Specialty networking in pediatric surgery - A paradigm for the future of academic surgery

Objective To review retrospectively a 4-year experience with pediatric surgical netwo rking at a major academic medical center in the Midwest. Background The growth of managed care in the United States during the past decade has had a major impact on the practice of medicine in general, but especially o n academic medicine. In some academic medical centers, the loss of market s hare has not only affected clinical activity but has also compromised the e ducational and research missions of these institutions. Methods At the authors' institution, a networking strategy in pediatric surgery was established in 1993 and implemented on July 1, 1994. In 1994, one new sate llite practice was established; over the next 4 years, four additional prac tices were added, including one in another state. To assess the impact on f inancial status, clinical activity, education, and academic productivity, t he following parameters were analyzed: gross and net revenue, surgical case s, clinic visits, ranking of the pediatric surgery residency, publications, grant support, and development and endowment funds. Results Gross and net revenue increased from $3,273,000 and $302,000 in 1993 to $10 ,087,000 and $2,826,000, respectively, in 1998. Surgical cases and clinic v isits increased from 1240 and 3751 in 1993 to 5872 and 11,604, respectively , in 1998. At the medical center's children's hospital, surgical cases and clinic visits increased from 1240 and 3751 to 2592 and 4729 during the same time period. During this 4-year period, the faculty increased from 4 to 1 1. Since 1997, the National Resident Matching Program has provided data on how pediatric surgery residency candidates ranked a training program. In 19 97, this program received the second-most one to five rankings; in 1998, it tied for first. This exceeds the faculty's perception of previous years' r ankings. Publications increased from 26 in 1993 to a peak number of 62 in 1 996; in 1997 and 1998 the publications were 48 and 37, respectively. Extern al grant support increased from $139,882 in 1993 to a total of $6,109,971 i n 1998. Development and endowment funds increased from $103,559 in 1993 to $2,702,2777 in 1998. Conclusions Pediatric surgical networking at the authors' institution has had a markedl y positive impact on finances, clinical activity, education, and academic p roductivity during a 4-year period. The residency training program appears to have improved in popularity among candidates, probably because of the in creased referral of complex cases to the medical center from the various ne tworking satellites. External grant support and basic laboratory research s ignificantly increased, most likely because of the greater number of facult y with protected lime for research recruited. Development and endowment fun ds dramatically grew because of the excellent fiscal health of the pediatri c surgical program. This experience may serve as a model for other academic surgical specialties.