A behavioral profile of physician executives

In late 1993, ACPE and Tyler & Company, a national health care executive and physician search firm based in Atlanta, Ga., jointly conducted a survey of physician executives to determine their most likely behavioral patterns. It is the first of a two-part survey that, when complete, will create a multifaceted profile of the "ideal" physician executive as seen through physician executives' eyes and through the eyes of hospital management. Questionnaires based on the DiSC method of behavioral analysis were mailed to 750 randomly selected members of ACPE. More than 170 responses were received. The survey results showed that the majority of physician executives have strong communications skills, are people-oriented, and are strong leaders. The majority of respondents are self-motivated and industrious and are driven by accomplishments. The second part of the survey, which will be conducted later this year, will poll hospital CEOs and boards of directors about their preferences for behavioral patterns in their executives. Comparisons and consistencies will be analyzed between the two surveys to develop a comprehensive profile of the "ideal" physician executive, and the results will be reported in Physician Executive.     

Role stress among physician executives

On the one hand, physician executives are clinicians who place value on professional autonomy. As clinicians, the best interests of the patient drive their decision making and their value system. On the other hand, as managers, physician executives serve as agents of an organization. Because of the differences in the two cultures, some physicians have called the physician executive position a "no man's land" To address these issues and answer the questions that surround them, the authors developed a survey that was mailed to a random sample of the membership of the American College of Physician Executives. Parts of the survey served in other studies of role conflict and role ambiguity. Parts of the survey are new, developed specifically to analyze the physician executive role. The findings are reported in this article.     

Health reform bridging gaps between physician executives and CEOs

Recently, Hospitals & Health Networks reported the results of a study it conducted, in conjunction with Premier Health Alliance, Inc., and among hospital CEOs and COOs to gauge their preparedness and level of concern about various health care reform issues. Because administrators and physician executives are not always in agreement, we wondered how physician executives would rate the same issues. To find out, the American College of Physician Executives polled some members and posed the original survey questions. The results and subsequent interviews revealed that health care reform appears to be a catalyst in bringing the two factions closer in their thinking.     

The ideal physician entrepreneur

How does the sometimes elusive and high-stakes world of venture capital really work? How can physician executives with innovative ideas or new technologies approach venture capitalists to help them raise capital to form a start-up company? These important questions are explored in this new column on the physician as entrepreneur. The ideal physician executive is described as: (1) an expert in an area that Wall Street perceives as hot; (2) a public speaker who can enthusiastically communicate scientific and business plans to a variety of audiences; (3) a team leader who is willing to share equity in the company with other employees; (4) a recruiter and a motivator; (5) an implementer who can achieve milestones quickly that allow the company to go public as soon as possible; and (6) a realist who does not resent the terms of the typical deal. The lucrative world of the venture capitalists is foreign territory for physician executives and requires a great idea, charisma, risk-taking, connections, patience, and perseverance to navigate it successfully.     

Selecting a physician executive.

Selecting a physician executive can be a complex task. The process is complicated by the explosive demand for qualified physician executives. Although the number of physician managers has grown since 1979, the demand still outstrips the supply of physicians with track records. Also, many organizations have never had a full-time person serving in the capacity of Medical Director or Vice President of Medical Affairs, so the process of recruiting this person is new to them.     

CEO behavioral pattern expectations for physician executives

This is a report on the second part of a two-stage survey. The first part of the survey, reported in the Nov. 1994 issue of Physician Executive, dealt with physician executive behavior tendencies as viewed from the perspective of physicians, largely in hospitals. In the follow-up portion of the survey, the views of hospital CEOs on this subject were sought. CEOs were also asked for their views on the roles of physician executives and on what they were seeking in physician leaders. CEOs were asked to assess these issues in terms of the ideal physician executive, not the persons currently holding such positions in their organizations. Finally, this second report draws on the results of both parts of the survey in order to make comparisons between the views of the two groups of managers.     

The physician executive in a changing world.

Physicians are losing their historic franchise as sole and primary providers of medical care. In addition to eroding moral and scientific authority, physicians are also losing income and status. It is no wonder that physicians are retrenching--confused and angry about the increasing marginalization of their profession and about society's changing expectations. Physicians are caught in a transition zone between the world that was and the one that will soon be. This is destabilizing and causes great anxiety. Rather than being buffeted by changing social and cultural definitions of health care, physicians must become proactively involved in the future of their profession. Physicians can only do this by offering a better mental model of health, medicine, and the community. This cannot be a defensive retreat from engagement. Rather, it must be an imaginative vision, vigorously set forth--a vision that will enlist the support of all constituencies involved in the effort to improve the health and well-being of all members of our society. The physician executive needs to work with physicians to orchestrate this effort to create a new vision of health in the 21st century.     

The compensation of physician executives.

In January of this year, the American Academy of Medical Directors and the Physician Executive Management Center mailed a survey questionnaire to the approximately 2,300 members of the Academy of record at that time. More than 1,000 responses were returned. The purpose of the survey was to begin to collect data and establish a reliable baseline of compensation information for the physician executive profession. Subsequent annual surveys will allow the two organizations to track the course of the profession, insofar as this can be done on the basis of compensation. In this article, we provide a summary of some of the findings of the survey as they relate to physician executives in a variety of nongovernment health care settings. Except for the summary of overall data, the report is limited to the responses of physicians who indicated full-time involvement (75 percent or more) in management. Later this year, the complete findings of the survey will be published in a monograph that will be available from the Academy and Center.     

