The new health care civilization: integration of physician land and manageria.

Changes occurring in health care demand that physicians expand their professional knowledge and skills beyond the medical and behavioral sciences. Subjects absent from traditional medical education curricula, such as the economics and politics of health care, practice management, and leadership of professional organizations, will become important competencies, particularly for physicians who serve in management roles. Because physicians occupy a central role in planning and allocating medical care services and other health care resources, they must be better prepared to work with other health care professionals to create a new civilization, even if this means leaving the cloistered domain of "physician land" to serve as interface professionals between the delivery of medical services and the management of health care. Our research findings and conclusions strongly suggest that economic, management, and leadership competencies need to be incorporated into the professional development of physicians, especially in postgraduate and continuing education curricula.

Ambulatory surgery and the hospital.

Ambulatory surgery can be a win-win proposition for patients, physicians, payers, and even for hospitals. The main elements at risk are high costs and the traditional models of hospital-based surgical care. If hospitals delay their responses to the challenges of the free-standing surgicenter, the latter will become as common as the multispecialty group practice. Health care institutions need to address some questions in responding to this trend: how hospitals should act to transform their bureaucratic, inefficient systems; who should assume the leadership role; and how much autonomy and pluralism will be appropriate.

Practical methods to improve fee collections.

A medical practice's financial policies should be frankly discussed with patients and explained at the initial visit. At that time, health insurance coverage should also be discussed. This candid conversation not only opens the door to further communication regarding a once-sensitive subject but also facilitates collection of fees--especially important when high-priced procedures are contemplated. The author also discusses third-party payers (including Medicare) and the pros and cons of prepaid health plans.

Strategic planning in academic medicine: a departmental case study analysis.

Family medicine departments face a variety of external and internal pressures that make astute planning imperative. A systematic planning process produces measurable outcomes, timetables to evaluate results, and assignments for individual responsibility. Strategic planning is discussed as it occurred during a year-long planning process in a family medicine department. Through the use of an external consultant and through the efforts of the department's division directors, a set of plans were written and approved for the residency program, clinical services, predoctoral education, geriatric education, research and development section, and the administration of the department. The consultation and strategic planning procedure produced a candid analysis of the department's strengths and growth needs, and specified the contributions that will be needed by all faculty to achieve the organization's goals.

Impact of IPAs on fee-for-service medical groups.

Individual practice association (IPA) is the newest and most rapidly growing HMO model. Despite potential benefits, IPAs have experienced a variety of difficulties. A case study analysis of community practices in North Carolina revealed satisfactory results as well as concerns.

Administrative skills for academic physicians.

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education now exists that addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies and references provide the academic physician with guidelines for expanding their professional expertise to include organizational and management skills. The continuing success of the academic medical center as a responsive health care system may depend upon the degree to which academic physicians gain sophistication in self-management and organizational administration.

Administrative skills for academy physicians.

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

Organizational development in academic medicine: an educational approach.

Can organizational development work in the academic setting? Because current cost constraints and federal regulations are forcing departments and services to integrate, organizational development may be the best option for management. The study reported here shows that it can work successfully in the family medicine department.

Implementing an automated financial management system for medical practices.

The increase in availability, affordability, and sophistication of computer technology over the past few years has prompted the development of numerous high-quality software packages for management of medical practice. Although the prices of computer hardware and software continue to decrease, the purchase of an automated system remains a major investment. To ensure a successful purchase and implementation of a system, physicians and office managers must first become knowledgeable about computers and their applicability to medical practice and then devise a strategy for the purchase of a system.

Computer literacy for physicians.

Medical schools and residency programs can help physicians acquire a basic knowledge of computers by offering education in computer literacy. The program currently being offered in the Family Practice Residency Program at Moses H. Cone Memorial Hospital has been integrated into the practice management curriculum and has proven very successful in its initial year. It has served to broaden the residents' knowledge of automation systems and has prepared them for the future automation of their offices. It is hoped this knowledge base will help physicians make sound decisions concerning the purchase of a computer system.

Administration in family medicine education: an academic quandary.

Family medicine leadership is faced with the challenge of maintaining the progressive development of a new academic discipline. Academic administration has presented a dilemma to all fields, and there has been very limited training to assist administrators in academe. A survey of department chairmen and residency directors in family medicine determined that a high percentage of leaders have moved into their positions directly from practice or from faculty responsibilities. Predominant needs were in the areas of finance, external relationships, time management, and conflict intervention. There are several implications from this study which should be considered in the selection, training, and evaluation of academic family medicine administrators.

Human relations training for family practice residents: a four year retrospective review.

The Family Practice Center of Akron has developed and implemented a human relations training program as an integral part of the family practice residency curriculum. Following two years of planning and experimenting, a 12-month course of study was formalized in July 1975. Two full-time behavioral scientists are responsible for planning, coordinating, and teaching the curriculum. The curriculum includes a variety of learning experiences throughout the three years and represents approximately ten percent of educational programming and costs.

The physician as manager. "What" and HOW" OF PRACTICE MANAGEMENT EDUCATION.

Management science and application play a pivotal role in preparing physicians for effective and efficient office practice. Integration of management theory into practice management education of family physicians may be accomplished by developing and maintaining a well-organized model practice, involving residents directly in management decisions and problem solving, using a variety of resource people in and outside the model unit, and providing quantitative analysis of practice performance. After three years of development, the Family Practice Center of Akron City Hospital has instituted a practice management curriculum whereby residents become actively involved in the management and supervision of the model practice, conduct research study into management problems, and receive training and supervision as they develop leadership and organizational skills.