General managers and top executives must have highly developed personal skills. An analytical mind able to quickly assess large amounts of information and data is very important, as is the ability to consider and evaluate the interrelationships of numerous factors; they must also be able to communicate clearly and persuasively, and need highly developed interpersonal skills.

General managers may advance to top executive positions, such as executive vice president, in their own firm or they may take a corresponding position in another firm. They may even advance to peak corporate positions such as chief operating officer or chief executive officer. Chief executive officers often become members of the board of directors of one or more firms, typically as a director of their own firm and often as chair of its board of directors. Some general managers and top executives go on to establish their own firms or become independent consultants.

Job Outlook

Employment of general managers and top executives is expected to grow about as fast as the average for all occupations through the year 2006. Because this is a large occupation, many openings will occur each year as executives transfer to other positions, start their own businesses, or retire. Nonetheless, competition for top managerial jobs will be keen. Many executives who leave their jobs transfer to other executive or managerial positions, limiting openings for new

entrants.

Projected employment growth of general managers and top executives varies widely among industries. For example, employment growth is expected to be faster than average in all services industries combined, but only about as fast as average in all finance, insurance, and real estate industry subgroups. Employment of general managers and top executives is projected to decline in manufacturing industries overall.

Experienced managers whose accomplishments reflect strong leadership qualities and the ability to improve the efficiency or competitive position of an organization will have the best opportunities. In an increasingly global economy, certain types of experience, such as international economics, marketing, information systems, and knowledge of several languages, may also help.

Earnings

General managers and top executives are among the highest paid workers in the Nation. However, salary levels vary substantially depending upon the level of managerial responsibility, length of service, and type, size, and location of the firm.

At the highest level, chief executive officers (CEOs) of medium and large corporations are extremely well paid. Salaries often are related to the size of the corporation-a top manager in a very large corporation can earn significantly more than a counterpart in a small firm. Total compensation often includes stock options, dividends, and other performance bonuses, in addition to salaries.

Salaries also vary substantially by type and level of responsibilities and by industry. According to a salary survey by Robert Half International, senior vice presidents/heads of lending in banks with $1 billion or more in assets earned about $200,000 to $215,000 in 1997. Executive Compensation Reports, a division of Harcourt Brace & Company, reports that the median salary for CEOs of public companies from the fiscal year 1995 Fortune 500 list was approximately $714,000, with three-quarters making less than about $900,000. In the nonprofit sector, three quarters of the CEOs make under $135,000 in 1996, according to a survey by Abbott, Langer, & Associates.

Company-paid insurance premiums and physical examinations, the use of executive dining rooms and company cars, and expense allowances are among benefits commonly enjoyed by general managers and top executives in private industry. CEOs often enjoy company-paid club memberships, a limousine with driver, and other amenities. CEOs of very large corporations may have the use of private aircraft.

Related Occupations

General managers and top executives plan, organize, direct, control, and coordinate the operations of an organization and its major depart

ments or programs. The members of the board of directors and supervisory managers are also involved in these activities. Related occupations in government with similar functions are President, governor, mayor, commissioner, and legislator.

Sources of Additional Information

For a wide variety of information on general managers and top executives, including educational programs and job listings, contact: ☛ American Management Association, 1601 Broadway, New York, NY 10019-7420.

☛ National Management Association, 2210 Arbor Blvd., Dayton, OH 45439.

Government Chief Executives and Legislators

Significant Points

Over 8 out of 10 government chief executives and legislators work in local government, while the rest work primarily in State governments.

Many jobs at the local and even State level are part time and pay little.

Few long-term career opportunities are available.

Nature of the Work

Chief executives and legislators at the Federal, State, and local level direct government activities and pass laws that affect each of us. Chief executives run the governmental bodies that formulate and enforce laws. These officials include the President and Vice President of the United States, State governors and lieutenant governors, county executives, town and township officials, mayors, and city, county, town, township, and special district managers. All except appointed government managers are elected by their constituents. Non-elected managers are hired by a local government council or commission.

