Present at the creation. Interview by Wesley Curry.

This is the inaugural issue of Physician Executive under the auspices of the new American College of Physician Executives. In this and subsequent issues of the journal, we will feature an interview with a prominent figure in the health care delivery system. We begin with Robert A. Henry, MD, FACPE, President and CEO of SwedishAmerican Corporation, Rockford, III. A Distinguished Fellow of the American College of Physician Executives, Dr. Henry is a Past President of both the American College of Physician Executives and the American Academy of Medical Directors. He currently serves as Chairman of the Board of Directors of the Physician Executive Management Center. Dr. Henry entered medical management in the early days of the profession and is a long-time member of the Academy and College, becoming a member of the former in 1975. He became a member of the College in 1980 and a Fellow in 1981. He became a Distinguished Fellow of the College upon its creation on January 1 of this year. He has followed the growth of the Academy and of the medical management profession for several years and has been an active contributor to the success of both. He is uniquely qualified to discuss both the profession and the professional organization that serves it. The following is a report on a conversation that was conducted with Dr. Henry in early November 1988 while he was in Tampa for a meeting of the Board of Directors of the Physician Executive Management Center.     

Innovative leadership: generating ideas.

One of the most challenging functions a physician executive performs is being an innovator--coming up with new ideas to keep ahead of the pack and to solve problems that need fresh solutions. Robert Hodge, MD, CPE, FACPE, and Barbara Linney interviewed Roger Schenke, Executive Vice President of the American College of Physician Executives, and gleaned seven pointers that you might consider to help generate a flow of new ideas or when you get "stuck." They are: (1) read voraciously and link unlike things together; (2) talk to people whose circle is bigger than yours; (3) stop thinking about the problem and focus on something else; (4) care enough to keep wrestling with a problem and not give up; (5) stay open to new ideas even if they are uncomfortable; (6) be willing to risk and take chances; and (7) find a place to carry out the ideas.     

Health care futures. Part 2: The future of physician executives? Panel discussion

What is the future of health care in America? This is Part 2 of The Physician Executive panel discussion that explores the future of health care in America. To narrow this ambitious focus somewhat, the future is defined as five to 10 years hence. In Part 1, which was published in the May/June issue, Russell C. Coile, Jr., Barbara LeTourneau, MD, MBA, FACPE, James Reinertsen, MD, Uwe Reinhardt, PhD, Marshall Ruffin, MD, MPH, MBA, FACPE, and David Vogel, MS, shared their opinions about what the future holds in managed care, information technology, and biotechnology. In Part 2, Susan Cejka, Barbara LeTourneau, MD, MBA, FACPE, John Henry Pfifferling, PhD, Uwe Reinhardt, PhD, and James Todd, MD, share their views on the future of medical education and physician executives.     

Leading an organization through change. Interview by Barbara J. Linney

Robert Jamplis, MD, FACPE, has been President and CEO of the Palo Alto Medical Foundation for the past 30 years. During those years, he has led his group through many of the changes that are just occurring in other medical group practices--movement away from long hospital stays and toward large integrated health care systems. In an interview conducted late in 1994, the author asked Dr. Jamplis to describe the major changes that have taken place in his organization during his tenure and the leadership skills he used to make them happen. His comments are summarized in the following report.     

Serving the public by serving the profession. Interview by Wes Curry.

With the formation this year of the American Board of Medical Management, the American College of Physician Executives took a giant step toward formal recognition of the medical management profession as a specialty of medicine. Much needs to be done, however, to make that dream a reality. Late last year, Physician Executive talked with Donald G. Langsley, MD, Executive Vice President of the American Board of Medical Specialties (ABMS), about the certification process for specialties of medicine and about the role of ABMS in ensuring high standards for the medical profession and for the practice of medicine.     

Certification: goals set, goals met.

When the American Board of Medical Management was founded by the American College of Physician Executives on January 1, 1989, it was understood that the process for formal recognition of medical management as a specialty of medicine would be rigorous. Understandably, particularly at a time when the medical profession and the health care delivery system are under increasing scrutiny by all third-party payers, the decision to expand medical specialization is made with great caution. But the process of recognition for medical management is now well under way. In an interview with Frank A. Riddick Jr., MD, FACPE, Chairman of the Board of Directors of ABMM, Physician Executive learned more about the specific goals of ABMM and about the degree to which those goals have been achieved.     

Money management,patient safety and customer service among top concerns for physician executives. Interview by Barbara Linney

Find out what's happening today and what the future may be like for physician executives. Seasoned physician executives and well-known physician executive recruiters share their insights on the profession.     

Physician executives and communication.

This article presents the results of a pioneering survey of American College of Physician Executives members' perceptions of just how skilled they are as communicators and where they feel the need for further training. Listening skills were rated most important and most in need of enhancement, but physician executives agree that managerial communication skills across the board are vital to the success of a health care organization.     

The Informatics Institute: why do we need it?

Why should physician executives care about medical informatics? For that matter, what is medical informatics anyway? Broadly defined, medical informatics is the study of the collection, storage, retrieval, and analysis of data and information in health care to support clinical and administrative decision making. Informatics is important because, in the past 10 years, powerful computer, software, and information technologies have been developed to enable health care organizations to automate some of the work of decision making, for improved quality of care and cost control, and for successful managed care contracting. This new emphasis on informatics in health care was the impetus for the founding by ACPE earlier this year of The Informatics Institute, which will be involved in educational and research activities in the growing area of medical informatics. In this new column in Physician Executive, Dr. Marshall Ruffin, President and CEO of the Institute, will discuss the role of medical informatics in health care delivery and financing and its relation to physician executives.     

