For hospital chief medical officers, 2008 was a good year as they saw their compensation increase 12.5%, up to $315,991 from $280,851, compared with the 4% pay increase received by group practice CMOs who were paid $304,822, up from $293,027, according to the 2008-09 Survey of Chief Medical Officers conducted by the Physician Executive Management Center, a Tampa, Fla.-based physician-executive search firm.
Despite these increases, they still lagged behind their peers who worked in other settings. Compensation for integrated system CMOs reached $376,681, a 4.9% increase from the $359,137 they made the previous year, the survey found. Also, CMOs for managed-care organizations were paid $334,171 up only 2.7% from $325,355.
“That's a pretty big jump,” says David Kirschman, president of the Physician Executive Management Center, in describing the hospital CMO pay increase. He adds, however, that next year, pay increases will be more modest and are projected to be in the 3% range.
“The physician-executive—the CMO-type position—has matured and its value has been established in hospitals, groups and systems,” Kirschman says. “To a certain extent, it's a thankless job, and I'm not certain that those senior physicians get appreciated for what they do. Leadership is a funny thing, if you do a good job, everybody doesn't like you.”
The survey doesn't lump the different types of CMOs together, so aggregate statistics are not given, but the survey shows that CMOs are still mostly male—by a roughly 9-1 ratio in most categories—and around 40% for each category are internists. Managed-care organizations are an exception, with 37% of the surveyed CMOs reporting family practice as their specialty, and 26% listing internal medicine.
Other trends the survey tracks are the large numbers of physician-executives with or pursuing advanced management degrees, and the low number of CMOs with clinical duties—though Kirschman says these numbers have been much the same over the past three surveys.
For hospital CMOs, 56% had an advanced degree—with an MBA (35%) and master of medical management (14%)—the most popular, and 8% reported that they are currently working on a degree.
“There has been a push for physicians who want to get involved in the executive side to get a management degree so they can better understand what the business guys are talking about,” Kirschman says. “Whether or not it's actually a help to them or perceived as a help to them, they've gone out and got it.”
For integrated systems, 51% reported having an advanced management degree (MBA, 21%, and master of medical management, 19%), with 10% pursuing one. For managed-care organizations, 60% of the CMOs had advanced management degrees (MBA, 30%, and master of public health, 12%), and 5% said they are currently pursuing one.
And, for group practices, 52% of the CMOs had an advanced degree (MBA, 17%, and master of medical management, 13%), and 9% are working on obtaining an advanced degree.
One thing Kirschman wonders is how do these executives find the time?
“It was definitely a challenge,” says James Casanova, M.D., vice president of medical affairs at 195-bed Aurora Sinai Medical Center in Milwaukee. “It took about 25 hours a week, and I was working 60 hours. So, it took a lot of work, but it was fun.”
Casanova says it took him two years to complete his MBA in 2006, offered through a distance-learning program at Denver's Regis University, and the format allowed for a better fit with his job.
“I don't think it made it easy, but it made it easier to fit into my schedule,” Casanova says.
And while getting advanced degrees “is definitely the trend” and something he views as positive, Casanova says he disagrees with the career path some healthcare executives are taking where they earn an M.D., but then don't practice and go straight into management.
“You need some clinical experience to do this type of job the best,” Casanova says. In Casanova's case, he says his MBA “has been helpful, but I think experience still trumps the degree.”
That said, Casanova says he thinks the trend of CMOs having few clinical duties is OK with him because of the growing complexity of the position.
“This is a long-standing debate with one side saying, 'The chief medical officer should continue to have some clinical responsibilities because it earns you the respect of the doctors,' ” Casanova says. “On the other side, you just can't do a little bit of this job and be good at it. You might wind up being mediocre at both because you stretch yourself too thin.”
On the hospital side, 14% of the CMO respondents reported having clinical duties. For integrated systems, 9% had clinical duties; managed care, 0%; and for group practice, 36%.
“I did both for about 20 years; for the past seven or eight years, it's been 100% on the management side without the clinical,” Casanova says, but he adds that it's a hard choice to make.
“If you're a physician, giving up the clinical piece could be difficult,” Casanova says. “It's part of your soul. It's what you went to school for and it's who you are.”
While many miss the direct feedback of dealing with patients on a one-on-one basis, Kirschman says the executives take pride in the overall quality of their organization, as 63% of respondents said the best part of their job is, “Having a positive impact on the quality of care that is provided.”
While CMOs are giving up clinical practice, one thing Casanova says he's seeing that's not being tracked by the survey is CMOs having responsibility for day-to-day operations of a department such as radiology, emergency medicine or even the laboratory or food service.
“There seems to be, in some health systems, a trend to have the CMO do more of these things,” Casanova says.
Of the gender gap, both he and Kirschman say the numbers reflect the demographics of senior physicians and are not expected to remain the way they are given the number of women entering the profession.
“Those ratios are bound to change now,” Casanova says. “Medicine has been lopsided until fairly recently, and so the lopsidedness is going away, but it's not totally gone yet.”
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