Assistant administrators without specific titles are health care generalists. They set the overall direction of the facility. They also are concerned with community outreach, planning, policymaking, and complying with government agencies and regulations. Their range of knowledge is necessarily broad, including developments in the clinical departments as well as in the business arena. They often speak before civic groups, promote public participation in health programs, and coordinate the activities of the organization with those of government or community agencies. CEO's make long term institutional plans by assessing the need for services, personnel, facilities, and equipment and recommending changes such as opening a home health service. CEO's need leadership ability as well as technical skills to provide quality health care while, at the same time, satisfying demand for financial viability, cost containment, and public and professional accountability.
CEO's prepare for oversight and scrutiny of their facility's past performance and plans by consumer groups, government agencies, professional oversight bodies, and insurance companies and other third-party payers.
Larger facilities typically have several assistant administrators to aid the top administrator and to handle day-to-day decisions. They may direct actitivies in clinical areas such as nursing, surgery, therapy, food service, and medical records; or the activities in nonhealth areas such as finance, housekeeping, human resources, and information management. (Because the nonhealth departments are not directly related to health care, these managers are not included in this statement. For information about them, see the statements on managerial occupations elsewhere in the Handbook). In smaller facilities, top administrators may handle more of the details of day-to-day operations. For example, many nursing home administrators directly manage personnel, finance, operations, and admissions.
Clinical managers have more narrowly defined responsibilities than the generalists to whom they report and have training and/or experience in the field. For example, directors of physical therapy are experienced physical therapists, and most medical records administrators have a bachelor's degree in medical records administration. These managers establish and implement policies, objectives, and procedures for their departments; evaluate personnel and work; develop reports and budgets; and coordinate activities with other managers.
In group practices, managers work closely with the physician owners. While an office manager may handle business affairs in small medical groups, leaving policy decisions to the physicians themselves, larger groups generally employ a full-time administrator to advise on business strategies and coordinate day-to-day business.
A small group of 10 or 15 physicians might employ a single administrator to oversee personnel matters, billing and collection, budgeting, planning, equipment outlays, and patient flow. A large practice of 40 or 50 physicians may have a chief administrator and several assistants, each responsible for different areas.
Health services managers in health maintenance organizations (HMO's) perform functions similar to those in large group practices, except their staffs may be larger. The size of the administrative staff in HMO's may vary according to the type of HMO and the size of the enrolled population.
Some health services managers oversee the activities of a number of facilities in multifacility health organizations.
Health services managers plan, organize, coordinate, and supervise the delivery of health care.
Many health services managers 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 problems. The job also may include travel to attend meetings or to inspect satellite facilities.
Health services managers held about 302,000 jobs in 1992. Over one-half of all jobs were in hospitals. About 1 in 7 were in nursing and personal care facilities, and 1 in 8 were in offices and clinics of physicians. The remainder worked in home health agencies, medical and dental laboratories, offices of dentists and other practitioners, and other health and allied services.
Health services managers must be familiar with management principles and practices. Some learn from work experience. However, formal education is usually necessary for advancement. For most CEO positions, a graduate degree in health services administration, nursing administration, or business administration is required. For some generalist positions, employers seek applicants with clinical experience (as nurses or therapists, for example) as well as academic preparation in business or health services administration.
Bachelor's, master's, and doctoral degree programs in health administration are offered by colleges, universities, and schools of public health, medicine, allied health, public administration, and business administration. There are also some certificate or diploma programs, generally lasting less than 1 year, in health services administration and in medical office management. A master's degree in hospital administration, health services administration, long term care administration, health sciences, public health, public administration, or business administration is regarded as the standard credential for most generalist positions in this field. However, a bachelor's degree is adequate for some entry-level positions and a few top positions in smaller operations, and for some middle management jobs in larger ones. Bachelor's degrees may not be needed in smaller nursing homes, physicians' offices, and other facilities. Appropriate experience or certificates and diplomas are sometimes acceptable. For clinical department heads, a degree in the appropriate field and work experience are usually sufficient, but courses in health services administration are helpful.
In 1993, 29 colleges and universities offered bachelor's degree programs in health services administration. Sixty-four schools had accredited programs leading to the master's degree in health services administration, according to the Accrediting Commission on Education for Health Services Administration.
Some graduate programs seek students with undergraduate degrees in business or health administration; however, many programs prefer students with a liberal arts or health professions background. 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, and course work in areas such as hospital organization and management, accounting and budgeting, human resources administration, strategic planning, health economics, and health information systems. Students generally specialize in one type of facility hospitals; nursing homes; mental health facilities; HMO's; or outpatient care facilities, including medical groups.
New graduates with master's degrees in health services or hospital administration may start as assistant hospital administrators, or as managers of nonhealth departments, like finance. Postgraduate residencies and fellowships are offered by hospitals and other health facilities; these are normally staff jobs. Graduates from master's degree programs also take jobs in HMO's, large group medical practices, clinics, mental health facilities, and multifacility nursing home corporations.
New recipients of bachelor's degrees in health administration usually begin as administrative assistants or assistant department heads in larger hospitals, or as department heads or assistant administrators in small hospitals or in nursing homes.
A Ph.D. degree may be required to teach, consult, or do research. Nursing service administrators are usually chosen from among supervisory registered nurses with administrative abilities and advanced education.
All States and the District of Columbia require nursing home administrators to pass a licensing examination, complete a State-approved training program, and pursue continuing education. Most States also have additional requirements. A license is not required in other areas of health services management.
Health services managers are often responsible for millions of dollars of facilities and equipment and hundreds of employees. To make effective decisions, they need to be open to different opinions and good at analyzing contradictory information. To motivate others to implement their decisions, they need strong leadership qualities. Tact, diplomacy, and communication skills are essential.
Health services managers advance by moving into more responsible and higher paying positions such as assistant or associate administrator and, finally, CEO, or by moving to larger facilities.
Employment of health services managers is expected to grow much faster than the average for all occupations through the year 2005 as health services continue to expand and diversify. Hospitals will continue to employ the most managers, although the number of jobs will not be growing as fast as in other areas.
Employment in home health agencies and nursing and long term care facilities will grow the fastest, due to an increased number of elderly who will need care. Demand in medical group practices will grow, too. As medical group practices and HMO's become larger and more complex, more job opportunities for department heads should emerge.
Health services managers in hospitals will face very keen competition for upper level management jobs, a reflection of the pyramidal management structure characteristic of most large organizations. In nursing homes and other long term care facilities, job opportunities for individuals with strong business and management skills will continue to be good.
According to a survey sponsored by the Hay Group and the American Society of Healthcare Human Resources Administration, half of all hospital CEO's earned $140,900 or more in 1993. The lowest 10 percent earned less than $77,000; the top 10 percent earned $223,600 or more.
Clinical department heads' salaries varied too. According to a survey by Modern Healthcare magazine, average salaries in 1993 for heads of the following clinical departments were: Medical records, $47,600; home health, $52,500; imaging/radiology, $53,300; physical therapy, $54,700; rehabilitation services, $58,800; and nursing services, $65,700.
According to the American College of Health Care Administrators, nursing home administrators had median annual total compensation of $44,100 in 1992. The middle 50 percent earned between $36,000 and $54,000. Those in facilities with less than 50 licensed beds earned $36,500; those in facilities with 400 or more beds, $68,200. Licensed assistant administrators earned median total compensation of $35,000.
Health services managers have training or experience in both health and management. Other occupations that require knowledge of both fields are public health directors, social welfare administrators, directors of voluntary health agencies and health professional associations, and underwriters in health insurance companies and HMO's.
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Reprinted with Permission of U. S. Department of Labor