The physician executive "arrives"--a new generation prepares for the future

The recent rise in the number of physician executives in the health care industry vividly demonstrates that a genuinely new generation of physician executives is seeking to combine the sensitivity of their clinical skills with the business acumen that today's health care organizations need to prosper and grow. But physicians who are preparing themselves to be selected one day as chief executive officers by hospitals, integrated systems, and managed care organizations should understand that the CEO role is radically different from that of the CEO of a physician practice. The corporate CEO role requires the management of managers and responsiveness to the organization's board. Those who imagine that the corporate CEO role bears any resemblance to the autonomous, independent existence of the practitioner are certain to have a rough time.     

The purpose of a job interview is a job offer

Perhaps empathy has been overdone in recent years. Most of us would admit to some cynicism or disbelief when we hear the words, "I know how you feel." Having said that, however, I actually do know how you feel. If I can't identify exactly where you are coming from, I do know where you are likely to be going and how bumpy the ride is likely to be. I'm a physician and a physician executive. I am also an executive search consultant who is daily in the field interviewing physicians who may or may not be the right individuals for a client's situation. If I don't exactly feel your pain, at least I know its sources. I know how difficult it is to make the move from challenging clinical work to an administrative role in health care. While, as a group, physicians are multiskilled and multitalented, it's an unfortunate fact that some of the skills and talents that made you an excellent physician may be blocking you from succeeding in an executive capacity. My hope is that, through an occasional entry in this column, I can share my experiences and relate the remarkable wisdom of the impressive physician executives whom I meet every day. The first issue I'm opening up for discussion is employment interviewing: Why the interview is so important, what the interviewing process is, and how you can become more adept in this critical skill area.     

Care management challenge is the toughest yet.

The newest health care trend involves changing the core business--health care delivery and the resources involved--through better care management. This impacts every practitioner all day, every day. This issue truly belongs to the physicians, and thus to physician executives. Care management is the latest frontier, the place where the delivery of quality care, in the most efficient way, at the best possible cost, all come together. And physician executives are being challenged to make it happen, to change the way medicine is practiced and health care is delivered across the country, to move from treating episodes of care to a true preventive mindset and population-based methodologies. This column outlines the skills in care management that systems-based physician executives will need to develop or enhance to remain competitive--effective communication skills and team-building capabilities are critical attributes for those who hope for success.     

Responding to Hard Times in the “Big Easy”: Meeting the Vocational Needs of Low‐Income African American New Orleans Residents

The already limited vocational prospects of low‐income African Americans in New Orleans were further devastated by Hurricane Katrina in 2005. The 2010 Deepwater Horizon oil spill added to the devastation, highlighting the continued vulnerability of New Orleanians seeking employment. As a result, opportunities persist for vocational practitioners to lend their expertise. In this article, the post‐Katrina vocational situation of low‐income African American residents is conceptualized using Bronfenbrenner's (1977) ecological model. Furthermore, needed interventions are described at each level of this ecological model.     

Distributional properties of simpson's index of diversity

Closed expressions for the first four moments of Simpson's index of diversity are derived using techniaues suggested by Haldane (1937). As the samole size increases the behavior of the skewness and kurtosis is studied for several Dopulations with varying degrees of diversity, If the populationproportions decrease accordinq to a geometric progression, graphs of β₁and β₂ indicate that convergence to normality in general is more rapid for populations which are less diverse.     

Decision Making in Voluntary Career Change: An Other‐Than‐Rational Perspective

The authors present a qualitative study of voluntary career change, which highlighted the importance of positive emotions, unplanned action, and building certainty and perceiving continuity in the realization of change. Interpretative phenomenological analysis was used to broaden theoretical understanding of real‐life career decision making. The accounts of 8 women who had changed careers were explored, and the analysis supported other‐than‐rational perspectives of career decision making. An action‐affect‐cognition framework of decision making is proposed. The framework adds the role of emotion and the importance of self‐regulation to existing theory of career decision making. Implications for career counseling are discussed.     

Hypothesis Testing in Multivariate Linear Models with Randomly Missing Data

Tests for mean equality proposed by Weerahandi (1995) and Chen and Chen (1998), tests that do not require equality of population variances, were examined when data were not only heterogeneous but, as well, nonnormal in unbalanced completely randomized designs. Furthermore, these tests were compared to a test examined by Lix and Keselman (1998), a test that uses a heteroscedastic statistic (i.e., Welch, 1951) with robust estimators (20% trimmed means and Winsorized variances). Our findings confirmed previously published data that the tests are indeed robust to variance heterogeneity when the data are obtained from normal populations. However, the Weerahandi (1995) and Chen and Chen (1998) tests were not found to be robust when data were obtained from nonnormal populations. Indeed, rates of Type I error were typically in excess of 10% and, at times, exceeded 50%. On the other hand, the statistic presented by Lix and Keselman (1998) was generally robust to variance heterogeneity and nonnormality.     

The Internet: An Essential Tool for College Health Networking

Abstract

With the advent of the Internet, college health professionals have available to them a new setting in which to network. The Internet provides opportunities for immediate communication with a large and diverse community of colleagues. Through both the Student Health Service (SHS) Discussion Group and numerous health-related databases, the Internet serves as a powerful research tool for program development and improvement. Answers to queries about practice options, solutions for local problems, and support of innovative policies can be received almost instantaneously from college health professionals from across the United States and Canada. In this article, the authors summarize the history and current use of the SHS Discussion Group, provide a brief overview of Internet basics, and identify more advanced uses of the Internet by college health professionals.     

Be positive--it's a necessary strategy.

The hallmarks of successful health care organizations include: A positive physician culture; meaningful physician involvement in governance and top management; and stability and strong community roots. Success is most likely where physicians in the facilities are having professional fun, where freedom from negativity allows them to perform at their highest level of quality. When a positive physician culture takes hold, remarkable things can occur. In the best scenarios, physicians are deeply involved in strategic direction, as well as in practice. They are part of making the decisions, instead of merely grumbling about decisions made by others. The column provides suggestions for creating a positive physician culture.     

Dis-integrated policy: welfare-to-work participants' experiences of integrating paid work and unpaid family work

Using a critical feminist theoretical lens, we followed 17 families for one year – as they attempted to make the transition from welfare to work – eliciting narrative accounts of their day-to-day lives. We used an institutional–ethnographic methodology to analyse the data. Our study shows that the juncture at which unpaid caring work and paid employment meet may be more difficult to negotiate for low-income lone-parent families than for coupled, middle-class employed families. Findings reveal that the unpaid work that happened on the edges of a paid work day, what we refer to as ‘the work outside the work’, took considerable time and energy for participants, making it difficult for them to procure and/or sustain employment. This was due to a number of factors including their limited access to economic and non-economic resources, and the complex nature of their lives, including struggles with day-to-day functioning and childcare arrangements. These challenges, combined with the realities of the low-income labour market made it difficult, if not impossible, for most participants to effectively integrate work and family. These findings suggest that the dis-integrated nature of welfare-to-work policies, which overlooks the actualities of low-income parents’ lives, limits families’ ability to become self-sufficient.