Adzick N S, Scipione A W
Department of Surgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
J Pediatr Surg. 1999 Jan;34(1):133-6. doi: 10.1016/s0022-3468(99)90243-9.
The authors hypothesized that there are significant differences in clinical effort among the faculty of the various departments at an academic Children's Hospital, and that the clinical workload of surgeons has increased over the past decade.
A retrospective analysis of clinical practice and financial performance of the five departments (anesthesiology/critical care medicine, pathology, pediatrics, radiology, and surgery) at the Children's Hospital of Philadelphia from 1987 to 1997 was performed including clinical activity parameters (admissions, discharges, clinic visits), departmental faculty rosters, number of operations for the department of surgery as a whole and for individual surgeons in each pediatric surgical specialty, and professional and hospital financial data.
Pediatric surgical specialists represented 15% of the total full-time physicians throughout the decade. In 1997, surgeons were responsible for 29% of hospital admissions, 28% of total outpatient visits at all clinical care sites, 37% of total professional fee revenue, 39% of hospital-based revenue, and a substantial portion of the hospital margin. Compared with 1987, the department of surgery in 1997 had a 60% increase in outpatient visits and a 58% increase in total operative case load (10,265 to 16,266). In terms of individual surgeon's workload during the decade, the outpatient visits per surgeon increased 45% and the operations per surgeon increased 27%, yet total reimbursement per surgeon slipped 16%.
For the Children's Hospital that was studied, pediatric surgical specialists are doing more clinical work compared with 10 years ago, which may impact teaching, research, and administrative responsibilities. Surgeons have a greater responsibility than nonsurgeons for the hospital's clinical activity and financial health.
作者推测，在一家学术型儿童医院中，各科室教职员工的临床工作量存在显著差异，并且外科医生的临床工作量在过去十年中有所增加。
对费城儿童医院1987年至1997年五个科室（麻醉/重症医学、病理学、儿科学、放射学和外科学）的临床实践和财务表现进行回顾性分析，包括临床活动参数（入院、出院、门诊就诊）、科室教职员工名单、整个外科以及各小儿外科专业中每位外科医生的手术数量，以及专业和医院财务数据。
在这十年中，小儿外科专家占全职医生总数的15%。1997年，外科医生负责29%的医院入院病例、所有临床护理地点门诊就诊总数的28%、专业费用总收入的37%、医院收入的39%，以及医院利润的很大一部分。与1987年相比，1997年外科科室的门诊就诊量增加了60%，总手术量增加了58%（从10265例增至16266例）。就这十年中每位外科医生的工作量而言，每位外科医生的门诊就诊量增加了45%，手术量增加了27%，但每位外科医生的总报销费用却下滑了16%。
对于所研究的儿童医院而言，与10年前相比，小儿外科专家承担了更多的临床工作这可能会影响教学、研究和管理职责。外科医生对医院的临床活动和财务健康承担的责任比非外科医生更大。
