|
Back To Career Index
Back To Main Index
Job Report - Health Services Managers
Published 1996
Mascor Publishing Co.
P.O. Box 8308
Silver Spring, MD 20907
Nature of the Work
Effective management of health care organizations, and of the considerable
resources at their disposal, requires competent managers. Like their counterparts in any
organization, health services managers are responsible for facilities, services, programs,
staff, budgets, and relations with other organizations.
Health services manager is an inclusive term for individuals in many different
positions who plan, organize, and coordinate the delivery of care. Hospitals provide
nearly
half the jobs in this field. Among the other organizations that employ health services
managers are clinics, health maintenance organizations (HMO's), nursing homes, home
health agencies, rehabilitation centers, and psychiatric facilities; surgicenters, urgent
care
centers, diagnostic imaging centers, and other ambulatory care facilities; and offices of
doctors, dentists, and other practitioners.
The job of managing a health facility has become highly complex due to the rapid
pace of change in medical technology and the emergence of dozens of specialty health
professions, in addition to significant changes in consumer expectations, business
practices, and health care financing. As a result, the need for professional managers
continues to grow.
Also contributing to the need for professional management is the extensive oversight
and scrutiny to which many health facilities are subject. Both past performance and plans
for the future are subject to review by a variety of groups and organizations, including
consumer groups, government agencies, professional oversight bodies, business coalitions,
and even the courts. Preparing for inspection visits by observers from regulatory bodies
and submitting appropriate records and documentation can be time consuming as well as
technically demanding.
Three functional levels of administration are found in hospitals and other large health
care settings--executive, internal management, and specialized staff. The chief executive
officer provides overall management direction, but also is concerned with community
outreach, planning, policymaking, response to government agencies and regulations, and
negotiating. The job often includes speaking before civic groups, promoting public
participation in health programs, and coordinating the activities of the organization with
those of government or community agencies. Institutional planning is an increasingly
important responsibility for chief administrators, who must assess the need for services,
personnel, facilities, and equipment and recommend such changes as shutting down a
maternity ward, for example, or opening an outpatient clinic. Chief administrators need
leadership ability as well as technical skills in order to respond effectively to the
community's requirements for health care while, at the same time, satisfying demand for
financial viability, cost containment, and public and professional accountability.
Day-to-day-management, particularly in large facilities, may be the responsibility of
one or more associate or assistant administrators, who work with service unit managers
and staff specialists. Depending on the size of the organization, associate or assistant
administrators may be responsible for budget preparation and finance; personnel
administration and in-service training; information management; or coordination of the
activities of the medical, nursing, physical plant, and other operating departments.
As the health care system becomes more complex, specialists in financial
management, marketing, strategic planning, systems analysis, and labor relations will need
to be hired.
Although managers in hospitals and nursing homes are both responsible for the
efficient operation of their facilities, their day-to-day duties differ markedly.
Hospitals are
complex in structure, housing a great many departments--admissions, surgery, laboratory,
therapy, emergency medicine, nursing, physical plant, medical records, accounting, and so
on. The hospital administrator works with the governing board in establishing general
policies and operating philosophy and provides direction to assistant administrators, or
vice
presidents as they may be called, and department heads who carry out those policies. The
administrator coordinates the activities of the assistant administrators and department
heads to assure that the hospital runs efficiently, provides high quality medical care,
and
recovers adequate revenue to remain solvent or make a profit.
Many of the same management skills are needed by nursing home administrators.
However, administrative staffs in nursing homes are typically much smaller than those in
hospitals--nursing home administrators often have only one or two assistants, sometimes
none. As a result, nursing home administrators "get their hands into" the
detailed
management decisions much more than hospital administrators in all but the smallest
hospitals. They wear various hats--personnel director, director of finance, director of
facilities, admissions director, for example--analyze data and then making daily
management decisions in all of these areas. In addition, because many nursing home
residents are long term, staying 2 years or more, these administrators must provide for
the
psychological and social well-being of residents, as well as for health care.
In the growing field of group practice management, managers tend to the
administrative and management functions involved in a large practice. Responsibilities
include personnel, billing and collection, budgeting, planning, and sometimes advertising.