Government chief executives, like their counterparts in the private sector, have overall responsibility for the performance of their organizations. Working in conjunction with legislators, they set goals and then organize programs to attain them. They appoint department heads who oversee the work of the civil servants who carry out programs and enforce laws enacted by their legislative bodies. They oversee budgets specifying how government resources will be used, and insure that resources are used properly and programs are carried out as planned.

Chief executives meet with legislators and constituents to discuss proposed programs and determine their level of support. They frequently confer with leaders of other governments to solve mutual problems. Chief executives nominate citizens to boards and commissions, solicit bids from and select contractors to do work for the government, encourage business investment and economic development in their jurisdictions, and seek Federal or State funds. Chief executives of large jurisdictions rely on a staff of aides and assistants, but those in small jurisdictions often must do much of the work themselves.

Legislators are the elected officials who pass or amend laws. They include U.S. Senators and Representatives, State senators and representatives, county legislators, and city and town council members.

Legislators may introduce bills in the legislative body and examine and vote on bills introduced by other legislators. In preparing legislation, they read staff reports and may work with constituents, representatives of interest groups, members of boards and commissions, the chief executive and department heads, and others with an interest in the legislation. They generally must approve budgets and the appointments of department heads and commission members submitted by the chief executive. In some jurisdictions, the legislative body appoints a city, town, or county manager. Many legisla

Government chief executives have overall responsibility for the performance of their organizations.

tors, especially at the State and Federal levels, have a staff to perform research, prepare legislation, and help resolve constituents' problems.

Both chief executives and legislators perform many ceremonial duties such as opening new buildings, making proclamations, welcoming visitors, and leading celebrations.

Working Conditions

The working conditions of chief executives and legislators vary with the size and budget of the governmental unit. Time spent at work ranges from meeting once a month for a local council member to 60 or more hours per week for a U.S. Senator. U.S. Senators and Representatives, governors and lieutenant governors, and chief executives and legislators in large local jurisdictions usually work full time year round, as do county and city managers. Many State legislators work full time while legislatures are in session (usually for 2 to 6 months a year), and part time the rest of the year. Local elected officials in many jurisdictions work a schedule that is officially designated part time, but actually is the equivalent of a full-time schedule when unpaid duties are taken into account. In addition to their regular schedules, chief executives are on call at all hours to handle emergencies.

Some jobs require occasional out-of-town travel, but others involve long periods away from home to attend sessions of the legislature. Employment

Chief executives and legislators held about 93,000 jobs in 1996. About 8 out of 10 worked in local government, while the rest worked primarily in State governments. Chief executives and legislators in the Federal Government include the 535 Senators and Representatives and the President and Vice President. State governors, legislators and other managers, as well as executives, managers, and council members for local governments made up the remainder.

Chief executives and legislators who do not hold full-time, yearround positions often work in a second occupation as well. This is commonly the one they held before being elected.

Training, Other Qualifications, and Advancement Voters seek to elect the individual believed to be most qualified from among a number of candidates who meet the minimum age, residency, and citizenship requirements. Successful candidates usually have a strong record of accomplishment in paid and unpaid work in their district. Some have business, teaching, or legal experience, but others

come from a wide variety of occupations. In addition, many have experience as members of boards or commissions. Some candidates become well-known for their work with charities, political action groups, political campaigns, or with religious, fraternal, and social organizations.

Management-level work experience and public service help develop the planning, organizing, negotiating, motivating, fundraising, budgeting, public speaking, and problem-solving skills needed to run an effective political campaign. Candidates must make decisions quickly, sometimes on the basis of limited or contradictory information. They must inspire and motivate their constituents and their staff. They should appear sincere and candid, presenting their views thoughtfully and convincingly. Additionally, they must know how to hammer out compromises and satisfy the demands of constituents. National and Statewide campaigns require massive amounts of energy and stamina, as well as superior fund raising skills.

