Physician executives boost clout, earning power.

Results of the 2001 Physician Executive Compensation Survey are in and they show that physician executives working in practice/hospital management companies or single specialty groups earn the highest pay. Physician executives with advanced degrees appear to earn more, as well.     

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.     

Physician organizations. Part 1: A report from the trenches of a start-up PO

How has Community Health Partners, a physician organization based in Kansas City, turned the corner as it rolls into the second year of operation? The biggest indicator is that CHP hammered out the city's first professional risk contracts and the PO has grown from 23 to more than 50 physician member/owners. Looking back, there are at least 10 reasons why CHP made it this far. These are not reasons you learn about in medical school or an MBA program. There is no one-size-fits-all template for building POs. No fixed organizational chart. No neon signs pointing to the best capital partner. Part I explores five reasons for success, such as having a strong board and physician leadership, as well as educating participating physicians about capitation and affiliating with any hospital or payer that really knows how to partner with physicians. Part 2 will focus on five more lessons learned from the trenches of a start up PO.     

Boards want leadership and decisiveness.

Regardless of whether they aspire to the top executive spot, physician managers are likely to benefit from insights into what hospital boards want in their chief executive officers. Many of the attributes board chairs desire in hospital CEOs involve how they handle medical staff matters. In general, board chairs want leadership and decisiveness--attributes they likely would covetin any physician manager who has hospital management responsibilities.     

Effects of role variables on job satisfaction

This study examines the effects of role variables on job satisfaction among physician and non-physician executives in hospital settings. Positive relationships were found for both groups between role variables and job satisfaction. The results indicate that role variables have a significant effect on stress, job satisfaction, and organizational commitment in the physician executive and the non-physician health care executive. On a theoretical level, this research allowed for an extended test of role theory, specifically as it applies to the management of health care. The implications of these findings for role theory and the physician executive are discussed. Since this study is of an exploratory nature, it offers new insights into the field of health care management, and the physician's role as the executive.     

Coaching für die Chefärztin der Chirurgischen Abteilung eines Kreiskrankenhauses

Coaching the head physician of a surgical department The author presents an individual coaching of a female head physician, who is leading the surgical department of a hospital for half a year. The motive were conflicts in the relationship to the colleagues, mainly an interactional conflict with the assistant medical director, caused by dysfunctional patterns of understanding and behaviour. Together with the coach objectives were developed to find a more planning, structuring and communicative leading style. Further more, interventions were prepared and the interactions with the assistant analyzed. Finally, as a first conflict intervention a team discussion is prepared and successfully supported.     

Anesthesia Patient Risk: A Quantitative Approach to Organizational Factors and Risk Management Options

The risk of death or brain damage to anesthesia patients is relatively low, particularly for healthy patients in modern hospitals. When an accident does occur, its cause is usually an error made by the anesthesiologist, either in triggering the accident sequence, or failing to take timely corrective measures. This paper presents a pilot study which explores the feasibility of extending probabilistic risk analysis (PRA) of anesthesia accidents to assess the effects of human and management components on the patient risk. We develop first a classic PRA model for the patient risk per operation. We then link the probabilities of the different accident types to their root causes using a probabilistic analysis of the performance shaping factors. These factors are described here as the "state of the anesthesiologist" characterized both in terms of alertness and competence. We then analyze the effects of different management factors that affect the state of the anesthesiologist and we compute the risk reduction benefits of several risk management policies. Our data sources include the published version of the Australian Incident Monitoring Study as well as expert opinions. We conclude that patient risk could be reduced substantially by closer supervision of residents, the use of anesthesia simulators both in training and for periodic recertification, and regular medical examinations for all anesthesiologists.     

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.     

Coach your physicians to care,listen and connect with patients

Developing strong physician/patient relationships isn't easy when doctors are pressed for time, forced to see more patients and overburdened with paperwork. Yet, successful organizations realize that the physician/patient relationship is the most valuable asset for the hospital or practice. Learn ways to cultivate the relationship and make it grow even stronger.     

Should the physician executive be the physician's advocate?

Medical staff commonly want to know if a prospective physician executive will serve as their advocate to management. A successful physician executive must like and respect physicians. But the question of advocacy must be answered thoughtfully, because the candidate must not imply that he or she will defend any action by any physician. A three-part conditional response is advisable.     

No longer a solo practice: how physician leaders lead

The authors conducted a national study to determine the factors associated with the success of physician leaders. They utilized the Leadership Practices Inventory (LPI) and a demographic survey followed by individual interviews with respondents. Data analysis revealed several implications for the selection, training, management, and career development of physician leaders. The results suggest that: Physician leadership training should have a strong focus on the "human side" of management, including negotiation, organizational "politics," conflict resolution, team building, and motivation. Data management and finance should be a focus represented in the curriculum. Mentoring relationships should be developed as an aspiring physician leader pursues a career shift. Self assessment, including an analysis of style, strengths, best potential organizational fit, and specific areas of strength and weakness should be an integral part of the development of an aspiring physician leader. Screening mechanisms to ascertain a physician's motivation to move toward a full-time leadership role should be developed to ensure appropriate intent. To facilitate this implication, more effective assessment tools need to be developed.     

Global view offers good news for physician executives

Do all physician executives have much "catching up" to do in relation to their non-MD colleagues? A comparison of the role of the physician executive versus the non-MD executive/administrator provides a big picture view and signals new opportunities for physicians in the evolving health care system. Physician executives have only recently become invested in the health care executive suite and are less wedded to old methods and "classic" ideas. They are more likely to be able to adapt to new circumstances, jettisoning traditional approaches that have outlived their usefulness. But each group-physician executives and their MHA- or MBA-credentialed, non-MD colleagues- has much to offer to or learn from the other. By retaining those skills that are applicable, while also adapting the useful characteristics of the "traditional" health care administrator, a physician executive can increase the likelihood of success today.     

