Empowering Surgical Faculty Ronald F Martin MD 20

Empowering Surgical Faculty Ronald F Martin, MD 20 April 2010 APDS, San Antonio, TX

Marshfield Clinic/St Joseph's Hospital u 760+ physician clinic (~350 at hub) u 505 bed tertiary referral hospital u. Level 2 ACS COT Trauma center u. Programs in Surgery, Pediatrics, Internal Medicine, Med/Ped, Psychology, Family Medicine, Dermatology, Transitional Year, Palliative Care (fellow), Pharmacy

Marshfield, WI u. Geographic center of Wisconsin u 18, 000 population- steady u. Predominant industry Marshfield Clinic- health care – Other industries, farming and manufacturing

Surgery program u. Established 1975 u 2 categorical residents per year u. No preliminary residents u. No University on site – Academic affiliation with UW Madison – WARM medical students 3 rd and 4 th year

Program Status u. Change 2008 in Program director Jan – 4 year accreditation (2 yrs in) – Minimal citations – Difficulty recruiting staff and residents – A perception of serious morale problems within department

A “forensic” analysis u. 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 u. 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 u. Virtually no one could articulate a rationale for the budget u. Serious misconceptions among faculty about performance and compensation were more toxic to morale than was recognized u. Resident performance was generally overestimated by faculty

What was done u. 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 u. 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 u. Pooled all teaching compensation* – *Does not mean all receive equal amounts and does not include extradepartmental funding u. Set criteria for inclusion in pooled compensation – Conference attendance, scholarly activity, evaluation, teaching agreements, and timeliness of all above

More hard stuff u. Division of education surrenders right to differentially compensate u. Global teaching budget re-negotiated annually u. Program director provides an accounting and selects/deselects recipients for compensation u. Program Director takes significant pay cut

What happened u. 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) u. 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 u. We have significantly improved our ability to recruit residents and some faculty (not trauma)

The take home lessons u. 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 u. Seek input from your faculty u. Explain why their desires can’t come true (when they can’t) u. Try to convince them that they are better off standing together than standing alone u. PDs take the first financial hit

More free advice u. Determine what you value u. Reward what you value – Even if the reward is small it will probably still get you what you want u. If you stand up for your faculty they will most likely stand up for you

Thanks!