Town, city, and county managers are generally hired by a council or commission. Managers come from a variety of educational backgrounds. A master's degree in public administration, including courses such as public financial management and legal issues in public administration, is widely recommended. Virtually all town, city, and county managers have at least a bachelor's degree and the majority hold a master's degree. Working in management support positions in government is a prime source of the experience and personal contacts required in eventually securing a manager position.

Generally, a town, city, or county manager in a smaller jurisdiction is required to have expertise in a wide variety of areas. Those who work for larger jurisdictions specialize in financial, administrative, and personnel matters. For all managers, communication skills and the ability to get along with others are essential.

Advancement opportunities for elected public officials are not clearly defined. Because elected positions normally require a period of residency and local public support is critical, officials can usually advance to other offices only in the jurisdictions where they live. For example, council members may run for mayor or for a position in the State government, and State legislators may run for governor or for Congress. Many officials are not politically ambitious, however, and do not seek advancement. Others lose their bids for reelection or voluntarily leave the occupation. A lifetime career as a government chief executive or legislator is rare except for those who reach the national level.

Town, city, and county managers have a better defined career path. They generally obtain a master's degree in public administration, then gain experience as management analysts or assistants in government departments working for committees, councils or chief executives. They learn about planning, budgeting, civil engineering, and other aspects of running a government. With sufficient experience, they may be hired to manage a small government and often move on to manage progressively larger governments over time.

Job Outlook

Little, if any, growth is expected in the number of State or Federal Government chief executives and legislators through the year 2006. Few new governments at any level are likely to form, and the number of chief executives and legislators in existing governments rarely changes. Some increase will occur at the local level as counties, cities, and towns take on new responsibilities. New positions will develop as cities and counties turn to professional management to deal with growth, Federal regulations, and long-range planning, and volunteer positions are converted to paid positions.

Elections give newcomers the chance to unseat incumbents or to fill vacated positions. In many elections, there is substantial competition, although the level of competition varies from jurisdiction to jurisdiction and from year to year. Generally, there is less competition in small jurisdictions, which have part-time positions offering relatively low salaries and little or no staff to help with routine work, than in large jurisdictions, which have full-time positions offering higher salaries, more staff, and greater status.

Earnings

Earnings of public administrators vary widely, depending on the size of the government unit and on whether the job is part time, full time

and year round, or full time for only a few months a year. Salaries range from little or nothing for a small town council member to $200,000 a year for the President of the United States.

According to the International City/County Management Association, the average annual salary of chief elected county officials in 1996 was $25,600, while chief elected city officials was about $12,200. ICMA data indicate that the average salary for city managers was about $70,600 in 1996, while that of county managers was about $86,700.

According to the National Conference of State Legislatures, the salary for legislators in the 40 States that paid an annual salary ranged from about $10,000 to $47,000 per year. In 6 States, legislators received a daily salary plus an allowance for expenses while legislatures were in session. Two States paid no expenses and only nominal daily salaries, while 2 States paid no salary at all but did pay a daily expense allowance. Salaries and the expense allowance were generally higher in the larger States.

Data from Book of the States, 1996-97 indicate that gubernatorial annual salaries ranged from $60,000 in Arkansas to $130,000 in New York. In addition to a salary, most governors received perquisites such as transportation and an official residence.

In 1997, U.S. Senators and Representatives earned $133,600, the Senate and House Majority and Minority leaders $148,400, and the Vice President $171,500.

Related Occupations

Related occupations include managerial positions that require a broad range of skills in addition to administrative expertise, such as corporate chief executives and board members, and high ranking officers in the military.

Sources of Additional Information

Information on appointed officials in local government can be obtained from:

☛ International City/County Management Association, 777 North Capitol St. NE., Suite 500, Washington, DC 20002.

Health Services Managers

(D.O.T. 072.117-010; 074.167-010, 075.117-014, -022, -026, -030 and -034, .167-010 and -014; 076.117-010; 077.117-010; 078.131-010, .161-010 and -014, .162-010; 079.117-010, .131-010, .151-010, and .167-014; 187.117-010, -058, -062, and .167-034, and -090; 188.117-082

Significant points

Earnings of health services managers are high, but long weekly work hours are common.

