David R. Kirschman
November 04, 2009

Introduction

Periodically, we conduct a survey of chief medical officers in health care
delivery organizations such as hospital systems, hospitals, group practice and 
managed care.  While the survey is mostly focused on compensation, we also ask
about the nature of their jobs and what it takes to do it well.  This article is
an analysis of the responses in our 2009 survey and a comparison with our 2007
survey report. 

Hospital and Hospital System Chief Medical Officers

Findings about duties:
We initially thought that hospital and hospital system CMOs would have a
different job orientation, but we found more similarities than differences in
both reports.  We decided to combine these two organizations for these comments.

The “most important” duty reported by chief medical officers in hospitals and
hospital systems in 2007 was “liaison” followed by “quality.”  These were the
duties most often selected by participants and were clearly the prime areas of
responsibility for these physician executives.  The results in 2009 are similar;
the two “most important” duties they selected are the same, but this time they
ranked “quality” ahead of “liaison.”  In both survey years, other offered duty
choices such as external relationships, supervision of physicians and strategic
planning were rarely chosen as “most important.”

It appears that hospital and system chief medical officers focus their
activities in what may be seen as the traditional senior management role for
hospital settings, that of monitoring the quality of care provided, making sure
that the organization’s practitioners are informed about the decisions of the
system, and that the perspective of its practitioners are communicated to
administration.  Not much seems to have changed over the years.

Findings about change:
In both the 2007 and 2009 survey years, 70% of the hospital and hospital system
participants reported that their chief medical officer positions had undergone
change from the previous year.  In both years “more responsibility” was added to
the positions.  This change was often defined as “added complexity” and/or an
“increased scope of duties.”  The second most reported change in their positions
was a “greater focus on quality.”

The Chief Medical Officer position in hospitals and systems is clearly a
dynamic situation in which the emphasis of the position’s responsibilities
changes and the CMO’s duties become more complex from year to year.
Presumably, the changes are necessary for these physician executives to
continue to concentrate on the effectiveness of the care and the quality of
the services  provided to the public.  We expect that the chief medical
officer position will continue to evolve as it becomes an even more critical
participant in the management and success of hospital systems.  Those who find
themselves in these CMO roles should expect continuing change and take steps
to maintain an awareness of the skills and expertise necessary for success.

Managed Care Chief Medical Officers

Findings about duties:
In both years of the survey, chief medical officers in managed care
organizations reported that their position’s two “most important” duties were
“strategic planning” and “external relationships.”  In 2007 the clear emphasis
was “strategic planning” activities; in 2009 it is “external relationships.”

Primary duties of managed care chief medical officers are different from
their colleagues’ duties in hospital environments.  It is interesting that
“quality” was not as often mentioned when these physicians were choosing an
area of job importance.  Perhaps that is a result of managed care systems
having more sophisticated quality systems that do not require the same level
of attention as in hospitals.  We assume that the “external relationships”
responsibility of these roles emphasizes creating and improving relationships
with physician networks and employer clients.

Findings about change:
The nature of the managed care chief medical officer position changed for about
half the respondents in both surveys, although a slightly higher percentage
noted change in the second year.  The changes in the position in the earlier
survey were represented by an “increase in responsibilities,” with little of
note otherwise.  In this year’s survey, however, managed care chief medical
officers reported a significant “increase in responsibilities” and an equal
increase in the emphasis of the position on its “strategic planning” and
“external relationship duties.”

These senior physician managers found themselves facing additional duties to
presumably better compete in their marketplace.  This again is different from
what the hospital chief medical officers reported, and may have been predicted
from the different emphases of these two segments of the health care industry.

Group Practice Chief Medical Officers

Group practice was a smaller sample from which to obtain results about the
extent of change in senior medical executive positions, but there were a
sufficient number of responses to produce findings of interest, especially when
contrasting them to the other organizational types

Findings about duties:
The most important duty cited by over fifty percent of respondents in this group
in  2007 was “strategic planning.”  In 2009, the duty of most importance
mentioned was “supervision of physicians,” followed closely by “quality” and
then “strategic planning.”  

These findings suggest that the job emphasis for group CMOs moved from planning
to what may be labeled operational effectiveness, with the management of
practitioners as one indicator of success in group operations.  This would also
suggest that chief medical officers in group practice have now been charged with
fewer strategic duties and are being assigned more practical, operational duties
related to production and quality of performance.

Findings about change:
Changes in the CMO position occurred often in group practice; 65% of the
respondents in the first and 78% in second survey reported that their roles had
changed.  In the 2007 survey, respondents noted that their positions had changed
with an increase in their responsibilities in a number of ways.  The two most
often mentioned were “more practitioner supervision” and “more focused
managerial duties.”  In the 2009 survey, the findings showed that, while the
position did change by a great degree, the resulting change was an increase in
the role’s “operational duties or emphasis.”  These findings are consistent with
and support the changes reported above.

Summary

So, what have we learned of interest from a review of these findings?

1. Chief medical officers in all health care delivery organizations are likely
to see yearly changes which will include additional duties and areas of
oversight to meet the needs and dynamic nature of their organizations.  As the
size of leadership teams are reduced, CMOs are being assigned new and expanded
responsibilities.  A CMO who finds himself in a position that does not change
should be wondering about the tenure of his situation.  Or, perhaps it should
raise some question about how his job compares with others in the profession. 
It might be wise for incumbent CMOs to expand the scope of their jobs as a
strategy to maintain their position in the organization’s leadership structure.

2. Chief medical officers in hospitals and hospital systems consider their most
important duties to be the “liaison” and “quality” functions.  While the scope
of their duties continues to expand, the position emphasis is similar to that of
the originally created senior medical leadership positions of the past.  If
“liaison” and “quality” remain at the top of their list of responsibilities,
what professional education is most important for physician leaders to be
successful in these activities?  Is an advanced degree the best route to this
education, or are there other effective pathways?

3. The nature of chief medical officer roles changes by organizational type. 
The hospital or system CMO is mostly an internally focused senior manager with
liaison and quality duties.  The managed care chief medical officer is
externally focused with strategy and external relationships as key duties.  The
group practice chief medical officers have an internal focus with physician
supervision and strategic planning as top duties.  All chief medical officer
roles therefore are not alike.  That fact should not come as a surprise to those
who are familiar with the industry, but it may be of interest to those
physicians considering a career in management.

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