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Survey provides overview of profession's responsibilities.

In 1990, for the third time in the past few years, the Physician Executive Management Center surveyed the membership of the American College of Physician Executives to determine levels of compensation and benefits. The comparative database that has been assembled since 1987 through these efforts provides an excellent picture of the growth in stature of the medical management profession. For the first time, however, a series of questions were asked about the management activities in which physician executives participated. These questions will be asked in subsequent surveys to develop trend lines on the roles and responsibilities of physician executives.

Because their compensation levels are not determined by market factors, physician executives in the military and in government organizations were not included in the survey. Both full- and part-time managers were included. In the full report of the survey findings, data are presented in terms of both place of employment and full- and part-time employment, as well as on regional bases. In this article, the aggregate sample is broken down only on the basis of the level of responsibility of the respondent. We will analyze only the survey questions that deal with the responsibilities of physician executives. Finally, only data from managers in hospitals, group practices, and managed care organizations are included in that summary.

In the discussion that follows, we follow the survey's design of designating the respondents as top managers, senior medical managers, and other managers. Top managers are CEOs and others who have overall responsibility for the management of health care organizations. Senior medical managers are medical directors, vice presidents of medical affairs, and others in the upper echelons of organizational management. Other managers are largely department and section chiefs and chairman. Selected results of the survey for the issue of responsibilities of physician executives are summarized in the table on page 39.

The only surprising aspect of the result is that the percentage of responses


in certain categories is not substantially higher. For instance, one would expect a major responsibility of the top manager to be strategic planning, and 93 percent indicated it is. What is surprising is that this is not a responsibility at all for 7 percent of the respondents. Similarly, for senior medical managers, why do 10 percent of the respondents have no involvement in liaison with the medical staff and administration, even if 90 percent do? Partly, this is the result of our reporting design. The data reflect all physician executives, both full- and part-time and in hospitals, groups, and managed care settings.

Even when the design is narrowed, however, participation in liaison activities remains below 100 percent. For instance, for full-time, hospital-based physician executives, 98 percent list liaison duties. Two percent is small, but it would be interesting to know why even that small number of physician executives fails to participate in what has become regarded as a fundamental responsibility for the profession. Its importance can be partially supported by the fact that it is the most frequent duty of senior medical managers, the third most frequent of top managers, and the second most frequent of other managers.

Another finding of the survey is that education is no longer a major function of the physician executives surveyed. This is a substantial change from the time, not so many years ago, when director of medical or continuing education was a top management position for physicians. Only about a third of top managers list medical education as a responsibility now. It is designated a responsibility by only 55 percent of the senior medical managers and by 63 percent of the other managers. The survey didn't determine who is responsible for this duty, but there is a suspicion that it has passed to other educational professionals, many of whom still are physicians. Another survey will have to confirm or deny that hypothesis.

Although it comes as no surprise that top managers are heavily involved in external relations, the high level of involvement of senior and other managers in this activity would not have been predicted. We suspect that the quality of the involvement among the three groups is quite different. Top managers probably deal mainly in a representational role for their organizations. Senior medical managers may perform this function and also an educational role. The high response rate for this group probably also represents senior medical managers, especially those in managed care environments, who are responsible for contractual relations with other providers. It is likely that other managers serve mainly in an educational role. Unfortunately, the question did not detail the exact nature of the external relations.

There was consistency across the three categories for recruitment activities. However, none was active much above the two-thirds level. It is not surprising that senior medical managers were most active in this area. One would expect them to be involved in the recruitment of physicians generally and for other staff positions within their areas. And it is not surprising that top managers are not as active in this regard. This is an activity largely left to others in management in most organizations, health care related or otherwise. It is somewhat more difficult to explain the lower percentage of activity on the part of other managers. The only explanation that we can offer is the diversity of the population of this category. The largest number of part-time executives can be found here, and recruitment efforts may be lodged elsewhere in their organizations where individuals have full-time involvement in management activities.

Finally, a sizeable portion of all three groups has no involvement in the supervision of physicians or physician executives. The levels range from 72 percent for senior medical managers to 64 percent for top managers. Other managers had a frequency for the activity of 70 percent. The large number of noninvolved managers in this category may be attributable to use of the word "supervise" in the questionnaire. For many, this may not be an apt description of the relationship between them and their physician colleagues.

The survey determined that credentialing is largely the purview of senior medical managers and that quality assurance is a shared responsibility of senior and other managers. The matter of compliance with licensing and regulatory agencies seems to be shared for the most part across all groups. What the survey shows is that there are differences, however subtle, among the three groups. A survey devoted to roles and responsibilities would be necessary to determine the exact nature of those subtleties.

David Kirschman is President and Jennifer Grebenschikoff is Vice President of the Physician Executive Management Center, Tampa, Fla.
COPYRIGHT 1991 American College of Physician Executives
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Copyright 1991, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:medical profession
Author:Grebenschikoff, Jennifer
Publication:Physician Executive
Date:Jul 1, 1991
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