For Physician Leaders, Is Managed Care Medical Director the Right Career Move?

By Sue LeGrand

The opportunity to impact care delivery for large populations, rather than one patient at a time, can be appealing to physician leaders considering a transition into managed care. The medical director position in particular has evolved from being known as “Dr. No” to one of listening, sharing information about what has worked from experience and evidence, discussions about options and working with providers collaboratively to develop a plan of action.

With the transition, managed care medical directors frequently enjoy a better work/life balance, without call and little, if any, weekend or holiday work responsibilities. At the entry level, larger national managed care organizations often allow remote performance of duties. Even with regional and national positions, relocation is not always required although a significant travel component may be involved. Smaller plans typically require relocation with the benefit of affording medical directors the opportunity to form close relationships with network providers.

In general, physician leaders who look to move into a medical director role in managed care may expect a pay cut. The level of compensation may often require flexibility. To offset what may be a lower salary, commercial plans can offer bonus and stock potential; Medicaid plans often have rich state pensions to counter the reduced pay. Entry-level medical directors can expect to start at a base in the upper $200,000 to lower $300,000 range. Additional bonuses and perks will vary with the type of plan and individual organization.

Prerequisites and “Human Factors”

For physicians considering this career path, a strong clinical background with several years of practice experience are musts. As Dr. Drew Oliveria, Senior Executive Vice Medical Director, Regence Blue Shield in Seattle, observes, “Physicians will find that flexibility is important; the pace is faster and more varied than in clinical practice, and with competing priorities and many times conflicting views. The medical director must be the voice of what is clinically appropriate, best for the member, and push back against those who are only looking at the financial part of the equation. The medical director needs to be the expert in more areas than traditionally taught in medical schools and business schools, which places us at a high value within organizations.”

Soft skills are essential, including the ability to listen and collaborate, and strong emotional intelligence. As Dr. Lakshmi Dhanvanthari, CMO, Health Plan of San Joaquin (HPSJ), comments, “I can educate medical directors about the business of managed care and the nature of the duties. The human factors are harder to teach. In their work, medical directors must form close relationships with our staff, external HPSJ network physicians, and community resource providers. I need physicians who are collaborative, eager to learn, and have a strong desire to make a difference. Exceptional communication skills are necessary, as well as a willingness and ability to educate our nurses and social workers internally, and our network of providers externally.”

Physicians with care management or care coordination experience will find it helpful in making the career change. In addition, primary care physicians and specialists, like emergency medicine physicians, who work collaboratively across disciplines, may have more understanding of issues of importance. Further, physicians with graduate degrees in health management, health policy, or business often bring more immediate value.

Responsibilities and Rigors

As is true of almost all organizations, managed care physicians executives, as they ascend in their organization, have more strategic and externally-facing responsibilities. In addition to serving as the clinical voice on the executive leadership team, they have the same function for sales internally and for client meetings. Doug Nemecek describes his responsibilities as National CMO of CIGNA Behavioral Health as content expert for clinical issues. He is often a public face for CIGNA at regional and national conferences, and has become their spokesperson for the emerging social determinant of loneliness as it impacts health. He elaborates, “As a commercial plan, CIGNA is exploring ways to incorporate social connections to improve the health of employees. We promote workplace interest groups, for example, as a means to enhance levels of interaction. New program development becomes a large component of work at the national level.”

Advocacy is another vital feature. In managed care, physician leaders often represent their organizations at the state legislative level and on the Hill, advocating for both their organizations and the populations they serve. Dr. Robin Hemphill, Chief Quality and Safety Officer, Associate Dean for Quality and Safety, Virginia Commonwealth University relates the importance of advocacy and how the responsibilities grow with career advancement: “Many local and state officials are interested in hearing from, and getting input, from those that have a high level view of health care systems. The expertise that managed care physicians may have can allow better legislative proposals as well as better informed legislators.”

Conclusion

Managed care physician leadership positions offer benefits and challenges. The better work/life balance is an obvious advantage. New skill development can be fun and also challenging. Extensive public speaking and the enormous amount of teamwork and collaboration often are learning opportunities. The chance to have great impact and be on the cusp on healthcare change may be the most motivating factor for transitioning, and progressing, in managed care leadership.

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