Community physicians and general managers: Experience and expectations

Abstract

Interview data from a two and a half year study of 20 District General Managers (DGMs) from a wide variety of backgrounds confirmed the view that there has been widespread dissatisfaction about the work of the District Medical Officer (DMO). This dissatisfaction was often mirrored by the DMOs themselves. We therefore supplemented the interviews with a questionnaire listing 16 principal functions of community medicine and asked the DGMs and their DMOs independently to rate the amount of attention devoted by the DMO to each function both currently and ideally. We found a contrast between the overall uncertainty and concern expressed about community medicine during discussions, and the enthusiasm for the itemized community medical functions. There was close correlation between the DGMs' and DMOs' mean rates, which were always higher in the ideal than the current rating, and particularly so for the DMO's work in information and assessment of need, in service evaluation, and — only among the DMOs' responses — in the independent advocacy of public health. We present the detailed results for all the functions, and discuss the implications of these and our interview data for the implementation of the Acheson Report and for the managerial education of public health physicians.