Career opportunities for physicians in health care system management and their changing preparation for these roles have been previously described.1 Today, the trend for physicians to enter active management roles is, if anything, accelerated. Between 1978 and 1988, the number of physicians classified as "administrative MDs" increased from 11 858 to 14 536, according to the American Medical Association's Physician Masterfile (Vicky Carlson, oral communication, February 26, 1990). The American College of Physician Executives reports a membership of more than 5000 (Robin Doty, oral communication, March 7,1990).
Physician-managers have found new opportunities in administration as the numbers of people enrolled in one or another managed-care organization have continued to increase. Managed-care programs include health maintenance organizations, preferred provider organizations, and managed fee-for-service entities. In 1980, the managed-care field was dominated almost exclusively by health maintenance organizations; at that time, 236 health maintenance organizations had 9.1 million enrollees. By 1989,