Views of managed care--a survey of students, residents, faculty, and deans at medical schools in the United States.
BACKGROUND AND METHODS: Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent. RESULTS: Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive as possible." The expressed attitudes toward managed care were negative, ranging from a low mean (+/-SD) score of 3.9+/-1.7 for residents to a high of 5.0+/-1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative. CONCLUSIONS: Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans. (+info)
Outcomes research: collaboration among academic researchers, managed care organizations, and pharmaceutical manufacturers.
Medical and pharmaceutical outcomes research has been of increasing interest in the past 10 to 15 years among healthcare providers, payers, and regulatory agencies. Outcomes research has become a multidisciplinary field involving clinicians, health services researchers, epidemiologists, psychometricians, statisticians, psychologists, sociologists, economists, and ethicists. Collaboration among researchers in different organizations that offer different types of services and various research expertise is the essential element for any successful outcomes project. In this article we discuss collaboration on outcomes research among academic researchers (mainly those who work in colleges of pharmacy), managed care organizations, and research-based pharmaceutical manufacturers, with a focus on the opportunities and challenges facing each party. The pharmaceutical industry needs information to make product and promotion decisions; the managed care industry has data to offer but needs analysis of these data; and pharmacy schools, among other academic institutions, have skilled researchers and data-processing capacity but require projects for revenue, research training, experience, and publications. Challenges do exist with such endeavors, but collaboration could be beneficial in satisfying the needs of the individual parties. (+info)
Impact factors: use and abuse in biomedical research.
Impact factors are increasingly being used as measures in the process of academic evaluation; however, the pitfalls associated with such use of impact factors are not always appreciated. Impact factors have limited use as criteria in determining the quality of scientific research. Classical anatomists may be actively discriminated against if journal impact factors are used as measures of scientific merit in comparison with colleagues in more popular or faster-moving disciplines such as molecular biology. Research evaluation based on citation rates and journal impact factors is inappropriate, unfair, and an increasing source of frustration. (+info)
Rewarding teaching faculty with a reimbursement plan.
OBJECTIVE: To develop a system for measuring the teaching effort of medical school faculty and to implement a payment system that is based on it. DESIGN: An interventional study with outcomes measured before and after the intervention. SETTING: A department of internal medicine with a university hospital and an affiliated Veterans Administration hospital. INTERVENTION: We assigned a value in teaching units to each teaching activity in proportion to the time expended by the faculty and the intensity of their effort. We then calculated total teaching units for each faculty member in the Division of General Internal Medicine and for combined faculty effort in each subspecialty division in the Department of Medicine. After determining the dollar value for a teaching unit, we distributed discretionary teaching dollars to each faculty member in the Division of General Internal Medicine and to each subspecialty division according to total teaching units. MEASUREMENTS AND MAIN RESULTS: The distribution of discretionary teaching dollars was determined. In the year after the intervention, there was a substantial redistribution of discretionary teaching dollars among divisions. Compared with an increase in total discretionary dollars of 11.4%, the change in allocation for individual divisions ranged from an increase of 78.2% to a decrease of -28.5%. Further changes in the second year after the intervention were modest. The distribution of teaching units among divisions was similar to the distribution of questions across subspecialties on the American College of Physicians In-Training Examination (r =.67) and the American Board of Internal Medicine Certifying Examination (r =.88). CONCLUSIONS: It is possible to measure the value of teaching effort by medical school faculty and to distribute discretionary teaching funds among divisions according to the value of teaching effort. When this intervention was used at our institution, there were substantial changes in the amounts received by some divisions. We believe that the new distribution more closely approximates the desired distribution because it reflects the desired emphasis on knowledge as measured by two of the most experienced professional groups in internal medicine. We also believe that our method is flexible and adaptable to the needs of most clinical teaching (+info)
Rewards and incentives for nonsalaried clinical faculty who teach medical students.
We surveyed the clerkship administrators of pediatrics, family medicine, and internal medicine at U.S. medical schools, and of pediatrics at Canadian medical schools to determine what rewards and incentives are being offered to nonsalaried faculty for office-based teaching. Monetary payment was offered by 13% to 22% of the programs. Nonmonetary rewards like educational opportunities were offered by 70% to 89%; academic appointments by 90% to 95%; special recognition events by 62% to 79%; and appreciation letters by 74% to 84% of programs. Only 3 of 338 responders offered no rewards or incentives. (+info)
Medical faculty use of the journal literature, publishing productivity and the size of health sciences library journal collections.
OBJECTIVES: This 1990-1991 study explored the relationship between the size of health sciences library journal collections and the number of different journals cited by medical school faculty in departments of biochemistry and medicine. METHODS: Two regression equations, including variables associated with a national stratified sample of 622 faculty who published articles during those two years, were used to explore factors correlated with variations in faculty use of the journal literature and faculty publishing productivity. RESULTS: Results suggest that, after controlling for other variables in the models, neither the number of different journals those faculty cited, nor the number of articles they published, had statistically significant correlations with the number of journals in the health sciences library collection. CONCLUSION: The traditional view that the size of an academic health sciences library's journal collection is a good measure of how well that library is positioned to support faculty research may not be entirely accurate. (+info)
A century of pathology at Yale: personal reflections.
This history is largely about the players on the stage of the Yale Pathology Department acting out their roles as observed by the author in over a half century as a member of the department and as associate dean of the medical school. (+info)
Student and faculty performance in clinical simulations with access to a searchable information resource.
In this study we explore how students' use of an easily accessible and searchable database affects their performance in clinical simulations. We do this by comparing performance of students with and without database access and compare these to a sample of faculty members. The literature supports the fact that interactive information resources can augment a clinician's problem solving ability in small clinical vignettes. We have taken the INQUIRER bacteriological database, containing detailed information on 63 medically important bacteria in 33 structured fields, and incorporated it into a computer-based clinical simulation. Subjects worked through the case-based clinical simulations with some having access to the INQUIRER information resource. Performance metrics were based on correct determination of the etiologic agent in the simulation and crosstabulated with student access of the information resource; more specifically it was determined whether the student displayed the database record describing the etiologic agent. Chi-square tests show statistical significance for this relationship (chi 2 = 3.922; p = 0.048). Results support the idea that students with database access in a clinical simulation environment can perform at a higher level than their counterparts who lack access to such information, reflecting favorably on the use of information resources in training environments. (+info)