Special Report: Chief Medical Officers

CMO or VPMA—Is There a Difference?

By Lois Dister

In this article… Survey respondents indicate that the majority of CMOs

(79 percent) report to the CEO, followed by 18 percent report-
A new survey looks at the similarities and differences ing to the COO or other executive, and 3 percent reporting to
the system or corporate CMO.
between CMOs and VPMAs.
In comparison, a smaller percentage of VPMAs report to
the CEO (63 percent), while 17 percent report to the CMO, 6
percent report to the COO or the system/corporate CMO and
The demand for physician leadership is increasing as 14 percent report to another executive within the organization.
organizations seek to effectively align the medical staff, Survey findings show that the CMO and VPMA are
manage advanced medical and information technology, and relatively similar with regard to whether they are promoted
remain fiscally healthy. from within or recruited from outside of the organization.
When an organization looks to recruit a top physician Additionally, both are mostly considered full-time roles (85
leader, two questions arise: percent of CMOs and 83 percent of VPMAs).
Fewer CMOs than VPMAs continue to see patients
1. Which position should we create: a vice president of (27 percent and 34 percent, respectively). Many physicians
medical affairs (VPMA) or a chief medical officer (CMO)? express the importance of continuing to practice medicine
on a part-time basis to maintain credibility with the medical
2. What is the difference?
staff, but agree it can be challenging to manage their admin-
Partly to blame for the confusion is the proliferation of istrative and clinical responsibilities effectively.
C-Suite titles that has brought us many new titles with similar More than half (55 percent) of all CMOs report they
meanings, such as chief executive officer versus president, or have a post-graduate business management degree including
chief nursing officer versus vice president, clinical services. MMM (23 percent), MBA (18 percent), MPH (7 percent) and
Organizations redefine their organizational structures MHA (7 percent).
and titles to address the growing complexity of health care, More than one-third (34 percent) report having no post-
due to consolidation, changes in governance and the system- graduate business management degree and 11 percent are
ization of health care. either in process of pursing some type of advanced degree or
How is the health care marketplace defining the roles of taking continuing education.
CMO and VPMA? What attributes delineate the differences Forty-four percent (44 percent) of VPMAs have advanced
between them? Approximately 90 physician executives con- business degrees: MMM (18 percent), MBA (16 percent), MPH
tributed their viewpoints about the differences and similari- (8 percent), MHA (2 percent). Forty-two percent (42 percent)
ties between these two leadership positions through a recent have no post-graduate business management degree and 14
survey, an online discussion group at acpe.org and personal percent are either in process of pursing an advanced degree
interviews as conducted by Cejka Search in partnership with or taking continuing education.
the American College of Physician Executives (ACPE).
When asked if the role of CMO or VPMA exists in their Comments
organizations, 66 percent of respondents cite having a CMO, 43 The survey results provide a baseline for comparing the
percent cite having a VPMA and more than a quarter (26 per- objective attributes of a CMO and VPMA. However, the com-
cent) confirm that both roles are present in their organization. mentary in the survey, as well as the online discussion group

12 PEJ may•june/2009
Table 1 Cejka Search/ACPE Survey Response Highlights

CMO VPMA
Does your organization have a CMO and/ 66% report their organization has 43% report their organization has
or a VPMA? (multiple answers possible) CMO title VPMA title
26% have both a CMO and a VPMA in their organization
To whom does the CMO or VPMA report? 79% report to CEO 63% report to CEO
18% report to COO/other executive 17% report to CMO
3% report to system or corporate 14% report to other
CMO
6% report to COO or system/
corporate CMO
Primary care and specialty medical 55% have primary care training 46% have primary care training
training? 45% have specialty medical training 54% have specialty medical training
Post-graduate business management 55% have post-graduate degrees: 44% have post-graduate degrees
degrees? 23% Master of Medical Management 18% Master of Business
Administration
18% Master of Business 16% Master of Medical Management
Administration
7% Master of Public Health 8% Master of Public Health
7% Master of Health 2% Master of Health
Administration Administration
Recruited from outside the organization? 53% are from outside the 46% are from outside the
organization organization
Is the position full-time or part-time? 85% cite full-time 83% cite full-time
Does your CMO or VPMA continue to see 27% continue to see patients 34% continue to see patients
patients?

