Anesthesia & Analgesia:
Letters To The Editor: Letters & Announcements
Feiner, John MD; Miller, Ronald D. MD; Hickey, Robert MD
University of California at San Francisco
Department of Anesthesia
San Francisco, CA
We appreciate the opportunity to interact with our colleagues, such as Dr. Whitten, regarding quantification of faculty clinical activities. We believe that the scholarly analysis of clinical activities has been enhanced by separation of actual clinical productivity versus clinical availability. This separation is important because their funding sources are usually different. Funding from traditional third-party sources (e.g., Medicare, contracts, insurance) is usually for only the actual delivery of clinical care not for the availability to deliver such care. Using these funds to pay for availability obviously dilutes the monies that can be used for the actual delivery of clinical care. Separating actual productivity, which is funded, from availability, which is not funded by third-party carriers, allows for much more precise discussions with the hospital. If they wish non-reimbursed availability to be present, perhaps they need to fund it. The separation of productivity from availability is less important for departments of anesthesia whose faculty are fully funded directly by the institution rather than indirectly from third-party carriers.
On a separate issue, a productivity analysis is helpful for explaining both intra- and intergroup (i.e., specialty) variability. Specifically, a productivity system will identify high versus low productivity anesthesiologists within a group. This allows separation of systems versus individual reasons for low and high clinical productivity from a given faculty.
Whitten’s emphasis on part-time faculty and the issue of concurrent care are important. To simplify our presentation, part-time faculty were not part of the analysis. However, we agree that part-time faculty can be very important and should be included in a more complex analysis than that which our paper provides. With regard to concurrent care, the focus of our paper was quantification of clinical time by actual delivery of anesthesia rather than availability. Whether single versus concurrent care is differentially treated is a variable to be considered in designing a productivity system. Our local experience is that this debate is substantial, and worthy of consideration. Lastly, we are not sure why the concurrent care issue was included in the Whitten letter because no previously described plan has treated covering two (versus one) operating rooms differently. If some program does not decide to treat them differently, this can be achieved in either an availability- or productivity-based system.
We disagree with the final conclusion of Whitten. The Abouleish et al. (1) system is a form of an “availability” system that we have used for many years. We believe an actual “clinical productivity” system based on the actual delivery of clinical care allows for better assessment and reimbursement of highly productive clinical faculty. Of prime importance is that an analytical and scholarly analysis of our funding sources and productivity allows departments of anesthesia to make better informed organizational and individual faculty decisions. In that regard, we believe that the study by Abouleish et al. (1) and, hopefully, our own study have facilitated understanding of academic anesthesia’s organizational options.
John Feiner, MD
Ronald D. Miller, MD
Robert Hickey, MD
1. Abouleish AE, Zornow MH, Levy RS, et al. Measurement of individual clinical productivity in an academic department. Anesthesiology 2000; 93: 1509–16.