With the health care industry transforming at an ever-more-rapid pace, physicians are stepping up and taking larger, more complex administrative roles. Health care organizations ranging from hospitals to group practices are figuring out how to compensate doctors for those duties that are pulling them away from patients.

"Because of the shrinking reimbursement pool and growing overhead costs, physicians are no longer willing to give up their time for free," says Justin Chamblee, a senior manager for the health care consulting firm Coker Group. "So by nature of doing that, they're asking health systems to compensate for the work they're completing in an administrative capacity."

Compensation amounts for directorship activities vary greatly depending on responsibilities and duties, not to mention the type of organization, according to a survey of 1,399 medical directors, released in April by the Medical Group Management Association. About 50 percent of those surveyed said they spent fewer than six hours as directors. The vast majority of stipends landed under $50,000, according to the report, and the median hourly compensation fell between $100 and $200.

At the hospital or integrated delivery system level, compensation for directors ranged from $15,600 for noninvasive cardiology and $16,000 for geriatrics to $58,040 for family medicine (with obstetrics).

Quality metrics increasingly are being factored into stipends, especially with health care moving further away from the fee-for-service world of today, says Todd Evenson, assistant director of surveys for the MGMA.

Whatever the compensation approach, it's critical that physicians are involved at a leadership level in helping to change the way hospitals think and operate, says John Combes, M.D., senior vice president of the American Hospital Association and president of its Center for Healthcare Governance.

"It's imperative that we engage physicians in redesigning the operation of the delivery system," he says. "The move is really more toward management of the clinical enterprise to focus it on outcomes for populations of patients, and to demonstrate value in doing that. And you can't do that unless you've engaged the people who are actually delivering the care."