DIFFERENTIAL CLINICAL WORKLOADS AMONG FACULTY AT A MAJOR ACADEMIC HEALTH-CENTER

Objective The authors analyzed patient care (1981-1995) and financial data (1991-1996) to determine if differential workloads existed at a m ajor academic health center. Summary Background Data Academic health c enters differ markedly from community-based medical centers, but they are required to compete with others who have a more circumscribed miss ion and a responsibility for providing less complex care. Changes in h ealth care systems may lessen incentives to generate clinical revenue and may adversely affect educational and research programs. Methods Pa tient care data at the University of Michigan Health System were analy zed by discipline for level of activity from 1981 to 1995 and were com pared to professional and institutional financial data from 1991 to 19 95. Results Surgeons represented 11% of the total full-time physicians throughout the period of the study (94 of the 836 Medical Center phys icians, 1995), They accounted for 33% of hospital admissions (11,616 o f 35,101) and 16% of outpatient visits (92,364 of 568,738). Since 1981 , Surgeons experienced a 249% increase in total operative workload (67 99-16,909 procedures), representing a 30% increase in operations/surge on (138-180 operations). Surgical efforts in 1995 accounted for 29% of the total professional fee revenue and $240 million of the $512-milii on University of Michigan Hospital revenue. Conclusions Surgeons had a greater collective and individual responsibility than did nonsurgeons for clinical activity and the financial viability of the academic hea lth centers studied. Many proposals for financing health care delivery systems have the potential to exacerbate this differential. Restructu ring of academic health centers must address this fact, lest their aca demic mission and scholarly activity be compromised.