Most are employed by hospitals, but the fastest employment growth will be in home health care agencies, longterm care facilities, and practitioners' offices and clinics.

Nature of the Work

Health care is a business, albeit a special one. Like every other business, it needs good management to keep it running smoothly, especially during times of change. The term "health services manager" encompasses individuals in many different positions who plan, organize, coordinate, and supervise the delivery of health care. Health services managers include both generalists-administrators who manage or help to manage an entire facility or system and health specialists-managers in charge of specific clinical departments or services found only in the health industry.

The structure and financing of health care is changing rapidly. Future health services managers must be prepared to deal with evolving integrated health care delivery systems, restructuring of work, technological innovations, and an increased focus on preventive care. They will be called upon to improve efficiency in all health care facilities, while continually improving quality of the health care

provided. Increasingly, health services managers work in organizations in which they must optimize efficiency of a variety of interrelated services, ranging from inpatient care to outpatient follow-up care, for example.

The top administrator or chief executive officer (CEO) and the assistant administrators without specific titles are health care generalists, who set the overall direction of the organization. They concentrate on such areas as community outreach, planning, marketing, human resources, finance, and complying with government regulations. Their range of knowledge is broad, including developments in the clinical departments as well as in the business arena. They often speak before civic groups, promote public participation in health programs, and coordinate the activities of the organization with those of government or community agencies. CEO's make long-term institutional plans by assessing the need for services, personnel, facilities, and equipment and recommending changes such as opening a home health service. CEO's need leadership ability, as well as technical skills, to provide quality health care while satisfying demand for financial viability, cost containment, and public and professional accountability.

Larger facilities typically have several assistant administrators to aid the top administrator and to handle day-to-day decisions. They may direct activities in clinical areas such as nursing, surgery, therapy, food service, and medical records; or the activities in nonhealth areas such as finance, housekeeping, human resources, and information management. (Because the nonhealth departments are not directly related to health care, these managers are not included in this statement. For information about them, see the statements on managerial occupations elsewhere in the Handbook). In smaller facilities, top administrators may handle more of the details of day-to-day operations. For example, many nursing home administrators directly manage personnel, finance, operations, admissions, and have a larger role in resident care.

Clinical managers have more narrowly defined responsibilities than generalists, and have training and/or experience in a specific clinical area. For example, directors of physical therapy are experienced physical therapists, and most health information administrators have a bachelor's degree in health information administration. These 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.

In group practices, managers work closely with the physician owners. While an office manager may handle business affairs in small medical groups, leaving policy decisions to the physicians themselves, larger groups generally employ a full-time administrator to advise on business strategies and coordinate day-to-day business.

A small group of 10 or 15 physicians might employ a single administrator to oversee personnel matters, billing and collection, budgeting, planning, equipment outlays, and patient flow. A large practice of 40 or 50 physicians may have a chief administrator and several assistants, each responsible for different areas.

Health services managers in health maintenance organizations (HMO's) and other managed care settings perform functions similar to those in large group practices, except their staffs may be larger. Also, they may do more work in the areas of community outreach and preventive care than managers of a group practice. The size of the administrative staff in HMO's varies according to the size and type of HMO.

Some health services managers oversee the activities of a number of facilities in multifacility health organizations.

Working Conditions

Most health services managers work long hours. Facilities such as nursing homes and hospitals operate around the clock, and administrators and managers may be called at all hours to deal with problems. They may also travel to attend meetings or inspect satellite facilities.

Employment

Health services managers held about 329,000 jobs in 1996. Over one-half of all jobs were in hospitals. About 1 in 4 were in nursing and personal care facilities or offices and clinics of physicians. The remainder worked in home health agencies, medical and dental laboratories, offices of dentists and other practitioners, and other health and allied services.

