Rapid employment growth is projected; job opportunities will
be especially good in offices of health practitioners, general
medical and surgical hospitals, home health care services, and
outpatient care centers.
Applicants with work experience in health care and strong
business and management skills likely will have the best opportunities.
Earnings are high, but long work hours are common.
A masterís degree is the standard credential for most positions,
although a bachelorís degree is adequate for some entry-level
positions in smaller facilities and in health information management.
Nature of the Work
Health care is a business and, like every other business, it
needs good management to keep it running smoothly. Medical and
health services managers, also referred to as health care executives
or health care administrators, plan, direct, coordinate,
and supervise the delivery of health care. Medical and health
services managers include specialists and generalists. Specialists
are in charge of specific clinical departments or services, while
generalists manage or help manage an entire facility or system.
The structure and financing of health care are changing rapidly.
Future medical and health services managers must be prepared to
deal with evolving integrated health care delivery systems, technological
innovations, an increasingly complex regulatory environment, restructuring
of work, and an increased focus on preventive care. They will
be called on to improve efficiency in health care facilities and
the quality of the health care provided. Increasingly, medical
and health services managers will work in organizations in which
they must optimize efficiency of a variety of related servicesófor
example, those ranging from inpatient care to outpatient followup
Large facilities usually have several assistant administrators
to aid the top administrator and to handle daily decisions. Assistant
administrators may direct activities in clinical areas such as
nursing, surgery, therapy, medical records, or health information.
(Managers in nonhealth areas, such as administrative services,
computer and information systems, finance, and human resources,
are not included in this statement. For information about them,
see the statements on management occupations elsewhere in the
In smaller facilities, top administrators handle more of the
details of daily operations. For example, many nursing home administrators
manage personnel, finances, facility operations, and admissions
and also have a larger role in resident care.
Clinical managers have training or experience in a specific clinical
area and, accordingly, have more specific responsibilities than
do generalists. For example, directors of physical therapy are
experienced physical therapists, and most health information and
medical record administrators have a bachelorís degree in health
information or medical record administration. Clinical 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.
Health information managers are responsible for the maintenance
and security of all patient records. Recent regulations enacted
by the Federal Government require that all health care providers
maintain electronic patient records and that these records be
secure. As a result, health information managers must keep up
with current computer and software technology and with legislative
requirements and developments. In addition, as patient data become
more frequently used for quality management and in medical research,
health information managers ensure that databases are complete,
accurate, and available only to authorized personnel.
In group medical practices, managers work closely with physicians.
Whereas an office manager might handle business affairs in small
medical groups, leaving policy decisions to the physicians themselves,
larger groups usually employ a full-time administrator to help
formulate business strategies and coordinate day-to-day business.
A small group of 10 to 15 physicians might employ 1 administrator
to oversee personnel matters, billing and collection, budgeting,
planning, equipment outlays, and patient flow. A large practice
of 40 to 50 physicians might have a chief administrator and several
assistants, each responsible for different areas.
Medical and health services managers in managed care settings
perform functions similar to those of their counterparts in large
group practices, except that they could have larger staffs to
manage. In addition, they might do more community outreach and
preventive care than do managers of a group practice.
Some medical and health services managers oversee the activities
of a number of facilities in health systems. Such systems might
contain both inpatient and outpatient facilities and offer a wide
range of patient services.
Most medical and health services managers work long hours. Facilities
such as nursing care facilities and hospitals operate around the
clock, and administrators and managers may be called at all hours
to deal with problems. They also may travel to attend meetings
or inspect satellite facilities.
Some managers work in comfortable, private offices; others share
space with other managers or staff. They may spend considerable
time walking, to consult with coworkers.
Training, Other Qualifications, and Advancement
Medical and health services managers must be familiar with management
principles and practices. A masterís degree in health services
administration, long-term care administration, health sciences,
public health, public administration, or business administration
is the standard credential for most generalist positions in this
field. However, a bachelorís degree is adequate for some entry-level
positions in smaller facilities, at the departmental level within
health care organizations, and in health information management.
Physiciansí offices and some other facilities may substitute on-the-job
experience for formal education.
Bachelorís, masterís, 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. In 2005, 70 schools had accredited
programs leading to the masterís degree in health services administration,
according to the Commission on Accreditation of Healthcare Management
For persons seeking to become heads of clinical departments,
a degree in the appropriate field and work experience may be sufficient
early in their career. However, a masterís degree in health services
administration or a related field might be required to advance.
For example, nursing service administrators usually are chosen
from among supervisory registered nurses with administrative abilities
and graduate degrees in nursing or health services administration.
Health information managers require a bachelorís degree from
an accredited program and a Registered Health Information Administrator
(RHIA) certification from the American Health Information Management
Association. In 2005, there were 45 accredited bachelorís programs
in health information management according to the Commission on
Accreditation for Health Informatics and Information Management
Some graduate programs seek students with undergraduate degrees
in business or health administration; however, many graduate programs
prefer students with a liberal arts or health profession background.
Candidates with previous work experience in health care also may
have an advantage. Competition for entry into these programs is
keen, and applicants need above-average grades to gain admission.
Graduate programs usually last between 2 and 3 years. They may
include up to 1 year of supervised administrative experience and
coursework in areas such as hospital organization and management,
marketing, accounting and budgeting, human resources administration,
strategic planning, law and ethics, biostatistics or epidemiology,
health economics, and health information systems. Some programs
allow students to specialize in one type of facilityóhospitals,
nursing care facilities, mental health facilities, or medical
groups. Other programs encourage a generalist approach to health
New graduates with masterís degrees in health services administration
may start as department managers or as staff. The level of the
starting position varies with the experience of the applicant
and the size of the organization. Hospitals and other health facilities
offer postgraduate residencies and fellowships, which usually
are staff positions. Graduates from masterís degree programs also
take jobs in large medical group practices, clinics, mental health
facilities, nursing care corporations, and consulting firms.
