COMPENSATION TO A DEPARTMENT OF MEDICINE AND ITS FACULTY MEMBERS FOR THE TEACHING OF MEDICAL-STUDENTS AND HOUSE STAFF

Background. Changes in the organization and financing of health care t hreaten to alter the prevailing system of financing the teaching of me dical students and residents, Little information is available from pri vate medical schools and teaching hospitals about the extent of teachi ng by faculty members or the mechanisms and levels of reimbursement fo r teaching. Methods. We surveyed faculty members in the Department of Medicine at Columbia-Presbyterian Medical Center to ascertain the exte nt of their teaching activities, A standard number of hours was assign ed to each activity, and the total number of teaching hours was calcul ated for each faculty member, Teaching of fellows and in continuing me dical education programs was excluded. We also determined how much mon ey the Department of Medicine received in payment for faculty members' teaching activities, and the sources of this compensation. Results. I n the 1992-1993 academic year, the 188 full-time faculty members spent a total of 46,086 hours teaching (mean [+/-SD], 245+/-178 hours per f aculty member); 10,780 hours (23.4 percent) were spent teaching medica l students, and 35,306 hours (76.6 percent) teaching house staff, Eigh ty percent of faculty members taught for 137 or more hours each. In a multivariate analysis including faculty rank, subspecialty division, y ears since graduation from medical school, sex, and tenure or clinical track, we found that senior faculty members (P=0.02), members of cert ain subspecialty divisions (P<0.001), and women (P=0.05) contributed m ore than the average number of teaching hours, An additional 56 non-fu ll-time faculty members contributed a total of 5684 hours, The net rei mbursement to the department for teaching totaled $965,808, or about $ 16 per hour of teaching by full-time faculty members, after the cost o f fringe benefits was excluded. Conclusions. Faculty members of the de partment of medicine at a major medical center contribute a large numb er of hours teaching medical students and house staff. This effort is poorly compensated, Cost-containment efforts have the potential to jeo pardize fragile social contracts at academic health centers whereby th e faculty participates in teaching by contributing unreimbursed or und erreimbursed time.