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!