Heath services managers in health maintenance organizations (HMO's) perform all
of the functions of those in large medical group practices, but they perform one
additional
function--that of an insurance company. HMO enrollees pay an annual fee that covers
almost all care. HMO managers must establish a comprehensive medical benefit package
with enrollment fees low enough to attract adequate enrollments but high enough to operate
successfully.
Working Conditions
Health services managers often work long hours. Facilities such as nursing homes
and hospitals operate around the clock, and administrators and managers may be called
at all hours to deal with emergencies. The job also may include travel to attend meetings
or to inspect health care facilities.
Employment
Health services managers held about 181,000 jobs in 1990. Half of all jobs were in
hospitals. About a quarter of health services managers worked in nursing and personal
care facilities and in offices of physicians. The remainder worked in outpatient care
facilities, other health and allied services, medical an dental laboratories, and offices
of
dentists and other practitioners.
Training, Other Qualifications, and Advancement
As is generally true with managerial jobs, most entrants transfer from other
occupations. Knowledge of management principles and practice is the essential
requirement for a position in this field, and such knowledge often is gained through work
experience. Nonetheless, formal educational preparation is important, especially for those
who wish to advance in the profession. Although a nurse supervisor may rise to director
of nursing services based upon merit or performance, for example, a master's degree in
health administration (MHA) is usually necessary for advancement beyond nursing director.
for some other positions, a degree in business, personnel administration, or public
administration provides an appropriate background; many graduate programs in these
disciplines offer concentrations in health administration.
Many hospitals are setting up separate ventures such as outpatient surgical centers,
alcohol treatment centers, and home health care services. When they operate at a profit,
separate companies such as these can funnel needed revenue to the hospital. To operate
and manage these subsidiary companies, hospitals--or the corporations that run them--are
looking outside the health industry for managers with well-established skills in profit
and
loss analysis, marketing, and finance. Nonetheless, graduate education in health services
administration remains a prerequisite for many upper level administrative positions within
hospitals and their subsidiaries.
Academic programs in health administration, leading to a bachelor's, master's, or
doctoral degree, are offered by colleges, universities, and schools of public health,
allied
health, and business administration. The various degree programs provide different levels
of career preparation. The master's degree--in hospital administration, health
administration, or public health--is regarded as the standard credential for many
positions
in this field. Educational requirements vary with the size of the organization and the
amount
of responsibility involved. Generally, larger organizations require more specialized
academic preparation than smaller ones do.
To enter graduate programs, applicants must have a bachelor's degree, with courses
in natural sciences, psychology, sociology, statistics, accounting, and economics.
Competition for entry to these programs is keen, and applicants need above average
grades to gain admission. The programs generally last between 2 and 3 years. They
include up to 1 year of supervised administrative experience, undertaken after completion
of course work in such areas as hospital organization and management, accounting and
budget control, personnel administration, strategic planning, and management of health
information systems.
New graduates with master's degrees in health or hospital administration may be
hired by hospitals as assistant administrators or, more often, as department heads or
project directors. Postgraduate residencies and fellowships are offered by hospitals and
other health facilities; these are normally staff jobs.
Growing numbers of graduates from master's degree programs are taking jobs in
HMO's, large group medical practices, and clinics as these facilities continue to
flourish.
Students should be aware, however, that midlevel job transfers between HMO's, large
medical groups, and hospitals may be difficult. Employers place a high value on experience
in similar settings because some of the management skills are unique to each setting.
Relatively few master's degree recipients take administrative positions in nursing
homes or life-care communities, although graduates of the small number of long-term care
administration programs generally do so. Many nursing home administrators pursue
graduate education while employed, however.
New recipients of bachelor's degrees in health administration usually begin their
careers as administrative assistants or assistant department heads in larger hospitals, or
as department heads or assistant administrators in small hospitals or in nursing homes.
The Ph.D. degree usually is required for positions in teaching, consulting, or
research. Nursing service administrators are usually chosen from among supervisory
registered nurses with administrative abilities and advanced education.
