суббота, 15 сентября 2012 г.

The broadening horizon for physician executives: the six constituencies of health care.(Career Choices) - Physician Executive

With each passing day physician executives are presented with a greater array of opportunities to apply their skills. Historically we were confined to leading other physicians and providing care with them directly.

The American College of Physician Executives once ran seminars on the advantage of remaining in active practice while serving as a medical director. In this way physician leaders would maintain credibility with the medical staffs they were charged with managing.

However, the field of medical management expanded our skill sets as we mastered utilization management, quality management, disease management, medical informatics and health education--all leading to an ability to improve the health of an entire population.

Many of us married our medical degree with a masters in business administration, a masters in public health or even a law degree. These newfound abilities, coupled with a unique insight into the health care industry, created many new opportunities.

Six constituencies of health care

Health care increasingly is viewed as patient-centric. Therefore it is reasonable to consider patients and other health care consumers as the first constituency. These patients are cared for by providers including doctors, nurses, therapists, pharmacists, podiatrists, optometrists, and all of their supportive staff.

Health care providers make up a second constituency. These providers usually are compensated by insurance companies and third-party administrators.

This group of payers defines the third constituency. These payers administer health care bills on behalf of the purchasers of health care.

The purchasers of care are the fourth constituency and include the government and employers.

Large purchasers, large payers and even large provider organizations often rely on health care consultants to make important decisions. For this reason we must include the consultants as the fifth constituency.

Lastly, the largest constituency by market capitalization is made up of the suppliers. This group includes the pharmaceutical industry, the laboratory industry and the durable and disposable medical equipment manufacturers.

Present and future careers for physician executives

Today physician executives are playing significant roles within all of the constituencies. We are no longer confined to leading a practice group, a medical department, a hospital or an integrated delivery system.

There are hundreds of medical directors serving health and disability insurers as well as the pharmaceutical industry. Most enlightened large employers have hired physician leaders to manage their occupational health needs as well as their health and productivity issues.

There are several hundred more doctors providing consultation to the health delivery industry. Physician executives are even representing consumer/patient advocacy organizations and companies.

Patient organizations

Representing the needs of patients is laudable. All physicians do this to some extent. But finding a full-time opportunity to truly represent the voice of the customer in health care is difficult.

Organizations such as the American Diabetes Association, the-American Heart Association or the American Cancer Society are benchmark examples of consumer advocacy. The American Association of Retired People, the Centers for Disease Control and prevention, quality assurance organizations and public health entities may also offer positions to doctors interested in advocating for patients.

Provider organizations

This is where physician leadership was born. Today, this constituency still dominates ACPE with physician executives running practices, departments, hospitals and integrated delivery systems.

Principal to their charge are adequate and fairly distributed compensation, liability defense, work-life balance, practice management, public relations, financial administration and coordination of services.


To meet these needs physician executives in this domain master pay-for-performance programs, risk management, career counseling, public speaking and business administration.

Payer organizations

Historically, insurance carriers and third-party administrators have dedicated themselves to establishing benefit plans, contracting for provider services, paying out claims and establishing fair premiums.

More recently they have attempted to improve health care delivery by reducing overuse, underuse and misuse of medical services. To accomplish this, physician executives working within the payer constituency have become experts in negotiation, benefit design and interpretation, coding, relative value scales, utilization management, case management, disease management, quality management, pharmacy benefit management, health informatics and predictive modeling.

Purchaser sector

In the past, large employers that had a sizeable enough population in one location would employ a physician at the worksite. That 'company doctor' was responsible for the care of the employee population especially if they were injured while at work. These occupational health physicians focused on workplace safety.

Witnessing great reductions in workplace mortality and morbidity, these physicians expanded their role into disability and workers' compensation. Today corporate medical directors work closely with human resource leaders to reduce absenteeism.

They apply public health sciences, health care informatics, predictive modeling, ergonomics, rehabilitation/return to work programs, travel medicine and emergency preparedness efforts in synergy with traditional executive skills such as system process improvement, finance and communication.

Health care consultancy

Physician executives in this domain provide intellectual support and guidance to all of the other constituencies.

They assist integrated delivery systems with garnering market share and obtaining sustainable profitability. They produce 'request for proposal' (RFP) documents to promote competitive bidding when purchasers seek out vendor relationships such as the third-party administration of their self-insured benefit packages. They connect suppliers to customers.

To perform at a high level, physician executives in consulting practices hone skills in public relations, marketing, informatics, business analysis, system process optimization, project management, benefit analysis and health care integration.

There are several large consulting houses that have health care practices including Towers Perrin, Mercer, Deloitte & Touche, Watson Wyatt, Hewitt, Price Waterhouse Cooper and AON.

Medical suppliers

From a global perspective, it is peculiar that this constituency is most highly valued in our marketplace. The pharmaceutical industry alone dwarfs the other sectors in capitalization. Each pharmaceutical company employs physician executives, some as many as 100 doctors outside of their research divisions.

Some of these physician executives are responsible for product development, marketing, sales, clinical application, product positioning, continuing medical education development and sponsorship, and medical consultation. Others are involved in population health analysis and long-term research strategy.

To excel in these roles physician executives must have superior skills in medical law, medical ethics, medical education, informatics, information technology, global health, business administration, and predictive modeling.

What's on the horizon?

If it is true that physician executives are in the best position to better health care delivery then perhaps the best way to exert this influence is by starting companies from scratch and directing them from the very top.

To win in this game, physician executives must be creative, visionary, persistent, hard-working and passionate. They must acquire skills in investor relations, finance, business administration, health law, business law, organizational dynamics, motivation, public speaking, writing, interpersonal communication and leadership.

The opportunities for well-trained, hard working and passionate physician executives have never been greater. Personally, this playing field has given me a chance to lead a primary care practice to become the largest provider of pediatric services in the county.

It afforded me an opportunity to serve three different national health insurance companies and contribute to the fields of utilization management, quality management and disease management. It granted me a chance to master and lead companies in eHealth and health informatics.

It offered me an opportunity to lead a global network of workplace health centers for General Electric serving as the global medical leader. And finally it has given me a chance to be entrepreneurial.

Today I am leading a company that provides workplace health solutions for approximately 100 large employers through over 210 on-site health centers. My adventure as a physician executive has been rich and fulfilling. I hope yours is, too.

Enjoy the ride!

Raymond J. Fabius, MD, CPE, FACPE, is president and chief medical officer for I-trax/CHD Meridian. He can be reached at 610-459-2405 ext. 105 or rjfabius@i-trax.com

By Raymond J. Fabius, MD, CPE, FACPE