range was from 94 percent (quality management) to 46 percent (education).

The greatest consistency among respondents was shown for quality management, strategic planning, and external relations. The ranges in percentage points for involvement were 6, 8, and 10, respectively. The largest range was 35 percentage points for the recruitment function. Recruitment is a significant job for senior medical managers in groups, but less so for those in hospitals and much less so for those in managed care organizations. Similarly, liaison is a Cunction of almost all hospital-based senior medical managers, but it does

not rank at all high with those in managed care. While education is a function with a significant number of hospital-based managers, it does not rank high among managed care managers. In a shift, supervision of physicians is a major undertaking of managers in groups, but neither of the other two categories ranks this function highly.

The data for senior medical managers in managed care organizations demonstrates a situation that isn't present in the other two categories. For both hospitals and groups, the top responsibility vote-getters on involvement also are indicated as requiting large segments of a manager's time. However, for managers in managed care organizations, liaison and supervision of physicians require large percentages of time, but do not rank high on the involvement list. It is not clear why this should be so, but it may mean that those involved in these activities are more intensely involved, perhaps to the exclusion of many of the other responsibility areas.

Part-Time Managers

Quality management was the top job across the board for part-time managers,-receiving 100 percent scores in all categories (table 2, above). It also requires the largest segment of medical managers' time, except in hospitals, where liaison tasks took slightly more time. Although the involvement levels are less, great consistency was also shown for the strategic planning function. Very little consistency is evident in the other responsibility categories. The least consistency is found in credentialing, a major effort for hospital-based managers and one that has little interest for those in groups. Two responsibilities, education and compliance with licensing and regulatory agencies, found negligible adherents in the group practice category.

Hospital-based managers, again, had the greatest involvement in all the categories, receiving cites from more than half the respondents in each case. The top responsibilities for these managers after quality management are liaison (tied with quality management), credentialing, and strategic planning. For managers in groups, the top categories after quality management are liasen, strategy planning, and recruitment in a tie. For managed care organizations, again after quality management, the top jobs are credentialing and external relations, in a tie, and strategic planning.

Conclusions

There are few surprises in the roles and responsibilities findings of the survey. In all environments, physician executives have major responsibilities in organizational activities that ensure high-quality patient care. Roles seem to be more tightly defined in hospitals, the most traditional of the environments, but the differences are, for the most part, small. Physician executives are put in place to ensure that medical staffs are ready and armed to provide patient care in a fashion acceptable to the missions of organizations. Much of the variation among the environments and between full-time and part-time service are probably explained by organizational size and complexity, factors that were not considered in this survey.