Licensure is not required in most areas of health services management, except for
nursing home or long-term care administration. About 18 States currently require at least
2 years of college for licensure, while about 20 require a bachelor's degree. All States
and
the District of Columbia require these administrators to pass a licensing examination, and
most students prepare for it by completing a special course of study. These preparatory
courses, usually consisting of 100 to 200 hours of study in long-term care administration,
are available through some colleges, universities, and home study programs. The licensing
examination covers principles of administration; management of a long-term care facility;
the role of government in long-term care; environmental health and safety; and medical,
psychological, and social aspects of patient care. Nearly half the States require
applicants
to complete an internship known as an Administrator-in-Training program before taking the
licensure examination. This internship generally lasts 1 year and is supervised by a
licensed administrator. Since requirements vary from State to State, persons considering
a career in long-term care administration should investigate licensing requirements where
they wish to work.
Health services managers are often responsible for millions of dollars of facilities and
equipment and hundreds of employees. They need a command of business and
communication skills that allows them to make timely policy decisions and to motivate
subordinates to implement those decisions. Administrators, especially head administrators,
of all types of health organizations need to be self-starters.
In order to create an atmosphere favorable to good patient care, managers must like
people, enjoy working with them, and be able to deal effectively with them. Managers also
should be good at public speaking.
Health services managers advance in the profession by moving into more
responsible and higher paying positions. They may do this within their own institution, or
by shifting to another health care facility or organization. Frequently, the first job in
a large
institution is fairly narrow in scope--department head in charge of purchasing, for
example.
Advancement occurs with promotion to successively more responsible jobs such as
assistant or associate administrator and, finally, chief executive officer (CEO). Health
services managers sometimes begin their careers in small hospitals in positions with broad
responsibilities, such as assistant administrator. Regardless of the path of advancement
chosen, the ultimate occupational goal in hospitals and nursing homes is the position of
CEO.
Outside the more traditional avenues of advancement, many managers take staff
positions with the Veterans Administration, U.S. Public Health Service, or State or local
departments of public health. Others find positions with voluntary health agencies such as
the American Cancer Society or with trade and professional associations in the health care
field. A growing number of jobs are available with firms that provide health management
services on a contract basis. Jobs also are available in health planning agencies and
professional review organizations. Individuals with academic training or experience in
health administration are well suited for such positions.
Job Outlook
Employment of health services managers is expected to grow much faster than the
average for all occupations through the year 2000 as the industry continues to diversify.
Most job openings, however, will result from the need to replace personnel who transfer to
another field or retire.
The various areas of health services management will grow at different rates in the
years ahead. This reflects anticipated changes in the organization and delivery of health
care due to overwhelming pressure to control costs.
Hospitals account for by far the largest proportion of health care spending. They are
likely to remain a focal point for cost containment, and will not contribute as heavily to
job
growth in health services management in the future as they did in the past. Hospital
employment is expected to grow more slowly than average between now and 1995, and the
number of hospitals may actually decline. Restructuring of the hospital industry--the
spinning off of separate companies to provide ambulatory surgery, alcohol and drug
rehabilitation, or home health care, for example--will reduce the number of jobs in
hospitals,
while creating opportunities in the subsidiaries.
The importance of the hospital sector for employment of health services managers
should not be underestimated, however. The rapidly changing hospital environment will
provide career and advancement opportunities for managers with appropriate skills and
experience. As hospitals become more specialized, concentrating on services that they are
particularly well suited to deliver--whether it be neonatal care or burn treatment, for
example--managers with strategic planning and marketing skills will be needed. Managers
will also be needed to plan, install, and oversee comprehensive systems for monitoring and
controlling resource use.
Facilities that provide outpatient care are expected to provide many of the new jobs
for health services managers. Demand will be stimulated by the very rapid expansion of
HMO's and group medical practices, and the emergence of such outpatient facilities as
urgent care centers, surgicenters, cardiac rehabilitation centers, diagnostic imaging
centers,
and wellness centers.
HMO's continue to grow in number and membership, and they will provide numerous
jobs for health services managers through 1995. Physicians forming group practices to
take advantage of economies of scale and shared expenses are expected to provide many
opportunities for administrators in the area of medical practice management. Ambulatory
facilities such as outpatient surgical centers and after-hours clinics are expected to
experience very rapid growth due to their convenience and competitive fee structure. As
such facilities become more widespread, additional jobs will be generated.
With better medical care and healthier lifestyles, Americans are living longer than
ever before. Very rapid growth in the number of older people in the years ahead is likely
to exert strong pressure for an expansion of long-term care facilities--not just nursing
homes, but home health agencies, adult day care programs, life care communities, and
other residential facilities.