Career paths for women physician executives

The career path leading toward being a physician executive is similar for men and women, but there are some issues that have unique elements for women. Thus, any person interested in developing a medical management career can follow the advice in the following pages, but it is especially useful for women or for those who are coaching women in career development and management.     

Managing the mixed physician practice.

In general, utilization of health care resources translates into physician income. In both a capitated and a fee-for-service environment, the physician is reimbursed for patient care. The reimbursement structures of these two systems is quite different, however, and this difference creates a perplexing reward system for the physician. This article has two goals: To focus on the decision-making process of physicians in a mixed fee-for-service/HMO environment and the potential for cognitive dissonance in this system. To propose an approach for physician leaders in this setting to not only manage and minimize cognitive dissonance, but also strategically position their group for a successful future.     

Making a match: inexperienced physician executives and the job market

Hospitals and other health care organizations are adding physician executives at such a rate that demand is outstripping supply-there are more opportunities for seasoned physician executives than there are physicians with track records as medical managers. It is possible that hiring management will have to consider the employment of a physician who wants to be in management but has no track record as a physician executive. In some cases, it may even be preferable to employ a neophyte physician executive, especially when the physician is a respected clinician already on the organization's medical staff. In selecting such a physician, however, an evaluation must be made of the probability that the physician will be successful in the new role. The author points to 10 criteria that the hiring organization should observe in hiring inexperienced managers.     

Crafting the new physician executive

We are at the beginning of a new revolution that will redefine work, the organizations in which the work gets done, and the relationships among organizations. The future for physician executives is imbedded in the phenomenon of such fragmentation and change. As a result, a new class of physician executives is emerging. The physician executive of the future will be an information builder, a visualizer, and a strategist--among other things.     

Skills needed by physician CEOs. Interview by Barbara J. Linney

How do you transition from physician executive to physician CEO? Three physician CEOs were interviewed to explore the skills they needed to land in the top position. They share their views on what it takes to be a successful CEO. They describe the skills that they needed when they moved into the CEO role and how they acquired them. Some of the qualities it takes to be a CEO include the ability to: Articulate your values; use your people skills; describe a vision; solve problems; listen; walk around; and use analytical skills.     

Management training for the physician executive

At conferences of physician managers, the issue almost always arises of whether or not a physician manager needs to obtain a formal management degree. There is no clear answer to such a question, reason enough for its perennial appearance at such meetings. These decisions are the result of both personal and environmental factors, each creating unique situations that will dictate the direction taken. In this article, one such direction is described.     

Doing physician terminations right

Few managers have the training or the expertise to terminate a physician. Some managers are uncomfortable with this process and may even subvert, delegate, or fumble the process. A properly performed termination will leave the physician with understanding of the termination and may assist in his or her development. A poor termination can cause ill effects not only with the involved physician, but also with the organization terminating the physician. Many physicians are leery of working for an organization that has the reputation of unfairly terminating physicians. They are also concerned with their job security. Potential legal ramifications make the process even more difficult.     

How to fire a physician

How does one fire a physician? In a word, carefully! Most of the legal protections for other employees apply just as well to physicians. And physicians have access to an expanded realm of protections because of the nature of their profession and because of its role in the health care delivery system. The ordinary employee cannot raise antitrust; the fired physician may very well raise just that issue. And yet the need to terminate a physician will sometimes, even though rarely, occur. How can the organization be certain that it has treated the physician fairly, has documented any and all offenses in a defensible fashion, and has generally followed accepted practices in all aspects of dealing with the physician? The author provides some guidelines for dealing with the problem or the incompetent physician.     

Recommendations for new medical directors and physician advisors. Administrative clinical pearls

Presented here are "administrative pearls" that evolved out of a health plan's program to help new physician advisors and medical directors in their daily operations and decision-making process. The list of eight recommendations represents accumulated wisdom from experienced medical directors, physician advisors, and nurse managers.     

Satisfaction higher for physician executives who treat patients,survey finds

If you're satisfied with your physician executive job, one factor contributing to your happiness may be that you're still seeing some patients. Check out the results of a national survey that examines why some physician executives are more satisfied with their jobs.     

Performance evaluations of physician executives. Interview by Barbara J. Linney.

Six senior physician executives were interviewed to see how they were doing or not doing performance reviews in their organizations. There seems to be a trend toward doing them, but it is in the beginning stages. Of the physician executives surveyed, the experience ranges from formal lengthy evaluations with rating scales to reviewing a short list of goals. Several are in the process of developing new systems or revising old ones. Probably the most useful part of a performance evaluation is the conversation between the physician executive and the person he or she reports to. If you can stop approaching performance evaluations as passing negative judgments on people, but as having a conversation to hear their concerns, learn what their goals are, and offer ways to help them achieve their potential, they can be useful, enjoyable experiences for both people.     

The new physician role as employee.

Rapid and ongoing changes in the way in which medicine is practiced and health care services delivered have made employees of physicians who were once the very definition of entrepreneurs. If this new role is difficult for physicians, it is doubly difficult for those who must manage such employees. To be effective managers of other physicians, physician executives must be aware of the historical and sociological basis of the physician profession.