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To explain job hours in four health-care occupations – physicians, nurses, emergency medical technicians (EMTs), and nursing assistants, this paper focuses on three sets of factors: class and gender, job conditions and commitment, and family situation. We find that class counts, whether understood in terms of occupation or earnings. Gender shapes hours, but more as a characteristic of occupations than of individuals. Job conditions that explain hours vary, depending on occupational grouping. Families also matter – children, but not spouses, shape the work hours of nurses; spouses, but not children, shape work hours for the other three occupations.

This article proposes a new disruptive innovation in healthcare through the development of a physician assistant business model, which can be most readily applied in vulnerable rural health care settings.

This study reviews the current state of the health care system in terms of physician assistant utilization and primary care shortages in rural communities. The study proposes that the physician assistant-owned and -operated primary care business represents a disruptive innovation, via the application of the five principles of Clayton Christensen’s (1997) thesis on disruptive innovation.

Considering the current state of the health care industry, the study logically defends the proposed model as a disruptive innovation in that it: focuses on an underserved market, has lower costs, has few competitors, offers high quality and provides a sustainable competitive advantage.

The physician assistant business model is a viable solution for providing primary care for rural communities with educational, financial, transportation and other resource limitations.

This is a unique application of the theory of disruptive innovation, which illustrates how a new business model can solve a chronic shortage in primary care, especially in underserved populations.

Little attention has been given to the field of medical assisting in US health services to date. To explore the roles medical assistants (MAs) currently play in primary care settings, the paper aims to focus on the work scope and dynamics of these increasingly common healthcare personnel.

This is a multiple step, mixed methods study, combining a quantitative survey and qualitative semi‐structured interviews: eight experts in the field of medical assisting; 12 MAs from diverse primary care practice settings in Northern California.

Survey results revealed great variation in the breadth of tasks that MAs performed. Five overarching themes describe the experience of medical assistants in primary care settings: ensuring patient flow and acting as a patient liaison, “making a difference”; diversity within the occupation and work relationships.

As the number of medical assistants working in primary care practices in the United States increases, more attention must be paid to how best to deploy this allied health workforce. This study suggests that MAs have an expertise in maintaining efficient clinic flow and promoting patient satisfaction. Future recommendations for changes in MA roles must address the diversity within this occupation in terms of workscope and quality assurance as well as MA relationships with other members of ambulatory care teams.

This is the first study to explore perspectives of medical assistants in the USA. As this is a largely unregulated and understudied field, a qualitative study allowed the exploration of major themes in medical assisting and the establishment of a framework from which further study can occur.

This article aims to investigate the impact of managerial orientation on the career success of physicians employed in hospitals.

The authors collected data between August and October 2006 using a written questionnaire that was sent to all 278 physicians employed in two German hospitals. The data was analyzed using a multinomial logistic regression.

The data indicate that a pronounced managerial orientation has indeed a positive impact on the career success of physicians in hospitals. But the results vary with respect to the different dimensions of managerial orientation.

Some aspects of managerial orientation are more compatible with physicians' professional values and, consequently, more relevant for career success than others. The acquisition and improvement of management skills seems to be a crucial factor.

The impact of managerial orientation on the career success of physicians has been unclear so far. Physicians are trained and socialized according to professional values and norms that are considered to be the antithesis of a managerial orientation. Furthermore, the typical career paths of professionals are different from careers of other occupational groups. However, this paper shows that physicians employed in hospitals need a certain degree of managerial orientation to have a successful and satisfying professional career.

Various health systems are challenged by a multifaceted crisis of increased service demand and workforce shortages. The effects are devastating and may end up in decreased access to care, poor quality of patient care and extreme demands on the workforce. The introduction of the physician assistant (PA) profession provided an avenue to address such challenges in several countries. In Germany, the integration of PAs has been proceeding slowly.

To understand the integration of the profession in Germany, we conducted 15 expert interviews to reveal how the PA profession is perceived among healthcare experts as well as the barriers and facilitators of integration in inpatient care.

