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The transformation of healthcare from a relatively sheltered sector of the economy into one characterized by market competition and volatility has tested the values, abilities, and leadership strategies of healthcare executives. Changes in the scale and complexity of healthcare organizations and in provider reimbursement impose demands on executives that bear little resemblance to those of the past. In light of these challenges, health management programs are reassessing their responsibilities and capacities in the preparation of MHA graduates. Unfortunately, there is a lack of consensus on how students should be trained, advised, and mentored for leadership responsibilities. In our view, MHA programs can begin to address this problem through support of a balanced normative model for leadership training whereby classroom immersion in academic subjects is complemented by exposure to practice and experience. This model must be value-oriented, balancing business imperatives with traditional service ideals, and reality-oriented, balancing the teaching methods of theory and practice. In our view, MHA programs can begin to adapt to this model though student selection, curriculum reform, and involvement by practitioners and alumni.

There is much concern about administrative costs in health care. But little has been written on the market for health managers. This article discusses Bureau of Labor Statistics data estimating a total of 362,500 health managers in the United States in 1990 and projections showing an increase to 517,800 in 2005. The article further discusses the composition of health care employment in terms of settings and functions, and evaluates the implications of a rapidly changing market for health administrators. The authors conclude that sufficient demand exists for AUPHA programs to produce more graduates, but that curriculum should be revised and should place greater emphasis on efficient production of health services. This will provide qualitative differentiation and give health management training a competitive advantage over business and other educational backgrounds.

The dramatically changing environment of the health care executive prompted the current survey of graduate students in health administration. The survey examined the types of attitudes and values that may influence students' future leadership style and ethical decision making. A self-administered questionnaire was designed to provide descriptive information as well as to allow comparisons with recent surveys of practitioners and peers and with other research. Respondents to the survey, conducted in the fall of 1986, included nearly half of the full-time students in 56 participating AUPHA graduate programs and one-quarter of the part-time students (N = 1,764). Students' characteristics such as age, sex, religious preference, work experience, and career aspirations were assessed in relation to their social philosophy on health issues, instrumental and terminal values, attitudes toward achievement, and degree of idealism versus relativism in moral reasoning. The typical student was a twenty-seven-year-old white female with a stated religious preference who expected in ten years to be associated with a multi-institutional system or consulting firm. Her social philosophy showed concern for the rising cost of health care on the consumer and an emphasis on self-help. Self-respect and honesty are her highest values; her ethical ideology had components of high idealism and relativism, which is indicative of a situational decision-making style. Work orientation and mastery were both above average sources of achievement motivation for her, whereas competitiveness was about average. When group differences in attitudes and values were evaluated, however, sex was the highest predictor, followed by age, expectation of becoming a CEO, and self-assessed potential for success. Although there was substantial agreement between students' and practitioners' attitudes and values, some differences were found. Implications for future research are discussed, as well as issues relating to education for health administrators.