DIFFERENCES IN THE ROLE AND ADMINISTRATIVE RELATIONSHIPS OF MEDICAL DIRECTORS IN COMMUNITY AND MIGRANT HEALTH CENTERS

This study examined differences in medical directors of Community and Migrant Health Centers (C/MHCs) in the United States based on the size of the center, including demographics, job characteristics, roles, and their relationship with C/MHC administrators and governing boards. Data for this analysis came from a 1996 cross-sectional survey of Community and Migrant Health Centers medical directors. A total of 411 centers (68.3% surveyed) responded to the survey including 240 rural centers (67.4%) and 171 urban (68.7%) centers. Small centers were categorized as those with three or fewer physicians (n = 136), medium centers had more than three but less than eight ETE physicians (n = 14), and large centers had eight or more ETE physicians (n = 109). Several differences were found regarding the medical directors' roles and relationships with the administrator and governing boards on the size of the center. Large C/MHC medical directors had more autonomy than did small and medium C/MHC medical directors including in the areas of managing clinical staff, the budget, and strategic planning activities. They spent more time cultivating community resources than small and medium center counterparts and were more likely to possess the management skills needed in their role than do those in small and medium centers. They also reported a stronger working relationship with the C/MHC administrator and had more input with the C/MHC board than small or medium medical directors.