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Views of Residency Directors and Managed Care Medical Directors

Michael J. Yedidia, PhD; Colleen C. Gillespie, PhD; Gordon T. Moore, MD

JAMA. 2000;284:1093-1098.

Context  Although medical educators recognize the need to prepare physicians to work effectively in managed care environments, managed care is often perceived negatively by academic physicians. Curricular reform has been hampered by a failure to seek agreement about specific clinical competencies that are important to both managed care directors and medical educators.

Objectives  To identify specific clinical competencies in the managed care setting and to assess agreement between residency directors and managed care medical directors on the importance of these competencies.

Design, Setting, and Participants  Surveys (1998-1999) of a national sample of 59 residency directors involved in managed care training programs (response rate, 94%); a sample of 186 residents in these programs and 258 matched control residents (response rate, 77%); and national samples of 147 managed care organization (MCO) medical directors (response rate, 67%) and 140 primary care residency program directors in areas of high MCO penetration (response rate, 73%).

Main Outcome Measures  Specific clinical managed care tasks as defined by residency directors; self-reported confidence in performing these tasks by sample residents vs control residents; and importance of these tasks as rated by MCO medical directors and residency program directors.

Results  Twenty-six specific clinical managed care tasks were identified by the residency directors. Residents who participated in managed care training were significantly more confident than their counterparts in performing 20 of the 26 tasks (P<.01 for all). Residency directors and MCO medical directors viewed 65% of these tasks as important to patient care during the next 5 years. Of the 10 tasks most highly rated by residency directors and MCO medical directors, 9 were the same, addressing time management, ethics, case management, practice guidelines, cost-effective clinical decision making, referral management, disease management, patient satisfaction, and clinical epidemiology.

Conclusions  Our data indicate that residency directors and managed care medical directors value mastery of many of the same specific clinical competencies in managed care. Previously documented negative attitudes toward managed care among academic physicians may obscure an underlying concordance about the skills essential to managing the health of populations.

Author Affiliations: Center for Health and Public Service Research, Wagner Graduate School of Public Service, New York University, New York, NY (Drs Yedidia and Gillespie); and Harvard Pilgrim Health Care, Boston, Mass (Dr Moore).

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