CMO Duties Intensify, But Compensation Lags

For physicians who trade their white coats for business suits by taking chief medical officer positions, there's still the pull of clinical work: that white coat. 

In some ways, physicians, ever competitive and super-achievers, want it both ways as CMOs. And that may not be a bad thing for healthcare, but for the physicians, that may mean more work, and for a few, simply not liking the job.

A recent survey of chief medical officers at health systems and hospitals reveals hints of what I'm talking about. The Physician Executive Leadership Center's annual compensation survey for 2009-2010 showed that more physician executives are adding clinical duties to their plates, and going through formal management training and education.

Reflective of physicians' competitive natures, perhaps, a significant percentage of CMOs currently in a senior position, with an average age of 55, have or are pursing a management degree. And the numbers are increasing: from 60% in 2001 to more than 80% in 2009, the survey shows. The degrees sought are MBA or other specialized graduate degrees.

"For most physicians, they are wanting a bigger impact than they have as an individual physician," says David Kirschman, executive vice president PELC, which specializes in physician executive search. PELC has conducted the survey of chief medical officers in hospitals and integrated systems since the early 1980s.

The survey also indicated that the percentage of fulltime CMOs in hospitals and health systems who have clinical duties was up to 15% -- up from 12% the previous year. "More physicians doing clinical work this year – that was a surprise," Kirschman says. "Every chief medical officer in a hospital works a lot of hours and [has] many things to do. When do they have time for clinical work? My guess would be they don't have much time for it."

A note in the survey report suggests that the findings seem "counter-intuitive given the increased administrative and leadership responsibilities of the chief medical officer positions."

Eventually, something will have to give, the report suggests. Eventually the number of CMOs who have clinical responsibilities "will remain low or perhaps fall even further" as the complexity of the CMO position increases. "We believe that those who do report continued clinical and academic duties are in reality minimally involved in those activities on a day to day basis," the report states.

Still, physicians who are continuing to work as CMOs as well as clinicians, whether at urgent care centers or even volunteering at clinics, "see it as a challenge," Kirschman says, "keeping a hand in something they were trained in for so many years." He notes that physician executives sometimes face criticism for "not being physicians anymore: suits." By involvement in clinical activities, "they are keeping their hands in it; and it helps credibility," Kirschman says.

Generally, service line leaders such as CMOs do not have much independence in decision-making, according to the HealthLeaders Media Survey 2011. About 70% of respondents say they have moderate decision making authority, with some independence but major decisions must incorporate other hospital initiatives and priorities. About 6% say their decision-making is largely independent.

Keeping a hand in clinical activities doesn't always mean more money. Interestingly, the PELC survey shows, those with clinical responsibilities earn about 10% less in compensation than those who don't. There's no clear explanation for this, says Aamir Rehman, MD, senior vice president of Navvis & Co., the parent corporation of PELC. "We intend to follow up on this data point in next year's survey."

Contrary to years past, hospitals and health systems are working with physicians on a formal basis in quality and informatics issues on a fulltime basis, he says.

And in that process, the evolving physician and hospital relationship is only gaining importance with integrated systems. Those relationships are still being ironed out. I asked J.R. Thomas, president and CEO of MedSynergies of Irving, TX, a provider of hospital-physician alignment strategies, about this issue. The leadership and experience of a physician in clinical matters appears to help the physician and hospital relationship, Thomas says, citing "doctors who are clinically involved and respected by staff" in healthcare facilities.

With an added responsibility for quality and operations, CMOs are finding their duties have much more "intensity" than in other years, according to the PELC survey. "We project continued emphasis on these duties in incoming years," the survey and attached report states.

Generally, CMOs having more clinical duties also have had more years of clinical practice before entering management, and were happy they made the career turn in that direction. "Virtually all participants feel that their move into management was an excellent decision and they are mostly satisfied with their career and current situations," the PELC survey states.

According to the survey compensation increased 2.5% in 2009 for physician executives serving in a full time chief medical officer position, with the average total annual compensation at $323,967, including base compensation and bonus or incentives. Hospital CMOs reported that they expected their 2010 salary to also increase 2.5 % over 2009, a "gain we expect we will expect to see in the next survey results," the survey shows.

However, the survey notes that 15% indicated "dissatisfaction with their current position, citing significant changes in their duties from previous years resulting in more responsibilities, suggesting that they like being a physician executive but not necessarily in their present situation."

"Their jobs are changing, their responsibilities are increasing and there is probably more work for them to do," says Rehman. "For physicians, more work is not often seen as a disadvantage, but rather a sign of their value to their organizations." In addition, they "assigned work volume" may be too much as part of an expanded job. There may be also instances in which management skills may be required that "they feel they may not have," Rehman says.

And some executives may feel some added stress, he says, because of the physician executive work. "Most physician executives seem to be working as hard if not harder than when they were not in the exec role," he says.