Shea S, Nickerson K G, Tenenbaum J, Morris T Q, Rabinowitz D, O'Donnell K, Perez E, Weisfeldt M L
Department of Medicine, Columbia University, New York, USA.
N Engl J Med. 1996 Jan 18;334(3):162-7. doi: 10.1056/NEJM199601183340307.
Changes in the organization and financing of health care threaten to alter the prevailing system of financing the teaching of medical students and residents. Little information is available from private medical schools and teaching hospitals about the extent of teaching by faculty members or the mechanisms and levels of reimbursement for teaching.
We surveyed faculty members in the Department of Medicine at Columbia-Presbyterian Medical Center to ascertain the extent of their teaching activities. A standard number of hours was assigned to each activity, and the total number of teaching hours was calculated for each faculty member. Teaching of fellows and in continuing medical education programs was excluded. We also determined how much money the Department of Medicine received in payment for faculty members' teaching activities, and the sources of this compensation.
In the 1992-1993 academic year, the 188 full-time faculty members spent a total of 46,086 hours teaching (mean [+/- SD], 245 +/- 178 hours per faculty member); 10,780 hours (23.4 percent) were spent teaching medical students, and 35,306 hours (76.6 percent) teaching house staff. Eighty percent of faculty members taught for 137 or more hours each. In a multivariate analysis including faculty rank, subspecialty division, years since graduation from medical school, sex, and tenure or clinical track, senior faculty members (P = 0.02), members of certain subspecialty divisions (P < 0.001), and women (P = 0.05) contributed more than the average number of teaching hours. An additional 56 non-full-time faculty members contributed a total of 5684 hours. The net reimbursement to the department for teaching totaled $965,808, or about $16 per hour of teaching by full-time faculty members, after the cost of fringe benefits was excluded.
Faculty members of the department of medicine at a major medical center contribute a large number of hours teaching medical students and house staff. This effort is poorly compensated. Cost-containment efforts have the potential to jeopardize fragile social contracts at academic health centers whereby the faculty participates in teaching by contributing unreimbursed or underreimbursed time.
医疗保健机构组织与筹资方式的变化可能会改变现行的医学生和住院医师教学筹资体系。私立医学院校和教学医院关于教职员工教学范围以及教学补偿机制与水平的信息很少。
我们对哥伦比亚长老会医学中心内科的教职员工进行了调查，以确定他们的教学活动范围。为每项活动分配了标准时长，并计算出每位教职员工的总教学时长。 fellows的教学以及继续医学教育项目的教学被排除在外。我们还确定了内科因教职员工教学活动获得的报酬金额以及这笔报酬的来源。
在1992 - 1993学年，188名全职教职员工总共花费46,086小时进行教学（平均[±标准差]，每位教职员工245±178小时）；其中10,780小时（23.4%）用于医学生教学，35,306小时（76.6%）用于住院医师教学。80%的教职员工每人教学时长达到或超过137小时。在一项包括教职员工级别、亚专业科室、从医学院毕业年限、性别以及终身教职或临床路径的多变量分析中，资深教职员工（P = 0.02）、某些亚专业科室的成员（P < 0.001）以及女性（P = 0.05）的教学时长贡献超过平均水平。另外56名非全职教职员工总共贡献了5684小时。在扣除附加福利成本后，该科室教学的净报销总额为965,808美元，即全职教职员工每教学小时约16美元。
一家大型医疗中心内科的教职员工花费大量时间进行医学生和住院医师教学。这种付出的报酬很低。成本控制措施有可能危及学术健康中心脆弱的社会契约，即教职员工通过贡献未获补偿或补偿不足的时间参与教学。