Graduates with bachelorís degrees in health administration usually
begin as administrative assistants or assistant department heads
in larger hospitals. They also may begin as department heads or
assistant administrators in small hospitals or nursing care facilities.
All States and the District of Columbia require nursing care
facility administrators to have a bachelorís degree, pass a licensing
examination, complete a State-approved training program, and pursue
continuing education. Some States also require licenses for administrators
in assisted living facilities. A license is not required in other
areas of medical and health services management.
Medical and health services managers often are responsible for
millions of dollarsí worth 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.
They must understand finance and information systems and be able
to interpret data. Motivating others to implement their decisions
requires strong leadership abilities. Tact, diplomacy, flexibility,
and communication skills are essential because medical and health
services managers spend most of their time interacting with others.
Medical and health services managers advance by moving into more
responsible and higher paying positions, such as assistant or
associate administrator, department head, or CEO, or by moving
to larger facilities. Some experienced managers also may become
consultants or professors of health care management.
Medical and health services managers held about 248,000 jobs
in 2004. About 30 percent worked in private hospitals, and another
16 percent worked in offices of physicians or in nursing care
facilities. The remainder worked mostly in home health care services,
Federal Government health care facilities, ambulatory facilities
run by State and local governments, outpatient care centers, insurance
carriers, and community care facilities for the elderly.
Employment of medical and health services managers is expected
to grow faster than average for all occupations through 2014,
as the health care industry continues to expand and diversify.
Job opportunities will be especially good in offices of health
practitioners, general medical and surgical hospitals, home health
care services, and outpatient care centers. Applicants with work
experience in the health care field and strong business and management
skills should have the best opportunities. Competition for jobs
at the highest management levels will be keen because of the high
pay and prestige.
Managers in all settings will be needed to improve quality and
efficiency of health care while controlling costs, as insurance
companies and Medicare demand higher levels of accountability.
Managers also will be needed to computerize patient records and
to ensure their security as required by law. Additional demand
for managers will stem from the need to recruit workers and increase
employee retention, to comply with changing regulations, to implement
new technology, and to help improve the health of their communities
by emphasizing preventive care.
Hospitals will continue to employ the most medical and health
services managers over the 2004-14 projection period. However,
the number of new jobs created is expected to increase at a slower
rate in hospitals than in many other industries because of the
growing utilization of clinics and other outpatient care sites.
Despite relatively slow employment growth, a large number of new
jobs will be created because of the industryís large size. Medical
and health services managers with experience in large facilities
will enjoy the best job opportunities, as hospitals become larger
and more complex.
Employment will grow fastest in practitionersí offices and in
home health care agencies. Many services previously provided in
hospitals will continue to shift to these sectors, especially
as medical technologies improve. Demand in medical group practice
management will grow as medical group practices become larger
and more complex. Managers with specialized experience in a particular
field, such as reimbursement, should have good opportunities.
Medical and health services managers also will be employed by
health care management companies that provide management services
to hospitals and other organizations, as well as to specific departments
such as emergency, information management systems, managed care
contract negotiations, and physician recruiting.
Median annual earnings of medical and health services managers
were $67,430 in May 2004. The middle 50 percent earned between
$52,530 and $88,210. The lowest 10 percent earned less than $41,450,
and the highest 10 percent earned more than $117,990. Median annual
earnings in the industries employing the largest numbers of medical
and health services managers in May 2004 were as follows:
General medical and surgical hospitals
Offices of physicians
Nursing care facilities
Home health care services
Earnings of medical and health services managers vary by type
and size of the facility, as well as by level of responsibility.
For example, the Medical Group Management Association reported
that, in 2004, median salaries for administrators were $72,875
in practices with 6 or fewer physicians, $95,766 in practices
with 7 to 25 physicians, and $132,955 in practices with 26 or
According to a survey by Modern Healthcare magazine, median
annual compensation in 2004 for hospital administrators of selected
clinical departments was $76,800 in respiratory care, $81,100
in physical therapy, $87,700 in home health care, $88,800 in laboratory
services, $90,200 in long-term care, $93,500 in medical imaging/diagnostic
radiology, $94,400 in rehabilitation services, $95,200 in cancer
treatment facilities, $96,200 in cardiology, $102,800 in nursing
services, and $113,200 in pharmacies. Salaries also varied according
to size of facility and geographic region.
According to a survey by the Professional Association of Health
Care Office Management, total 2004 median compensation for office
managers in specialty physiciansí practices was $72,047 in gastroenterology,
$66,946 in dermatology, $66,207 in cardiology, $64,543 in ophthalmology,
$63,801 in obstetrics and gynecology, $62,545 in orthopedics,
$58,595 in pediatrics, $52,211 in internal medicine, $50,924 in
psychiatry, and $50,049 in family practice.
Medical and health services managers have training or experience
in both health and management. Other occupations requiring knowledge
of both fields are insurance underwriters and social and community
service managers. See the Career
Database for more information on these careers.
Sources of Additional Information
Information about undergraduate and graduate academic programs
in this field is available from:
Association of University Programs in Health Administration,
2000 North 14th St., Suite 780, Arlington, VA 22201. Internet:
For a list of accredited graduate programs in medical and health
services administration, contact:
Commission on Accreditation of Healthcare Management Education,
2000 North 14th St., Suite 780, Arlington, VA 22201. Internet:
For information about career opportunities in health care management,