The Role of the Physician Executive: Cases and Commentary.

David A. Kindig, MD, and Anthony R. Kovner, Phd, Editors. The Role of the Physician Executive: Cases and Commentary. Ann Arbor, Mich.: Health Administration Press, 1992. 268 pages. $30.

This new book by two educators in the field of medical management represents the logical next step in the advancement of the profession. As medical management progresses from its status as an intriguing sidebar within the realm of medicine to a position of prominence in the evolving health care environment, the need for formal training that evokes the experiential knowledge of the field becomes ever more acute.

Drs. Kindig and Kovner, drawing upon their personal knowledge and experience, have compiled a text filled with material that elicits the essence of the physician manager's role. They have collected several earlier sentinel essays concerning the unique circumstances of the physician's transition from clinician to manager. These deal with the dual role in which a transitioning physician finds him or herself, balancing the changing relationships that appear as one attempts to affect the delivery of health care through managerial influence. Kindig presents his vision of the physician executive in a reprint of one of his earlier articles that reviewed the characteristics of those who fulfill these roles and discussed what future trends are likely to occur within the profession. This chapter is followed by Michael Kurtz's excellent presentation of the dual-role dilemma that was first published in New Leadership in Health Care Management: The Physician Executive (Curry, W., Ed., Tampa, Fla.: American College of Physician Executives, 1988).

The text then presents a new commentary from Don Detmer, MD, expanding that foundation into an examination of the emerging role of the physician executive. Detmer characterizes the position as requiring the simultaneous capacities of human being, manager, and juggler. Four case studies follow his commentary, each revealing the real-life challenges faced by physician executives in their normal routine. The inclusion of case studies signals a maturing of the profession. They may be new to those not yet exposed to a formal business curriculum, but will be recognized by physicians as akin to the clinical case studies they have studied in the past.

The book continues with four similar sections, each dealing with a specific topical area of managerial concern. The individual managerial issues presented are control, organizational design, adaptation, and accountability. Each section is introduced with a commentary from an experienced physician executive, followed by three to five case studies that provide suitable business examples of the topical area being presented. Carl Getto, MD, begins with an examination of the overall issue of managerial control and its achievement through strategic management. Dr. Getto stresses the commonality of quality, access, and cost as primary goals of both clinicians and physician leaders. Aligning these goals and thus the behavior of the clinical staff requires a basic agreement on a mutual purpose, e.g., the overall survival of the institution within which the clinicians derive a portion of their livelihood. Strategic planning that defines priorities for all parties is a prerequisite for the development of specific techniques for monitoring behavior and performance as they apply to the attainment of the strategic goals. The case studies that follow his commentary present managerial situations that highlight the application of his strategic management approach to overall control of the business system.

J. Richard Gaintner, MD, examines the role of organizational design in the successful workings of a health care system. He presents the triad of value, values, and leadership as central to effective functioning of the organization. He cites as a prime example of this approach the organizational restructuring that was implemented at Johns Hopkins Hospital in the 1970s. The case studies following his commentary provide suitable examples to consider the application of these principles to a variety of organizational settings.

Robert B. Klint, MD, considers the utility of adaptation within the context of successfully meeting the challenges of the rapidly evolving health care arena. Klint contrasts evolution and adaptation, characterizing the former as too slow and haphazard a mechanism for organizations in the current environment. We are in the midst of such dynamic change that only a conscious decision to use adaptation as an strategic tool can provide the framework for success. In an examination of the organizational strategies that may support this approach, he reviews the classification system described by Miles and Snow, which discusses defenders, analyzers, entrepreneurs, and prospectors. Klint summarizes by then characterizing adaptation as encompassing a domain where resources are best employed; survival and growth are most favored; and creativity, risk taking, and change management are the desired tools. Four case studies follow his commentary and provide the necessary substrate to embark on an indepth analysis of the application of adaptation as a strategic tool.

Martin Cherkasky, MD, concludes the presentation of the major managerial areas with discussion of the role of accountability. He considers the current compact between providers and the general public regarding health care as a basic societal right. Noting that the time has passed when physicians could alone could decide issues of health care delivery, he says that we have yet to reach agreement among the involved parties as to how these decisions will be made in the future. He examines the special accountability that physician executives will have in these decisions, especially as to how well they can acquaint their clinical colleagues with the need to address these complex issues. The three case studies that follow Dr. Cherkasky's commentary examine the issue of clinicians and physician executives balancing the demands of consumers, organizations, and society in the allocation of health care resources.

The editors have accomplished several goals with this book. First, they have provided a manual that examines the framework within which a physician executive practices and that explores the major issues with which he or she must struggle. Second, they have produced a text that will permit the examination and teaching of a particular aspect of the knowledge base of medical management that has heretofore been anecdotal and not well suited to the case study methodology common in business school education. Third, they have produced a primer for existing and aspiring physician executives, who will benefit from considering these managerial issues and from analyzing the situations illustrated by the case studies.

The Role of the Physician Executive will be a useful addition to the managerial library of every physician executive as well as an indispensable text in a formal medical management degree curriculum. Not necessarily intended to be read in its entirety or in any sequence, it provides a most useful reference for periodic examination of the often unique situations in which physician executives find themselves.

Guidelines for Authors

The Journal welcomes articles on topics for or about the medical management profession. We encourage prospective authors to all or to submit a brief outline or precis of the article before writing. All materials submitted to the journal reviewed by at least two persons with expertise in the subject area covered. Any topic that deals with medical management or with health care delivery from a medical management perspective will be considered for the journal.

All manuscripts should be submitted in triplicate. Where possible, a floppy disk, ideally in WordPerfect 5.1 or ASCII format should be sent. Manuscripts and disks will not be returned unless specifically requested. Only original manuscripts are considered. However, a new article that expands on issues raised in other articles, books, or speeches is acceptable. Graphs, charts, photographs, and other illustrations are encouraged. Except for photographs, triplicate copies are required.

Receipt of all manuscripts is acknowledged. The review process requires 8 weeks. The editors notify authors of the results of review and of the tentative publication date as soon as it is known. All accepted manuscripts are subject to editorial revision. Edited copy is always submitted for author approval.

For further information on the submission of articles or to submit article, contact:

Wesley Curry Editorial Director

ACPE 

Suite 200 4890 W. Kennedy Blvd. Tampa, Fla. 33609

813/287-2000