Barbara LeTourneau and Wesley Curry successfully argue that an increasing number of physicians are moving into the executive suites of a diverse range of health organizations. This trend is vividly illustrated by the enrollment of the American College of Physician Executives (ACPE), which swelled from 2,244 in 1986 to 12,251 ten years later, an increase of 445.9 percent. The authors primarily attribute this growth in the number of physician executives to the significantly expanded role of managed care plans and the formation of politically and fiscally powerful health networks.
Their discussion covers a broad spectrum of topics as they outline why physicians in management will continue to be a boon rather than a boondoggle. My disappointment with their thoughtful efforts is not with what they have expressed so well, but with what they have left out. In my opinion, their comments appear to be overly constrained to avoid any possible differences between ACPE and the leadership of the American College of Healthcare Executives, which during the last ten years has experienced a smaller percentage of growth in membership (48.1 percent) (ACHE 1996). The remarks that follow, therefore, concentrate primarily on those topics that might well have been included by LeTourneau and Curry.
A Resurgence of Physician CEOs?
The major reports on health and hospital administration education prepared during the past half-century offer continuously changing recommendations for the focal content of the core curriculum. Key suggestions ranged from public health, which was presented in the Prall study (Joint Commission on Education 1948), to business administration principles, introduced in the Olson study (Commission on University Education in Hospital Administration 1954), to combining health services organization with general management concepts (Chester 1969), and now on preparing executives who possess the know-how and ability to implement costcutting measures without seriously impinging on access to services and the quality of patient care, which is discussed in the Pew study (O'Neil 1992). Therefore, it may not be surprising that in the early 1950s, physicians were the chief executive officers of 32.5 percent of all acute care facilities in the United States (Katzive 1965). This was followed by a slow decline, approximately 13.5 percent, in physician administrators from 1,851 in 1952 to 1,602 in 1962. During the ten-year span beginning in 1972, however, the number of physician CEOs slipped abruptly from 813 to 202, a drop of 72.5 percent (Neuhauser 1983).
The enormous increase in the number of "generalist" hospital administrators during the past two decades should not be perceived as an onslaught against physician executives. This trend may be more accurately depicted as a sign of an increasing specialization in all health and business disciplines, the immediate availability of qualified graduates of hospital and health services administration programs, and the more complex mercantile aspects of the health field. Significantly, the authors omitted any prediction of whether the pendulum will shift once again toward physicians being the chief executive officers and chief operating officers of more American health organizations. If so, what percentage of the health alliances and insurers in the United States by the year 2010 will be piloted by doctors?
The Glut of Physicians
An ever-increasing number of physicians now assuming executive positions, who eventually serve as part of the candidate pools when selecting new CEOs or COOs, could be most easily explained by the current glut of well-trained doctors (Weiner 1994). The negative effects of having an excess number of doctors available will only intensify with the fiscal incentives inherent in capitated payment and the unwillingness of medical schools to curtail their enrollment significantly.
The income potential in managerial roles is perceived by doctors to be relatively comparable to what currently, or certainly in the future, can be anticipated from the clinical practice of medicine. …