Enhancing Faculty Enhancing Faculty PerformancePerformance

Mark L. Friedell, MDMark L. Friedell, MDOrlando HealthOrlando Health

APDSAPDSSan AntonioSan Antonio

April 20, 2010April 20, 2010

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Orlando Health Program

60 years old – growth began in 1995 Originally 2 chiefs, now 4 Non-university to hybrid to

university Full and part-time faculty 800 bed hospital (ORMC)

– Level 1 trauma center– Integrated women and children's

hospitals Satellite hospital (Dr. Phillips)

Full-Time Faculty

Originally just a PD

Now 15 surgeons– 5 Trauma/SCC Surgeons – 2 General Surgeons – 2 MIS/Bariatric Surgeons – 3 Surgical Oncologists – 3 Vascular Surgeons

Full-Time Faculty Responsibilities

M & MM & M Grand RoundsGrand Rounds Skills LabSkills Lab Pig LabPig Lab Director of TraumaDirector of Trauma Basic Science CurriculumBasic Science Curriculum Resident ResearchResident Research Overall oversight of Overall oversight of

programprogram

Part-Time Faculty

Originally just individual surgeons and small groups

Now 3 groups– General Surgeons – 6 (4 prior residents)– Pediatric Surgeons – 4 (1 prior resident)– Colorectal Surgeons – 5 (2 prior fellows)

Part-Time FacultyPROSPROS

– Provide large breadth and depth of cases

– Teaching in OR, on wards and in clinic– Provide excellent feedback about

residents (when given)

CONSCONS– Little control over them for:

»Evaluations»Didactic teaching»Attendance at conferences»Scholarly activity

Part-Time Faculty

CarrotsCarrots– Annual $$ – Get just one or two surgeons in

each group to do composite evaluations, attend important department meetings and give mock orals

– Teacher of the Year– Offer full-time status (with

practice buy-out)

Part-Time Faculty

SticksSticks– Withholding $$– Resident evaluations of

attendings/rotations (could back-fire)

– Threaten to withdraw resident coverage»MLP replacement would be costly»Must have a backup plan first

Attending Resignation

Harshest and least technically-adept surgeon in the group

Poor evaluations from residents – surgeon became infuriated when given them

No resident coverage when he is on call

When his patients have problems residents respond only to an emergency situation

$$$$$$$$$$$$$

General Surgery Group– Teaching Stipend – MDACCO Stipend

Pediatric Surgery Group– Medical Director, Children’s

Trauma Services Stipend– Medical Director, Pediatric Surgical

Education Stipend– Director, Surgical Liaison Services

Stipend

$$$$$$$$$$$$$

Colorectal Surgery– Salary and benefits for 3 fellows – Stipend for the program director

Part-Time Faculty Contract Addendum

Participate in research projects with residents

Participate in the recruitment and selection of residents

Provide assistance with goals and objectives and curriculum revisions

Participate in the annual review of the program

Give formal lectures

Ensure clinical education of residents Attendance at some department

conferences (M&M, grand rounds) and faculty meetings

Participate in department mock oral examinations

Ensure resident compliance with duty hours

Complete resident evaluations (in a timely fashion).

Part-Time Faculty Contract Addendum

What they actually do

Alliance of Independent Academic Medical Centers

How to compensate PT faculty for educational work? (Feb, 2010) No payments Lump sum to the practice in keeping with federal guidelines Teaching stipends based on time spent on educational activities (away from practice) “Teaching RVU” model

APDS List Serve

Criteria needed for attendings to Criteria needed for attendings to participate on a teaching service participate on a teaching service (i.e., have resident coverage):(i.e., have resident coverage):

1.1. Adherence to the six ACGME Core Adherence to the six ACGME Core Competencies Competencies

2.2. Completion of a minimum of 75% of Completion of a minimum of 75% of Resident Evaluations (including Resident Evaluations (including written comments)written comments)

3.3. Completion of the Annual Program Completion of the Annual Program EvaluationEvaluation

APDS List Serve4.4. Participation in an annual faculty Participation in an annual faculty

evaluation meeting; the faculty member evaluation meeting; the faculty member will agree to participate in a structured will agree to participate in a structured program to improve their teaching scoresprogram to improve their teaching scores

