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.
Dr. Coleman is acting chair, Department of Medicine, Yale University School of Medicine. At the time this report was written, he was chief of medical service, VA Connecticut Healthcare System and Yale University School of Medicine, both in New Haven, Connecticut. Dr. Rosenthal is chief of surgical service, VA Connecticut Healthcare System and Yale School of Medicine; Ms. Moran is health system specialist, Mr. Serfilippi is analyst for the specialty and acute care line, and Dr. Mulinski is associate chief of staff, VA Connecticut Healthcare System; Dr. Mogielnicki is staff physician, White River Junction VA Healthcare System, and professor of medicine, Dartmouth Medical School, Hanover, New Hampshire; and Mr. Gordon is director, VA Northampton Healthcare System, VA Medical Center, Northampton, Massachusetts.
Correspondence should be addressed to Dr. Coleman, Department of Internal Medicine, 1072 LMP, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510. Reprints are not available.