Training, Other Qualifications, and Advancement

Health services managers must be familiar with management principles and practices. Some learn from work experience. However, formal education is usually necessary for advancement. Most CEO positions require a graduate degree in health services administration, nursing administration, public health, or business administration. For some generalist positions, employers seek applicants with clinical experience (as nurses or therapists, for example) as well as academic preparation in business or health services administration.

Bachelor's, master's, 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. There are also some certificate or diploma programs, generally lasting less than 1 year, in health services administration and in medical office management. A master's 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 bachelor's degree is adequate for some entry-level positions in smaller operations. A bachelor's degree is required to work in some settings, such as nursing homes, and for entry level positions at the departmental level within health care organizations. Physicians' offices and some other facilities may substitute on-the-job experience for formal education. For clinical department heads, a degree in the appropriate field and work experience may be sufficient, but a master's degree in health services administration usually is required to advance.

In 1997, 67 schools had accredited programs leading to the master's degree in health services administration, according to the Accrediting Commission on Education for Health Services Administration.

Some graduate programs seek students with undergraduate degrees in business or health administration; however, many programs prefer students with a liberal arts or health professions background. Competition for entry to these programs is keen, and applicants need above-average grades to gain admission. The programs generally last between 2 and 3 years. They may include up to 1 year of supervised administrative experience, and course work in areas such as hospital organization and management, marketing, accounting and budgeting, human resources administration, strategic planning, health economics, and health information systems. Some programs allow students to specialize in one type of facility—hospitals; nursing homes; mental health facilities; HMO's; or outpatient care facilities, including

medical groups. Other programs encourage a generalist approach to health administration education.

New graduates with master's degrees in health services administration may start as department managers or in staff positions. The level of the starting position varies with the experience of the applicant and size of the organization. Postgraduate residencies and fellowships are offered by hospitals and other health facilities; these are usually staff positions. Graduates from master's degree programs also take jobs in HMO's, large group medical practices, clinics, mental health facilities, and multifacility nursing home corporations.

Graduates with bachelor's degrees in health administration usually begin as administrative assistants or assistant department heads in larger hospitals, or as department heads or assistant administrators in small hospitals or nursing homes.

A Ph.D. degree may be required to teach, consult, or do research. Nursing service administrators are usually chosen from among supervisory registered nurses with administrative abilities and a graduate degree in nursing or health services administration.

Most States and the District of Columbia require nursing home administrators to have a bachelor's degree, pass a licensing examination, complete a State-approved training program, and pursue continuing education. A license is not required in other areas of health services management.

Health services managers are often responsible for millions of dollars 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 health services managers spend much of their time interacting with others.

Health services managers advance by moving into more responsible and higher paying positions, such as assistant or associate administrator, or by moving to larger facilities.

Job Outlook

Employment of health services managers is expected to grow faster than the average for all occupations through the year 2006 as health services continue to expand and diversify. Opportunities for health services managers should be closely related to growth in the industry in which they are employed. Opportunities will be good in home health care, long-term care and nontraditional health organizations such as managed care operations, particularly for health services managers with work experience in the health care field and strong business and management skills.

Hospitals will continue to employ the most managers, although the number of jobs will grow slowly compared to other areas. As hospitals continue to consolidate, centralize, and diversify functions, competition will increase at all job levels.

Employment will grow the fastest in home health agencies, offices of physicians and other health practitioners, and nursing and personal care facilities due to an increased number of elderly individuals who will need care. In addition, many services previously provided in hospitals will be shifted 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. Health services managers will need to deal with the pressures of cost containment and financial accountability, as well as the increased focus on preventive and primary care. They will have more responsibility for improving the health of populations and communities.

Health services managers will also be employed by health care management companies who provide management services to hospitals and other organizations, as well as specific departments such as emergency, information management systems, managed care contract negotiations, and physician recruiting.

Earnings

Earnings of health services managers vary by type and size of the facility, as well as by level of responsibility. For example, the Medi

cal Group Management Association reported that the median salary for administrators in small group practices-with fewer than 7 physicians was about $56,000 in 1996; for those in larger group practices -with more than 7 physicians-$77,000.