5.5. Teaching faculty will agree to meet with Teaching faculty will agree to meet with PD outside of the scheduled annual PD outside of the scheduled annual faculty evaluation when needed in faculty evaluation when needed in response to a low score notification on response to a low score notification on the electronic evaluation systemthe electronic evaluation system

6.6. Participation in residency selection Participation in residency selection processprocess

7.7. Allow resident participation in substantial Allow resident participation in substantial portion of operative procedures portion of operative procedures

List Serve Comments

““I like the list; I wish all of our I like the list; I wish all of our faculty would do all of these things. faculty would do all of these things. What is done with faculty who are What is done with faculty who are not compliant?”not compliant?”

““While the list is good in theory, I While the list is good in theory, I wonder if you set the bar too high wonder if you set the bar too high you might alienate some good, hard-you might alienate some good, hard-working volunteer faculty that just working volunteer faculty that just can’t keep up with the paperwork can’t keep up with the paperwork demands. Then who loses?”demands. Then who loses?”

““I would not settle for less than I would not settle for less than 100% compliance with evaluations.” 100% compliance with evaluations.”

ACS Surgeons as Leaders Vignette 2008

You are the PD of a free-standing surgical residency You are the PD of a free-standing surgical residency at an 800-bed multispecialty community hospital. The at an 800-bed multispecialty community hospital. The program depends upon a busy surgical group for a program depends upon a busy surgical group for a breadth and depth of cases for the residents. These breadth and depth of cases for the residents. These surgeons receive a stipend to “teach” in the surgeons receive a stipend to “teach” in the operating room. Most are unwilling to participate in operating room. Most are unwilling to participate in conferences (such as M&M and Grand Rounds) or conferences (such as M&M and Grand Rounds) or faculty meetings. Resident evaluations are rarely faculty meetings. Resident evaluations are rarely completed on time. The hospital administration is completed on time. The hospital administration is proud of its excellent surgical residency yet also proud of its excellent surgical residency yet also aware of the shortcomings of these private aware of the shortcomings of these private practitioners. However, it is reluctant to alienate practitioners. However, it is reluctant to alienate these surgeons because of the business they bring to these surgeons because of the business they bring to the hospital and their importance to the residency. the hospital and their importance to the residency. You are told to do your best to get them to meet all You are told to do your best to get them to meet all of the obligations they contractually agreed to when of the obligations they contractually agreed to when they accepted the teaching stipends, particularly they accepted the teaching stipends, particularly since there is an upcoming RRC visit next year.since there is an upcoming RRC visit next year.

Question

What approaches can be used to What approaches can be used to motivate your PT faculty?motivate your PT faculty?

Get the administration behind you Get the administration behind you firstfirst

Throw more money at themThrow more money at them Engage another equally Engage another equally

competent group as possible competent group as possible alternativealternative

Hire more full-time facultyHire more full-time faculty Give them perksGive them perks

Conclusions No magic answers for this

complex problem 100% compliance by PT faculty is

unrealistic Money placates but does not get

them to do everything you want Bringing them in full-time will not

guarantee greater compliance Try to find another group of

surgeons Hire more full-time faculty if

possible

Conclusions Use composite resident evaluations

from one or two members of the group Work closely with the private groups

via:– A recent resident graduate– The practice manager

Working with part-time faculty requires a PD to “pick his/her battles”:– Bimonthly faculty meetings– Annual program review– Mock Orals– M&M attendance if case is presented– Evaluations

Most Recent Crisis

PT attending concerned that his PT attending concerned that his cases are being presented “too cases are being presented “too often” at M&M. He never goes to often” at M&M. He never goes to conference and only knew about the conference and only knew about the presentations because the residents presentations because the residents routinely inform faculty members routinely inform faculty members before cases are presented.before cases are presented.

The veiled threat was that he would The veiled threat was that he would resign from the faculty. resign from the faculty.

Residents concerned because he Residents concerned because he provides great cases for them.provides great cases for them.

Need PD interventionNeed PD intervention