Our results highlight a generally positive perception of PAs, particularly in terms of workload relief and bridging the gap between healthcare professionals. Nonetheless, barriers include resistance from healthcare workers unfamiliar with the PA role, while workforce shortages and collaborative teamwork facilitate integration.

These findings lay the groundwork for potential integration-enhancing strategies in Germany.

Pharmaceuticals are essential for the management of many chronic conditions. As a result, it is important to examine how the administration of pharmaceutical benefits affects physicians and pharmacists providing chronic care services. In the 1990s, HMOs and PPOs began to more aggressively manage outpatient pharmaceutical benefits, leading to the growth of pharmaceutical benefit management companies (PBMs).

In this exploratory study, 10 primary care physicians and 12 pharmacists in the San Francisco area were interviewed in 1999, and 11 more pharmacists in 2004, on how they worked with PBMs and their controls on prescribing and dispensing. Responses indicated major problems for both health professionals in negotiating with the PBM as a third party payor, in coping with switches and multiple formularies, and in added work for the health care professional. Increased risk to chronically ill patients for poorer outcomes is an important related problem with PBMs.

The Medicare drug benefit law passed in 2003 will likely result in similar problems for many beneficiaries, including those with chronic care needs. The paper proposes some policy solutions to reduce PBM problems for physicians, pharmacists and the Medicare population.

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.

A multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.

While each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the continuum of care for older adults. In addition, managers in Ontario secured additional funding, while managers in Quebec organised biannual meetings and joint training to enhance inter-organisational partnerships.

This study has two main implications. First, efforts to enhance inter-organisational partnerships should strategically include institutional entrepreneurs. Second, successful institutional changes may be supported by investing in integrated implementation strategies that target roles of staff, co-location and inter-organisational agreements.

The purpose of the visit was four‐fold: • to discuss at first hand, with those directly involved, the major movements and problems in American higher education, especially those matters arising from relationships between two year and four year colleges; • to examine certain aspects of management education and training and, in particular, to ascertain the scope and nature of activities of the Small Business Administration of the US Government and to determine the involvement of business schools in management education and development for smaller businesses; • to ascertain the major thrusts and practices in education and training for allied health services, in particular, in nursing and social work; • to see something of the social services in operation, as provided by city, State and voluntary (including Church) agencies and to discuss major problems in relation to existing and developing social need.

Healthcare facilities are entering an era of increased oversight and heightened expectations concerning both reduced costs and measureable quality. The US Affordable Care Act requires healthcare organizations to collect certain metrics, including patient assessments of quality, in order to monitor and improve the quality of healthcare. These metrics are used as a basis for graduated insurance reimbursements, and are available to consumers as an aid in selecting healthcare providers and insurance plans. The purpose of this paper is to provide healthcare providers with the analytic capabilities to better understand quality of care from the patient’s point of view.

This research examines patient satisfaction data from a multi-specialty Medical Practice Group, and uses regression analysis and paired comparisons to provide insight into patient perceptions of care quality.

Results show that variables related to Access, Moving Through the Visit, Nurse/Assistant, Care Provider and Personal Issues significantly impact overall assessments of care quality. In addition, while gender and type of care provider do not appear to have an impact on overall patient satisfaction, significant differences do exist based on age group, specialty of the physician and clinic type.

This study differs from most academic research as it focusses on medical practices, rather than hospitals, and includes multiple clinic types, medical specialties and physician types in the analysis. The study demonstrates how analytics and patient perceptions of quality can inform policy decisions.

The purpose of this paper was to discover the views of doctors regarding the managerial skills of their principal physicians and the views of doctors of their postgraduate specialist training in management. This was done by sending out a questionnaire to every second physician registered in 1977‐1986 in Finland. They were asked to evaluate their principal physicians' managerial skills using a visual analogue scale. A five‐point Likert scale was used to inquire how much training doctors had received for different professional tasks, including management, during their specialist training. Of all the 318 principal physicians in this study, 85 percent reported that they had had too little training for managerial skills. It was found that doctors in leading positions, both in public hospitals and the primary health care sector, are aware of the need of training for managerial and leadership skills.