View
218
Download
1
Category
Tags:
Preview:
Citation preview
Empowering Surgical Faculty
Ronald F Martin, MD20 April 2010
APDS, San Antonio, TX
Marshfield Clinic/St Joseph's Hospital
760+ physician clinic (~350 at hub) 505 bed tertiary referral hospital Level 2 ACS COT Trauma center Programs in Surgery, Pediatrics,
Internal Medicine, Med/Ped, Psychology, Family Medicine, Dermatology, Transitional Year, Palliative Care (fellow), Pharmacy
Marshfield, WI
Geographic center of Wisconsin 18,000 population- steady Predominant industry Marshfield
Clinic- health care–Other industries, farming and
manufacturing
Surgery program
Established 1975 2 categorical residents per year No preliminary residents No University on site–Academic affiliation with UW Madison
–WARM medical students 3rd and 4th year
Program Status
Change in Program director Jan 2008–4 year accreditation (2 yrs in)
–Minimal citations
–Difficulty recruiting staff and residents
–A perception of serious morale problems within department
A “forensic” analysis
Approximately 2 months–Met with every person at every site
directly involved with the program
–Reviewed every document and report on goals, objectives and performance
–Reviewed all budgets
What was learned
Most members of the department were less than fully aware of – Their described performance
objectives by the department
–The “external” rules governing the department
–The basis for administrative decisions
What else was learned
Virtually no one could articulate a rationale for the budget
Serious misconceptions among faculty about performance and compensation were more toxic to morale than was recognized
Resident performance was generally overestimated by faculty
What was done
Final bilateral acceptance of the program director was contingent on–Developing an agreement among the
faculty
–Developing an agreement between Med Ed and the Program
The “soft” stuff Multiple sessions with the faculty were
scheduled:–Education as to the “rules and
constraints” and situational awareness
–Developed mechanism to re-write all documents for performance in ways that allowed metrics and analysis*
–Decision to re-format entire curriculum to allow for assessment of resident and faculty performance
The “hard” stuff
Pooled all teaching compensation*–*Does not mean all receive equal
amounts and does not include extra-departmental funding
Set criteria for inclusion in pooled compensation–Conference attendance, scholarly
activity, evaluation, teaching agreements, and timeliness of all above
More hard stuff
Division of education surrenders right to differentially compensate
Global teaching budget re-negotiated annually
Program director provides an accounting and selects/deselects recipients for compensation
Program Director takes significant pay cut
What happened
We negotiated a nearly cost/revenue neutral solution that allowed–Purchase of a CBT program to augment
conferences
–Slightly increased median teaching compensation (non-PD)
–Augmented Assistant PD support
–Integrated new medical student program
What happened (cont) We have seen –A significant increase in real time
involvement by faculty in non-RVU acitivity
–a significant upwards trajectory of ABSITE score and other std metrics
– better morale among residents and faculty We have significantly improved our
ability to recruit residents and some faculty (not trauma)
The take home lessons
Faculty feel empowered when–They know what is expected of them
–They know how it is measured
–They had a say in determining the goals and metrics
–They are compensated for something of perceived value
Free advice
Seek input from your faculty Explain why their desires can’t come
true (when they can’t) Try to convince them that they are
better off standing together than standing alone
PDs take the first financial hit
More free advice
Determine what you value Reward what you value–Even if the reward is small it will
probably still get you what you want If you stand up for your faculty
they will most likely stand up for you
Thanks!
Recommended