Managed care will dominate the healthcare landscape in the years ahead. And in managed care's drive to wring the most healthcare out of a dollar, it will continue to press for efficiencies such as organizational integration, flattening and downsizing.
I think it's pretty clear that managed care is driving integration. And integration will mean fewer jobs. Integration brings about a qualitative assessment of the new organizational hierarchy. Do we really need all these managers? Do we really need a department head for each part of the body? Do we really need to hire people to watch other people? Probably not, or at least not as many.
In the same way that managed care changes an organization's marketing strategy from retail to wholesale--from recruiting individual patients to recruiting groups of patients--it will also change, at the strategy level, an organization's approach to clinical care from individuals to groups or populations. Capitation for these groups or populations will press organizations to find additional efficiencies, i.e., fewer physicians (too expensive) and fewer traditional managers (not effective enough).
Add to all this a growing cynicism about today's manager. Industry is rife with examples of middle managers cut from the rolls as organizations streamline and "right size." The power of the traditional manager lay in having access to information and decisionmaking authority. Now, information technology makes information available to everyone, and organizations have discovered that decisions are more effectively and efficiently made by workers close to the customer. The raison d'etre of the traditional manager has run its course.
How soon will we see the effects? My guess is some are seeing it now, and most will see it within the next five years.
Some may judge these developments to be bleak. Others, I hope, will see the opportunities. While managed care, integration, flattening, downsizing and the "defrocking" of traditional management will eliminate many management jobs, I believe there will be a greater need for physician executives in new roles.
Payers and patients will demand greater accountability; healthcare organizations will need professionals to develop measures of health outcomes and health status. The clinical process will come under greater scrutiny, not only by the legal profession, but also by healthcare organizations striving to find more effective and cost-efficient models of care. This, of course, will require greater emphasis on standards of care. So I see a growing need for physician executives in the management of outcomes, quality and clinical standards. (The trap is assuming these roles will necessarily be filled by physicians. They will be filled by whoever has a differential competence. My hope is that they will be filled by physicians.)
As managed-care organizations cause a shift in medicine's approach to populations and groups, physician executives who have prepared themselves in statistics, epidemiology and environmental health will be in increasing demand.
Management of disease in populations requires more than just physician input. Teams of physicians and other clinically trained professionals will be put in place to develop standards and manage the care of not only populations but also individuals. Capitation will force organizations to find the most efficient and effective ways to provide care, and my sense is that physicians will be seen as too expensive for routine care. Who will manage these teams? Here again, my hope is that physician executives, the logical though not necessarily popular choice, will prepare themselves to manage these multiprofessional teams.
I think we'll also see work, task and project teams formed as organizations try to push decisionmaking closer to the potential customer. These teams will need to be managed or will need to be taught how to manage, and physicians should find roles in the effort.
Clearly, information technology is driving many of these changes. Its rapid growth is not likely to abate, but the translation of clinical needs to information resources, or general informatics, will require a distinctive competence.
And lest we forget, there appears to be a growing recognition that physicians, properly prepared through training and experience, bring a new and necessary dimension to the role of chief executive officer by integrating the needs of organizations with the needs of clinical care.
These thoughts about the future are not based on scholarly research but rather on my own feel for the changes taking place. The important point is not what I see as the future but what you see and what you see for you. No matter what changes occur, we'd be foolish to assume that the role of the physician executive will not change. The real question, it seems to me, is: Are we preparing to change?
Roger Schenke is executive vice president and chief executive officer of the American College of Physician Executives, Tampa, Fla.