According to a 1997 survey by Modern Healthcare magazine, half of all hospital CEO's earned total compensation of $190,500 or more. Salaries varied according to size of facility and geographic region. Clinical department heads' salaries varied also. Median total compensation in 1997 for heads of the following clinical departments were: Respiratory therapy, $54,500; home health care, $62,000; clinical laboratory, $63,700; radiology, $64,000; physical therapy, $64,900; ambulatory/outpatient services, $68,500, rehabilitation services, $70,400; and nursing services, $97,000.

According to the Buck Survey conducted by the American Health Care Association in 1996, nursing home administrators had median annual compensation of about $49,500. The middle 50 percent earned between $42,100 and $57,300. Assistant administrators

earned about $32,000, with the middle 50 percent earning between $26,200 and $40,000.

Executives often receive bonuses based on performance outcomes such as cost-containment, quality assurance, and patient satisfaction.

Related Occupations

Health services managers have training or experience in both health and management. Other occupations requiring knowledge of both fields are public health directors, social welfare administrators, directors of voluntary health agencies and health professional associations, and underwriters in health insurance companies.

Sources of Additional Information

General information about health administration is available from: American College of Healthcare Executives, One North Franklin St., Suite 1700, Chicago, IL 60606. Homepage: http://www.ache.org

Information about undergraduate and graduate academic programs in this field is available from:

Association of University Programs in Health Administration, 1911 North Fort Myer Dr., Suite 503, Arlington, VA 22209. Homepage: http://www.aupha.org

For a list of accredited graduate programs in health services administration, contact:

☛ Accrediting Commission on Education for Health Services Administration, 1911 North Fort Myer Dr., Suite 503, Arlington, VA 22209.

For information about career opportunities in long term care administration, contact:

☛ American College of Health Care Administrators, 325 S. Patrick St., Alexandria, VA 22314.

For information about career opportunities in medical group practices and ambulatory care management, contact:

Medical Group Management Association, 104 Inverness Terrace East, Englewood, CO 80112.

make available meeting rooms and various equipment, including slide projectors and fax machines.

Hotel managers are responsible for the efficient and profitable operation of their establishments. In a small hotel, motel, or inn with a limited staff, a single manager may direct all aspects of operations. However, large hotels may employ hundreds of workers, and the general manager may be aided by a number of assistant managers assigned to the various departments of the operation. Assistant managers must ensure that the day-to-day operations of their departments meet the standards set by the general manager.

Computers are used extensively by hotel managers and their assistants, to keep track of the guest's bill, reservations, room assignments, meetings, and special events; order food, beverages, and housekeeping and other supplies; and prepare reports for hotel owners and top-level managers. Managers work with computer specialists to ensure that the hotel's computer system functions properly. Should the hotel's computer system fail, managers must ensure that guests' needs continue to be met.

The general manager has overall responsibility for the operation of the hotel. Within guidelines established by the owners of the hotel or executives of the hotel chain, the general manager sets room rates, allocates funds to departments, approves expenditures, and establishes standards for service to guests, decor, housekeeping, food quality, and banquet operations. Managers who work for chains also may be assigned to organize and staff a newly built hotel, refurbish an older hotel, or reorganize a hotel or motel that is not operating successfully. In order to fill some low-paying service and clerical jobs in hotels, some managers attend career fairs. (For more information, see the statement on general managers and top executives elsewhere in the Handbook.)

Hotel Managers and Assistants

(D.O.T. 187.117-038, .137-018; .167-046, -078, -106, -122; and 320)

Significant Points

Long hours and the stress of dealing with hotel patrons result in high turnover.

College graduates with degrees in hotel or restaurant management should have good job opportunities.

Nature of the Work

A comfortable room, good food, and a helpful hotel staff can make being away from home an enjoyable experience for both vacationing families and business travelers. Hotel managers and assistant managers strive to ensure their guests will have a pleasant stay by providing many of the comforts of home, including cable television, fitness equipment, and voice mail. For business travelers, hotel managers

Hotel managers plan business, social, and recreational events.