Specific clinical competencies for managing care - Views of residency directors and managed care medical directors

Context Although medical educators recognize the need to prepare physicians to work effectively in managed care environments, managed care is often pe rceived negatively by academic physicians. Curricular reform has been hampe red by a failure to seek agreement about specific clinical competencies tha t are important to both managed care directors and medical educators. Objectives To identify specific clinical competencies in the managed care s etting 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 (respo nse rate, 94%); a sample of 186 residents in these programs and 258 matched control residents (response rate, 77%); and national samples of 147 manage d care organization (MCO) medical directors (response rate, 67%) and 140 pr imary care residency program directors in areas of high MCO penetration (re sponse rate, 73%). Main Outcome Measures Specific clinical managed care tasks as defined by re sidency directors; self-reported confidence in performing these tasks by sa mple residents vs control residents; and importance of these tasks as rated by MCO medical directors and residency program directors. Results wenty-six specific clinical managed care tasks were identified by t he 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 direc tors 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, cas e management, practice guidelines, cost-effective clinical decision making, referral management, disease management, patient satisfaction, and clinica l epidemiology. Conclusions Our data indicate that residency directors and managed care med ical directors value mastery of many of the same specific clinical competen cies in managed care. Previously documented negative attitudes toward manag ed care among academic physicians may obscure an underlying concordance abo ut the skills essential to managing the health of populations.