Legal issues in accepting capitation

The effort to reduce the cost of medical, hospital, and ancillary services increasingly focuses on shifting the financial risk for the cost of these services to those who provide them. Shifting arrangements include capitation for physicians classified as "primary care" physicians; capitation arrangements that include primary and specialty services; risk shifting to medical groups, IPAs, and other physician organizations; as well as the packaging of physician and hospital services on a "full risk," "per case," or other basis. Accepting financial risk for the cost of medical and other health care services, as well as the responsibility for managing the provision of services, may very well be the only remaining opportunity for providers to maximize reimbursement and maintain administrative and clinical self-direction. However, physicians must work with managed care organizations (MCOs) through negotiation of contracts and throughout the relationship to make sure: Unnecessary financial and legal risks to the MCO and physicians are eliminated. Risks that cannot be eliminated are apportioned between the MCO and physicians. All risks are managed in a coordinated fashion between the MCO and physicians.     

Hospital medical directors, quality of care, and financial returns

You are a physician executive working very hard within a hospital on all sorts of medical staff issues and quality of care. You answer to the board. The latter, through its administrators, may still have difficulty documenting the precise value of a full-time physician executive. Your hospital is losing money or not making enough profit for capital expenditures and salary raises. It is considering or will have to consider staff cuts. What can you do that will influence the bottom line, produce a quality image, and quantify your value?     

Ascendancy of primary care will create role intensification for physician executives

The need for physicians in management roles in the health care system has never been greater. And the years ahead will see that need broadened and intensified. To maintain their leadership role in medical affairs in hospitals and other types of health care delivery organizations, physician executives will have to envision provider organizations and systems that have not yet been conceived, let alone developed and implemented. They have to become totally open-minded and futuristic in their thinking. And they will have to help other physicians accommodate this new way of thinking if the medical profession is to continue in a leading role in health care matters. Although numerous factors will have to be anticipated and analyzed by these new physician leaders, the ascendancy of primary care in a managed health care world long dominated by the technical and technological superiority of hospital care will present a particular challenge to the physician executive.     

Examining Pathways from Innovation Orientation to Patient Satisfaction: A Relational View of Healthcare Delivery*

The federal government and industry leaders view innovation as a potentially fruitful way to improve hospital performance, specifically patient satisfaction. However, translating a hospital's innovation orientation into improved performance is challenging given that important network participants—namely physicians—may possess different aims. Grounded in Relational RBV, this study tests a model linking innovation orientation to patient satisfaction through a pathway of knowledge‐sharing routines (physician partnering and customer relationship management) and complementary capabilities (hospital responsiveness). Further, this study investigates the moderating role of physician employment (a form of governance) by examining hospitals with high and low levels of employed physicians. Structural Equation Modeling results from a paired sample of primary survey and secondary data from 173 acute care hospitals in the USA reveal the following. Hospitals with high levels of employed physicians translate innovation orientation into patient satisfaction by using customer relationship management (CRM) programs to influence hospital responsiveness directly, ultimately leading to patient satisfaction. Hospitals with low levels of physician employment use CRM programs in a fully mediated fashion to inform physician partnering activities, which influence hospital responsiveness, driving patient satisfaction.     

Wanted--seasoned veterans. Diamonds in the rough need not apply

Health care organizations looking for physician executives prefer seasoned veterans--doctors who have already done the job. They want job-specific experience. Most organizations do not provide training grounds and orderly career ladders for aspiring physician executives. The Permanente Medical Groups, Family Health Plans, and some very large group practices are exceptions, but, for the most part, rising medical directors in these organizations stay with them. Most hospitals are not large enough to have associate or assistant medical directors or an environment that could provide a training ground for rising physician executives. On the other hand, hospitals, larger group practices, health insurance companies, and managed care organizations provide ample opportunities for nonphysician managers to train, gain experience, and climb the ladders. How can the novice physician executive break into the world of management and begin establishing management credentials? The author provides some key steps that can lead to success.     

Complementary and alternative medicine. Integrative medicine: business risks and opportunities.

Much of the buzz over integrative medicine is well deserved. The opportunities seem to outweigh the risks, but superior management skills are needed to guide these programs through adolescence into clinical and business maturity. By carefully considering the staffing, team building, compensation methods, marketing, and program evaluation and development issues explored in this article, health care and physician executives should be able to steer between the rocks on their way to integrative medicine decisions that are right for their organizations. Many claim that integrative medicine has the potential to reshape health care delivery in a more patient-centered direction. While this may be true, such programs must prove themselves from financial and clinical operational perspectives in order to achieve this potential. Luminary clinical skills are not enough to guarantee the survival of such programs--a strong clinical base of expertise in alternative therapies is a key success factor. As with any health care venture, there are no substitutes for clinical excellence or sound management.     

The evolution of the VPMA (vice-president, medical affairs)

In the past, the VPMA's role was clearly defined. So were the skills required to do the job. Initially VPMAs served an inside role in an organization as the liaison with the medical staff and the hospital administration. That role has matured and is currently evolving. Ultimately the expansion of the VPMA role will provide alternative career directions for physician executives. The wise physician executive learns from those who have knowledge--or who are in the process of acquiring it. That means keeping an eye on active managed care markets nationwide for trends that may be coming to his or her locale. The physician who does not do this kind of professional introspection and evaluation of the national market may find him- or herself professionally behind the curve.