When Catholic Healthcare West recently posted an opening for a regional vice president of medical affairs, 20 physicians applied for the job. Such a large response would have been unheard of a few years ago, says Keith Marton, M.D., vice president of academic medical affairs at St. Mary's Medical Center in San Francisco, which is part of CHW.
"Physicians look at the vice president of medical affairs position as being important to the work physicians do," Marton says. "More of them are interested in taking on those responsibilities."
Traditionally, the position's duties have included managing medical staffs, overseeing healthcare quality and serving as a liaison between the senior management group and physicians.
But the job description is changing. Vice presidents of medical affairs increasingly are expanding their roles to include business decisionmaking, strategic planning and quality improvement initiatives. They are managing larger and more complex medical staffs and taking on responsibilities that cover the entire continuum of care within integrated delivery systems. They also have been charged with encouraging other physicians to develop leadership skills.
Although the number of vice presidents of medical affairs has been growing in recent years, it's estimated only about half of all healthcare organizations have created a position with this title. Those that haven't sometimes ask the medical director or chief of staff to take on business and strategy decisionmaking roles.
To find out more about the challenges associated with the position, Modern Physician spoke with Marton and two other vice presidents of medical affairs: Barbara LeTourneau, M.D., and John C. Babka, M.D.
Marton had never heard of a vice president of medical affairs when he began practicing medicine 20 years ago. At that time, the chief of staff, often a practicing physician, was an organization's top-ranking physician leader. The responsibilities of the job included solving day-to-day clinical problems, monitoring quality and reviewing the credentials of physicians who wanted to join the medical staff.
While chiefs of staff still exist in many healthcare organizations, paid physician administrators have taken on many of the management responsibilities, Marton says.
"Nowadays, the vice president of medical affairs goes beyond being a problem solver to being a business developer," Marton says. "We develop new projects, programs and plans, and we oversee areas of the hospital that relate to what physicians do but not always directly, such as medical records. We're in charge of budgets. We write business plans. We anticipate the future and engage in strategic planning."
Healthcare organizations have a growing appreciation for physician administrators, Marton says. "Organizations increasingly recognize that physician leadership is important when it comes to maximizing the quality of care and keeping a strict focus on the true mission of the organization."
At St. Mary's, a 500-plus-bed facility that is part of CHW's West Bay region, Marton's job includes overseeing residency training; education; quality improvement; and information services, which includes library services as well as medical information systems.
"When I started out, I had no idea that I would oversee quality improvement or information systems," Marton says. "But both of those are crucial to what the hospital does, and organizations need people who have an understanding of patient care and what physicians do to play a role in those areas."
Marton's position has expanded to include regional and systemwide duties as well. He is chief of graduate education and health services research for CHW, also based in San Francisco, and is part of the senior management team for the West Bay region.
Marton joined St. Mary's 31/2 years ago after spending most of his career as a primary-care physician practicing in academic settings. He held several dual administrative and clinical positions and experienced many changes in the industry firsthand, such as hospital mergers and early capitated contracts.
One of Marton's main responsibilities today is to help other physicians hone administrative skills. He is working on a systemwide physician leadership development program. Its goal is to find midcareer physicians within CHW who are potential leaders or are early on in mastering their leadership roles, he says.
"We're developing a multipronged educational program to give physicians the competencies they will require to become more effective leaders," he says. "Business, computer and leadership skills such as strategic planning are all part of what the modern physician needs to know."
LeTourneau decided early in her career she wanted to influence the way healthcare is delivered by bringing a physician perspective to the business side of the industry. Her goal was to do more than offer suggestions, however. She wanted to be a physician who made business decisions.
She began practicing emergency medicine 18 years ago and noticed physicians did not discuss business issues as peers with administrators.
"Businesspeople sought physicians' opinions, but I didn't see a lot of physicians participating in actual decisionmaking," she says.
To correct that situation, LeTourneau went back to school in 1985 to earn a master's degree in business administration. She's now vice president of medical affairs for Allina Health System's north region, Minneapolis, where her work ensures physicians have a role in all business discussions.
Physician input is important to the business side of healthcare, she says. "There are huge cost pressures on the healthcare industry. When you have efforts to save money, you need to have physicians who understand the business part of medicine as well as patient care to help determine where it is practical and safe to cut costs."
In LeTourneau's region, a team of eight physicians (including her), representatives from the region's two hospitals and the vice president of quality work together to affect the way the hospitals are run, LeTourneau says.
For example, the team helped decide how the 1997 capital expenditures budget would be spent.
"That's a very big change," LeTourneau says. "Physicians are now participating equally. We have a key part in determining which things are priority and which are not."
Generally decisions are reached by consensus and everyone has an equal voice, LeTourneau says, but physician opinions about clinical matters tend to carry more weight with committee members. They tend to focus more on how decisions will affect the practice of nurses and doctors and the impact on patient care, she says.
As vice president of medical affairs, LeTourneau also helps define general business strategy. "It used to be that the vice president of medical affairs was only involved in strategic planning for the doctor stuff," she says. "But physician executives are becoming a more integral part of the management team."
She and others in her position across the country are helping address such issues as how health systems can link clinics to hospitals, provide joint services with community physicians and decide what budget items to cut when that is necessary.
"As healthcare has become more complex, physician executives have become more important because they have a good understanding of patient care," says LeTourneau, who is also president of the American College of Physician Executives, Tampa, Fla. "It's easier for a physician to learn the business parts of medicine than it is for businesspeople to study and learn the clinical parts of medicine."
Babka spends more than 60% of his time working on quality improvement initiatives as vice president of medical affairs at Morton Plant Mease Health Care, a three-hospital integrated delivery system based in Clearwater, Fla.
That's a big change from nine years ago when he joined Morton Plant Hospital in Clearwater as director of medical affairs. At that time, his main duties were acting as a liaison between the medical staff and hospital administration, overseeing the review of physician credentials and managing medical staff support.
"There was very little in the way of quality management functions," he says.
Today Babka leads teams of physicians who work together to identify how care practices for specific diagnoses or procedures can be adapted to save money or improve care. It's Babka's job to question whether a certain laboratory test is needed, for example, and then to turn the team's findings into recommendations for the entire medical staff.
Managed care adds urgency to such efforts, Babka says. "We're in a very competitive market. To survive, we have to have lower costs and better outcomes than anybody else. Quality improvement activities are one of the main ways we achieve that."
Babka oversees clinical operations for organizations throughout the health system. "I started out as a hospital vice president of medical affairs," he says. "We now have a rehabilitation center, outpatient centers, a primary-care physician group, a home health agency and more."
The expanding scope of the health system means communicating with clinicians is getting more difficult, Babka says. Almost 900 physicians are part of the medical staff, up from 250 when he first started at Morton Plant Hospital.
Babka sends physicians periodic newsletters and notices, and he hopes the health system will build electronic links to physician offices in the future.
The effort it takes to meet new management challenges is well spent, says Babka, who began his career in the Navy, where it is not uncommon for a practicing physician to take on administrative duties.
"I can have more impact on patient care in one day in a major management role than I can in a lifetime of taking care of patients one at a time," he says.