P&S Journal: Spring 1996, Vol.16, No.2
Study Questions Compensation for Teaching Medical Students
Measures aimed at containing health-care costs ultimately may jeopardize the traditional system by which faculty members of medical departments teach medical students and residents with little or no compensation for their time, concludes a study led by Dr. Steven Shea, associate professor of medicine and former Irving Research Scholar, and reported in a January issue of New England Journal of Medicine.
"The necessity for unreimbursed teaching has traditionally been accepted as a quid pro quo for appointment to university faculty, which until recently was a requirement for hospital privileges," says Dr. Shea. But as cost-saving measures reduce the traditional benefits of the teaching program to clinical faculty members, "physicians may view teaching as a burden or an unreimbursed service."
Dr. Shea and a team of researchers surveyed 188 full-time P&S Department of Medicine faculty members in the 1992-93 academic year. In total, the faculty spent 46,086 hours teaching, with the mean time spent being 245 hours per faculty member (plus or minus 178 hours). Of that total, 23.4 percent-or 10,780 hours-went to teaching medical students, and 76.6 percent (35,306 hours) was devoted to teaching house staff.
The study also divided teaching time by types of activities. Serving as attending physician on a ward accounted for 29.2 percent (13,468 hours) of the total time; acting as attending physician on a subspecialty service occupied 17.7 percent (8,152 hours). All other teaching-related activities accounted for no more than 10 percent of total time each, which, the researchers note, indicates the breadth of teaching activities in which the faculty was engaged.
The number of hours spent teaching did not vary significantly by faculty rank, years since graduation from medical school, sex, tenure, or clinical track. Except for members of the infectious diseases division, directors of the intensive care unit, and directors of the unit for patients with AIDS, all of whom logged more than 500 hours teaching, there were no significant variations by subspecialty division.
The study notes that cost-cutting measures are now threatening or eliminating the traditional benefits of teaching to clinical faculty members. For instance, many hospitals are giving admitting privileges to non-teaching physicians. Hospitals are also adding part-time staff members but exempting them from teaching, increasing the teaching burden on full-time faculty. In addition, subsidized office space for faculty members also is being eliminated in many cases. Finally, the study notes that Medicare funds for physician training are already not commensurate with the time spent by physicians in teaching; proposed cuts to these funds may exacerbate the problem.
At a time when physicians are being asked to identify and justify each budgetary allocation, uncompensated teaching time is likely to become an issue, says Dr. Shea. "If the playing field were truly level, there would be direct payment to faculty members for time spent teaching."