The survey was conducted electronically in early 2009 and the findings represent input from 91 participants who represent a relatively even mix of CMOs
(34%), VPMAs (29%) and other physician or clinical leaders (37%). Survey respondents work in hospital systems or integrated delivery networks (IDN)
(40%), hospitals (34%), managed care (16%), and group practice (10%)

ACPE.org 13
 and interviews with physician leaders,
reveal a range of opinions about the
differences and similarities between
CMOs and VPMAs.
Viewpoints diverge widely, with
some responding that they believe
there is little to no difference: “seman-
tics, no difference, the same jobs, syn-
onymous, interchangeable.”
Others believe there is clear dif-
ferentiation, citing the CMO role as
“more strategic, externally focused
and closer to the executive office,”
while describing the VPMA as “more
operationally focused, involving man-
agement of the medical staff office.”
A number of respondents point
out that the roles are often performed
by the same person: “In organizations
where there is only one top physician
executive, he or she ends up perform-
ing both roles.”
The common themes heard
among the participants include the
recognition that the definitions of
CMO and VPMA are likely influenced
by the respondents’ organizational
experiences, and the expression of a
sincere interest in better defining the
CMO and VPMA roles.
David DiLoreto, MD, MBA,
FACS, who is senior partner with
CMO VPMA Grace & Associates and former chief
A part of the C-Suite structure, A part of the organization’s VP structure
medical officer at Baptist Health Care,
closer to the CEO Pensacola, Florida, offers his insight
about the core challenge in defining
Strategic Hands-on and tactical
these roles.
Reports to CEO Reports to CMO “The decision about titles for
Larger organization Smaller organization leadership roles in medical manage-
Broader responsibility: business and Traditional responsibility: UR, PI, quality, ment should be rooted in the context
service line development medical staff issues and physician review of the organization,” says DiLoreto.
Executive and strategic functions Day-to-day operational and medical staff “Clearly defining the responsibilities
office functions of a position can help the organiza-
System or group practice clinical Single hospital medical staff oversight tion identify an appropriate job title.
oversight Ultimately what is important is to cre-
ate a medical management system that
Operational accountability Ambassadorial
works for a particular organization.”
Career physician executive Physician liaison between management and Fifty-two percent say the CMO
medical staff
and VPMA jobs are different based on
Quality management and service line Credentialing and physician review and key responsibilities.
development development
Choosing from a list of responsi-
Many direct reports including medical Limited or no direct reports bilities presented in the survey, only
executives
quality management is identified

14 PEJ may•june/2009
in the top three for both positions. • Physician relations and outreach • Physician management/relations
Each has three responsibilities that and mid-level oversight
• Serving as an officer or board
are unique in their list of top seven
member in some organizations • Infection control
responsibilities.
The top seven CMO responsibili- • Participating in or providing input
ties ranked by frequency of selection: The top seven VPMA responsibili- to the executive team
ties ranked by frequency of selection:
When asked to explain the differ-
1. Chief clinical spokesperson
ences between a CMO and a VPMA,
(81 percent) 1. Credentialing, re-credentialing and
approximately 52 percent identify one
privileging (85 percent)
2. Quality management or more key differentiators.
(79 percent) 2. Medical staff office According to DiLoreto, the core
(75 percent) distinction between the two positions is
3. Performance improvement
the level of strategic input the physician
(70 percent) 3. Quality management
leader provides to their organization.
(71 percent)
4. Credentialing, re-credentialing, “While both the VPMA and CMO
privileging (57 percent) 4. Utilization and case management are considered an integral part of the
(71 percent) administrative team at the facility, it is
5. Utilization and case management
the CMO who is responsible for corpo-
(57 percent) 5. Joint Commission readiness
rate system strategy design and strat-
(67 percent)
6. Clinical program development egy implementation,” he states.
(53 percent) 6. Performance improvement “The CMO is responsible for
(60 percent) bringing significant business exper-
7. Physician executive development
tise to the leadership team, typically
(49 percent) 7. Physician recruitment
including a business graduate degree
(58 percent)
with additional clinical business expe-
In the free text area of the survey, rience in the health care services and
respondents also cite the following In the free text area of the survey, the hospital industry.”
additional responsibilities of the CMO: respondents also cite the following
additional responsibilities of the VPMA: Same job, different title
• Strategic planning The balance (approximately 40
• Budgeting percent) of the survey respondents said
• System-wide coordination of
medical activities • Contract review clearly that the difference is based on
semantics or the structure of the orga-
• Clinical policy oversight • Space planning nization, and not on the job within it.

