Session V - Polytrauma

Fri., 10/10/03 Polytrauma, Paper #30, 11:05 AM

*The Academic Orthopaedic Trauma Service: An Analysis of Its Financial Viability and Its Impact on Resident Education and Faculty Job Satisfaction

Mitchel B. Harris, MD; Sean J. Gregory, MD; Wake Forest University, Baptist Medical Center, Winston-Salem, North Carolina, USA (a-Synthes, USA)

Purpose: Academic medical centers are in the midst of adjusting to decreasing reimbursements and dramatic changes in residents' work hours. These changes have forced academic departments to become more cognizant of the need for business plans and strategic planning. These factors have led many departments to create specialty and subspecialty services that function as independent cost centers. The intention of this intradepartmental reorganization is to improve fiscal accountability while supporting physicians in their effort to focus their practices on their chose area(s) of subspecialty training. These changes are particularly relevant to academic university-based clinical practices.

Hypothesis: A dedicated orthopaedic trauma service (OTS) will improve the financial productivity of an academic department, improve patient care, improve resident education, and increase individual faculty members' level of job satisfaction.

Method: The original analysis of the financial viability of an academic OTS was previously presented to the OTA (Harris et al., OTA '02). This study represents the initial results of a prospectively planned, quarterly analysis of the productivity of an academic orthopaedic department. Departmental productivity was evaluated by WRVUs, number of cases, and charges. Collections were also monitored. These figures were principally obtained with use of the software program Analyzer (IDX Systems, Burlington, Vermont). The data was collected for members of the OTS, non-OTS faculty members, and overall departmental totals. Productivity over a 3-month period was compared with similar quarters in preceding years prior to the initiation of an OTS.

Six months after the onset of the OTS, resident and faculty surveys were distributed to assess the short-term effects of the OTS on resident education, patient care, departmental research goals, and faculty job satisfaction.

Results: First quarter analysis (July to October, 2002 compared with July to October, 2001). WRVU department total: increase 3.7%; WRVU OTS: increase 4%; and WRVU Non-OTS: increase 3.5%. Number of cases performed by the department rose 2.1% compared with the previous year's quarter. Charges at the department level increased 7.2%. OTS member charges increased 4.3%, and non-OTS member charges increased 9.3%. Total department collections increased 12.1%; OTS members increased 11.8%; non-OTS members increased 12.3%.

The results of faculty surveys showed that 11 of 12 faculty members thought that the OTS "enhanced their ability to provide optimal subspecialty care." Eleven of 12 faculty members thought that the implementation of the OTS "enhanced their personal research goals." Personal job satisfaction results showed that eight improved, three had no effect, and one reported that it had deteriorated. Eleven of 12 faculty members thought that the OTS facilitated their ability to "idealize" their practices. All 12 residents thought that the OTS had led to slightly or significantly more teaching and that they had greater confidence in caring for the trauma patient. All 12 residents thought that the initiation of the OTS had improved esprit d' corps within the department. The OTS did not negatively affect any resident's level of job satisfaction despite increasing their work hours while on that service. Ten of 12 residents thought that the presence of a weekly trauma clinic further benefitted their education. Second and third quarter financial analysis will be presented upon completion.

Conclusions: The creation of a dedicated OTS has improved faculty job satisfaction as well as productivity. Academic departments must identify strategies to maintain and enhance job satisfaction. With use of a business model to create a dedicated OTS, there is potential for improvement in financial productivity.

* If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options and e-consultant or employee.