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.     

Some thoughts on becoming an ACPE Fellow (American College of Physician Executives)

Why pursue Fellowship in the American College of Physician Executives? Three physician executives talk about their experiences and explain why becoming an ACPE Fellow is an opportunity to become a leader in shaping the future of the College and medical management. The greatest value of Fellowship is that it shows that you have stature in the profession and it distinguishes you from your colleagues. Becoming a Fellow is evidence of attaining a next higher level of expertise. The process and requirements for becoming a Fellow are outlined, along with many ways to contribute to the field of medical management.     

Health care futures, Part 1. The emergence of the new health care consumer. Panel discussion

In Part 1 of this second annual panel discussion, six experts examine the new health care consumer. The whole concept of the patient as consumer still makes people uneasy when it's applied to health care. Whether you prefer consumer, customer, purchaser, end-user, ultimate buyer, or beneficiary, one thing's for sure: Many of us are as different from the bygone patient as an HMO is from the general practitioner who made house calls. One of the reasons for many Americans' new interest, knowledge, attitudes, and expectations about health and health care is the Internet, the second topic in this discussion. In Part 2, physician executives from the three leading physician practice management companies (PPMCs) join Jeff Goldsmith, Barbara LeTourneau, and Uwe Reinhardt for a spirited exchange about this burgeoning new industry in the American health care sector. They will tackle questions such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? Can PPMCs meet Wall Street's earnings expectations and also help physicians deliver better care? When PPMCs win, who loses? And, what roles will physician executives play in PPMCs?     

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.     

The medical director as educator: an interview with Elizabeth M. Gallup, MD, JD, MBA. Interview by Richard L. Reece

Richard L. Reece, MD, interviewed Elizabeth M. Gallup, MD, JD, MBA, on July 9, 1999, to talk about the evolving role of the physician executive. Dr. Gallup discusses how medical directors have evolved from a purely clinical role to participating in the business side of medicine as well. The traditional medical director, a Dr. No who denies treatment and watches clinical performance, is now becoming an educator helping physicians to manage their behavior and change their practices based on comparative data. Her book, How Physicians Can Avoid Surrender and Lead Change: Gaining Real Influence in Your Own Health Care Organization Before It's Too Late, (American College of Physician Executives, 1996) promotes acting together as a group if physicians want to stay independent and not become employed. Independent physicians can form IPAs and act together as a group, avoiding some antitrust laws. Unless physicians get together and act as a group, she says, they are doomed to further and further erosion of their economic interests as well as their clinical autonomy.     

The physician glut: a different view. Interview by Donna Vavala

An interview with nationally known futurist Leland Kaiser, PhD, on the changes physician executives are likely to face as a result of the coming dislocation in the health professions. Or will there be a shrinking career pie at all? The real question is: What new mental models are we going to use and as a result of the new models, what new jobs are going to be created that will ameliorate some of the surplus we've created in the old model? Dr. Kaiser predicts a model will soon emerge that will open a myriad of new career opportunities for physicians. The new model he foresees is community-based medicine.     

What physician executives and health care organizations should expect from each other

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. What attributes should health care organizations look for when hiring physician executives and what should they should expect of them once they are on the job? Physician executives should: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient. Physician executives should expect the following support from their organizations: (1) varied roles and responsibilities; (2) mentoring by other senior executives; (3) lifelong learning opportunities; and (4) complete support of the management team.     

The future of health care, Part 2. The PPMC debate. Panel discussion

In Part 2 of this second annual panel discussion, Jeff Goldsmith, Barbara LeTourneau, Uwe Reinhardt, and physician executives from three physician practice management companies (PPMCs) examine this burgeoning new industry. They grapple with questions (and occasionally with each other), such as: Are PPMCs delivering what they promise? What will separate successful PPMCs from the rest? When PPMCs win, who loses? What value do PPMCs add to health care? What lies ahead for this industry? Could Wall Street pressure cause PPMCs to put profit ahead of physicians and patients? And, what roles will physician executives play in PPMCs?     

Physician executives in the 21st century: new realities, roles, and responsibilities

This article is based in part on responses from 150 physician executives who participated in an interactive discussion of future trends at the American College of Physician Executives' 1999 Spring Institute and Senior Executive Focus, in Las Vegas, Nevada, on May 13, 1999. The session included electronic polling on 40 predictions, such as the future composition of the clinical workforce and how technology will affect the way that medicine is practiced and the patient-physician relationship. The prediction for physician executives? A growing number of physician executives will find themselves at the top of their careers in the next decade. The physician executive of the future will have a broad array of management opportunities and career choices. More doctors will be managers. Physician executives will work at every level of health care organizations, across the continuum of care, from large complex urban systems to small rural settings.     

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.     

Physician anger--Part 1. Changing perception: an interview with Charles E. Dwyer, PhD. Interview by Richard L. Reece.

On January 21, Richard Reece, MD, interviewed Charles E. Dwyer, PhD, to talk about solutions for changing the perceptions of today's beleaguered physicians. He discusses the state of affairs of physician executives in this turbulent industry and how they need to move beyond their thinking about organizations and their current responses to change. The key, Dwyer emphasizes, is influencing people to do what you want them to do. "If you want somebody to do something other than what they are doing now, then you must bring them to perceive that what you want them to do is better than what they are doing now in terms of what is important to them." He also explores how physicians can change their responses to the health care environment: "You can actually decide how you are going to respond conceptually, emotionally, and behaviorally to anything that happens in your life." Part 2 of this interview will appear in the upcoming May/June issue and will provide hands-on strategies for dealing with physician anger, fear, and resentment.