ACPE.org 15
 may have a sole individual in a posi-
Compensation for CMOs and VPMAs
tion with both titles.
2007 Cejka Search/ACPE Median High Low A number of survey respondents
Compensation Survey state that it really is just about the
CMO $292,000 $356,000 $280,000 title. Success should be measured
by the value the physician executive
VPMA $275,000 $300,000 $266,000
provides in improving a health care
organization.
Advanced business degrees are becoming increasingly important requirements But, perception is reality. As
for physician leadership positions. “CMOs generally have advanced business one respondent said, “Titles do mat-
management degrees and training beyond their clinical education,” explains ter—both internally and external-
Robert Pryor, MD, who is CMO and chief operating officer of Scott & White ly—whether from the C-suite, staff,
HealthCare, Temple, Texas. patients or shareholders.” In publicly
held organizations, having a CMO
“For example, we are recruiting a CMO for one of our hospitals and an MBA is a
position makes strategic sense so that
requirement. It’s important for the CMO to generate a creative tension in the
shareholders can see this type of
negotiation between the financial model and the medical model…not swinging too
management structure in place.
far one way or the other.”
So, what is the difference between
According to Pryor, a CMO should be a CEO in training, developing a strong clini- a CMO and a VPMA? The survey find-
cal background in conjunction with a business background, and being active at the ings do not offer a definite answer to
senior leadership table on top line issues such as redefining health care delivery. this question. Health care organiza-
tions and physician leaders widely vary
in their readiness to put a stake in the
Approximately 8 percent do not clearly that there is a big difference. In my ground on this subject. While some of
declare an opinion. health system, most of my counter- the survey participants denote clear
Key themes explaining the opin- parts are listed as VPMAs. When we differences between the two roles,
ion that there is no difference include: sat down and looked at each other’s others in essence say “Tom-A-to/
list of goals and duties, it is apparent To-MAH-to” and it’s a matter of
• Small- and medium-sized organiza- that there are significant differences semantics.
tions have one person serving all based on location and individual hos- The information gathered through
the responsibilities, under one of pital priorities, more than there are interviews, discussion groups, data
the titles or a combination. differences based on the title.” and anecdotal responses from the
Conversely, the same title can be survey reflects a cross-section of
• Moving to a new organization— experience and opinions. It certainly
carried by individuals with vastly dif-
or undergoing reorganization— constitutes fuel for further discussion.
ferent levels of responsibility. “Is there
brings a new title, not different Organizations seeking to establish
a difference in leadership required for
responsibilities. and develop a top physician leadership
a 40-bed rural hospital and a hospital
• The titles are interchangeable based system with eight hospitals and ultimate role should clearly define their clini-
on an array of job descriptions. oversight of 2000 beds?” asks DiLoreto. cal and business objectives, honestly
“Both can be lead by a CMO—but the assess the culture and relationships
• It has to do with how flat or within their organization, and define
responsibilities and requirements of the
vertical the hierarchy is. There’s no a role that will attract and leverage
two roles are very different.”
real difference in the functions. the talents of the best physician
Differences between the two roles
• The culture, not responsibilities, can depend on the specific sector executives available.
dictate the title. of the health care industry, the size
of the organization and the specific
Charles Schauberger, MD, chief
organizational context in which the
medical officer at St. Luke’s Hospital,
leaders find themselves. According to Lois Dister
a member of the Iowa Health System
DiLoreto, large- and medium-sized Vice president and practice leader at
in Cedar Rapids, Iowa, echoes this
hospital systems might have both Cejka Search Executive Search Division
finding. in St. Louis, Missouri.
CMO and VPMA positions. Smaller
“As for the difference between a
systems and single hospital facilities [email protected].
CMO and a VPMA, I don’t really know

16 PEJ may•june/2009