Opportunities for health services managers in nursing homes should be extremely
favorable, in view of the exceptionally rapid growth that is projected for the population
85
years of age and above, expected to exceed 4 million persons by 1995. Compared to
people in their 60's or 70's, very old people experience a greater incidence of chronic
diseases and incapacitating conditions, and are far more likely to require institutional
care.
Nursing homes will need additional managers as these facilities add beds and expand the
scope of their activities. Some nursing homes, for example, are already moving into the
area of community care by setting up respite and adult day care programs.
Overriding concern for cost containment is producing shorter stays for hospital
patients and, at the same time, generating demand for "after-care" in a
rehabilitation unit,
nursing home, or at home. Rapid employment growth in the home health field is anticipated
for the same reason, and also because of technological advances that make it possible for
patients to receive services at home that previously would have required a hospital stay.
Examples are intravenous chemotherapy and home ventilators for respiratory support.
Opportunities for administrative positions in home health will be found in visiting nurse
associations and other nonprofit agencies, in hospital-based home care programs, and in
the rapidly expanding for-profit sector.
New approaches to delivering care for the sick and dying will create some openings
in hospices, which may be freestanding or based within a hospital or nursing home.
Hospice programs are very small and take a personal approach to each patient. The
hospice movement stresses emotional and spiritual support for the dying patient and the
family, and ready availability of drugs to control the excruciating pain that often
accompanies terminal cancer, the disease most often suffered by hospice patients.
Because the movement is so new, it is too soon to say what background lends itself best
to hospice management.
Job opportunities for health administration graduates are expected to be best in
HMO's, group medical practices, and nursing homes, although these jobs may not pay as
well as hospital jobs. Traditionally a favored employment setting for health
administration
graduates, hospital management has become increasingly attractive to people with formal
training in business administration. The suddenness of hospitals' shift from a service to
a
business orientation is expected to sustain demand for new MBA graduates. This
development, coupled with slow industry growth, will greatly intensify competition for
entry
level jobs in hospital administration. One result may be that new graduates will be
offered
jobs at the department head or staff level rather than at the assistant administrator
level,
as was commonly the case until recently. Very stiff competition for upper level
management jobs will continue, a reflection of the pyramidal management structure
characteristic of most large and complex organizations.
In nursing homes and other long-term care facilities, where a graduate degree in
health administration is not ordinarily a requirement, job opportunities for individuals
with
strong business or management skills will continue to be excellent.
Earnings
The median earnings for all health service managers were $32,355 in 1990. The
middle 50 percent earned between $23,866 and $43,460. The lowest 10 percent averaged
less than $16,650, the highest 10 percent more than $53,900. The personal standing and
performance of the administrator, geographic locations, type and size of facility and type
of ownership are all factors in determining the earnings of administrators. For example,
median salaries for hospital CEO's range from $75,000 in hospitals with fewer than 150
beds to $143,100 in hospitals with 500 or more, according to the Hospital and Health Care
Report, 13th edition, 1989/90, published by the Executive Compensation Services, a Wyatt
Data Services Company, Fort Lee, N.J.
Management incentive bonuses based on job performance are increasingly
commonplace in executive compensation packages.
Related Occupations
Health services managers plan programs, set policies, create marketing plans, and
coordinate the use of resources for a health facility agency. Other administrators with
similar responsibilities include social welfare administrators, emergency medical services
coordinators, public health directors, comptrollers, department store managers, directors
of data processing, and recreation superintendents.
Sources of Additional Information
Information about health administration and academic programs in this field is
available from:
American College of Healthcare Executives, 840 North Lake Shore Dr.,
Chicago, Ill. 60611.
Association of University Programs in Health Administration, 1911 Fort Myer
Drive, Suite 503, Arlington, Va. 22209.
National Health Council, Health Careers Program, 70 West 40th St., New
York, N.Y. 10018.
American College of Health Care Administrators, P.O. Box 5890, 8120
Woodmont Ave., Suite 200, Bethesda, Md. 20814.
The American Association of Homes for the Aging maintains a listing of positions
available and positions wanted in nonprofit nursing homes, life care communities, and
housing for the elderly. For details, write:
Job Mart, AAHA, 1050 17th St. NW., Suite 770, Washington, D.C. 20036.
Back To Career
Index Back To Main Index |
|