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TWENTY YEARS AGO, WHEN a hospital established a medical director position, the goal was to place a physician on the senior management team who would be the liaison between the administrative and medical staff, keeping all parties informed and assuring that decisions included a clinical perspective. The medical director or vice president of medical affairs assumed differing levels of responsibility and management duties depending on the support of the hospital's CEO and the board and medical staffs commitment to the concept of a physician in a leadership role.

Managed care organizations had a place for medical directors from the beginning as a liaison between the plan and the physicians in the community. Self-governed group practices tended to use one of their own physicians to serve as intermediary, as well as to improve communications. All of these physician executives were also responsible for the utilization review and quality of care functions, and these positions increased in levels of responsibility as the organizations grew and the marketplace became more complex.

The Physician Executive Management Center conducted a study in 1998/99 of 1,500 physicians serving in senior medical management positions to learn about their perceived value to their organizations. They were asked to identify the top two services they provide. More than 350 chief medical officers in systems, hospitals, group practice, and managed care organizations responded. providing an excellent view of the physician executive in full-time leadership positions.

Greatest value

Senior physician executives believe that the greatest value they provide to their organizations is their accumulated knowledge and experience--both in medicine and management. This medical management expertise is considered the key advantage of serving on the senior management team in helping to shape the organization's decisions and direction, and in planning and managing clinical affairs. Respondents also cited their leadership role and serving as a liaison for the medical staff or the physician practitioners in the community as a critical aspect of their position.

The survey results reinforce the importance of a solid clinical background for physician executives. The time spent as a practitioner and the necessary clinical training is a prerequisite for being accepted as a leader among other physicians and being seen as a credible member of the management team. Even with the trend of pursuing advanced management degrees, physicians also need the grounding of clinical experience to be successful in a senior management position in a health care delivery organization.

Functions related to managing the organization and day-to-day operational decisions were cited most often as valued services by physician executives in managed care organizations and group practices and only rarely by those in health care systems. Managed care organizations and groups typically have smaller management teams and the medical director must serve in an operational role more often than in a hospital or system environment. Also, since groups and managed care organizations are on the forefront of primary care delivery, the medical director would be the logical manager to oversee the operations of medical delivery and to provide direction to the physicians.

Personal values and characteristics were also considered important. About 10 percent of respondents cited characteristics such as judgment, loyalty, rational thinking, common sense, ethics, and integrity as the most valued services they provide. Here, we see an example of the value of the profession based on the physician and his or her reputation, rather than on the work that they do on a daily basis.

The medical director's role in quality management was rarely cited in the value equation. This represents a change in the nature of the position-the responsibility for overall quality of patient care likely continues to fall under the purview of the chief medical officer but is delegated. In group practices, no CMO said that quality management is one of their top two valued services.

Most enjoyed

We also asked chief medical officers what parts of their jobs they enjoyed the most. The number one response was working with the physicians on the medical staff and in the community. This includes the day-to-day involvement as a leader, as a mentor and educator, and overall as a liaison to the organization's practitioners. A closely ranked activity that respondents cited was management duties, such as daily operations and problem-solving, implementing new programs, negotiating, and meeting the challenges of managing in a complex environment.

If these physicians are correct about what is valued in their organizations, they are the right people in the right jobs. The activities respondents most enjoyed were the same as the functions they believe are of highest value to their organizations. So, they are doing what they like to do, and what they do is good for their organizations.

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