Coleman David L, Moran Eileen, Serfilippi Delchi, Mulinski Paul, Rosenthal Ronnie, Gordon Bruce, Mogielnicki R Peter
Department of Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
Acad Med. 2003 Jul;78(7):682-9. doi: 10.1097/00001888-200307000-00007.
The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.
退伍军人事务部的使命包括患者护理、教育、研究以及为国防部提供后援支持。由于对医生生产力的衡量必须既反映机构目标又反映市场力量，作者设计了一种生产力模型，该模型采用与退伍军人事务部在这些活动上的投入相称的临床工作量和学术活动衡量指标。该生产力模型评估医生活动的四个领域：临床工作、教育、研究和管理。文中提供了该生产力模型在评估退伍军人事务部支付薪酬的医生员工以及临床服务合同构成方面的应用示例。所提出的模型是一种相对简单的策略，用于衡量退伍军人事务部医疗中心学术医生的广泛工作。该模型为记录住院医师监督情况以及参与有效和高效临床护理所需的行政活动提供了激励措施。此外，该模型有助于确定临床服务之间的资源分配，并允许与非退伍军人事务部医疗保健系统进行比较。本文还提出了一种修改该模型的策略，以纳入临床护理、研究、教育和管理质量的衡量指标。该模型一直是确保资源最佳利用以及实现临床和学术机构目标过程中的一个有用部分。用于界定医生生产力的活动和成就将对医学专业的性质、医学教育和研究的活力以及医疗保健的成本和质量产生重大影响。
