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Hospital size determines department director policy.

4 Early in 1990, the American College of Physician Executives undertook a survey of its hospital-based members to determine the extent to which hospitals had department directors and the roles, responsibilities, and compensation of those directors. The survey form was mailed to about 1,400 College members; responses were received f rom 734-approximately a 52 percent response rate. This article reports the results of the survey.

The College survey of hospital based clinical department directors shows that the existence of these directors is pervasive, although the phenomenon is more pronounced in larger than in smaller hospitals. Overall, 92 percent of hospitals report such positions, but the figure drops to 43 percent for hospitals with 1-49 beds and is only 77 percent for those with between 50 and 99 beds. Hospitals in other bed-size categories reported the position at about the average level. Table 1, page 25, shows the percentages of 12 selected clinical departments with directors both overall and for various bedsize categories. (The responses from hospitals with fewer than 50 beds have not been included in this breakdown because of the small sample size for the group.) Overall, the departments most likely to have directors are emergency medicine and pathology. The least likely is rehabilitation. For smaller hospitals, psychiatry is the most likely site for a department director, and family medicine, anesthesiology, and rehabilitiation are the least likely. Anesthesiology consistently ranks near the bottom in percentage of department directors, and pathology and radiology are just as consistently near the top. Unfortunately, the survey doesn't provide any insights on the reasons for this result. The most common method for selection of department directors is appointment (68 percent overall). Forty percent of the respondents reported selection through elections. (The figures for this part of the survey add to more than 100 percent because some respondents indicated multiple selections methods.) Appointment seems to increase as the preferred method as hospital bedsize decreases, and election seems to decrease, but the trend is not perfect. (See table 2, page 25.) Surprisingly, only 64 percent of the directors are compensated for their management efforts. Larger and smaller hospitals are more likely to compensate clinical department directors, while midsize hospitals are less likely to do so. Regrettably, the survey uncovered no pattern in compensation itself. For all bed size categories and for all departmental specialties, the range in compensation was extreme, from a few thousand dollars annually to more than $200,000. The data suggest that most of the department directors are part-time managers and maintain a clinical practice that dominates their work load. A future survey would have to illuminate the compensation issue further and show any trends. The means of compensation also varied widely. Overall, payment on the basis of specialty was the dominant method, with department size and complexity the next most frequent determinant. As with the actual compensation amounts, the payment method varies in a random fashion, so that interpretations are difficult and probably unwarranted. However,it seems safe to assume that hospitals of all sizes use some differentiating technique for compensating these directors. Very few of the respondents reported that all specialties are paid on the same basis. Quality assurance is the main responsibility of department directors, regardless of hospital bedsize (table 3,page 25). Supervision of other practitioners is the second most indicated responsibility, again for all hospital bed sizes. Budget development, recruitment activities, and supervision of other employees also received notice. The relative rankings of these roles does not seem to be affected by bed size. The survey asked respondents to state the reasons physicians accept director positions.

As shown in table 4, page 25, the most frequent reason is the honor, but only narrowly more so than duty. Compensation and the opportunity for management training were farther down the list. Because this is the first survey of the prevalence of department directors in hospitals, no trend lines can be offered. That situation win have to be corrected by future surveys. Given the rapid growth in recent years in medical director positions in hospitals, and the continuing move to the creation of the vice president of medical affairs position, it seems likely that more and more hospitals will add the department director function and will begin to compensate these individuals at higher and less variable levels. It is also likely that these positions will be filled, as medical director and vice president of medical affairs positions are, increasingly by the appointment process rather than elections.
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Author:Curry, Wesley
Publication:Physician Executive
Date:Nov 1, 1990
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