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Compensation to a department of medicine and its faculty members for the teaching of medical students and house staff
hemorrhagic lesions, three cases of Coats' disease, two retinal detachments, one metastasis, one patient with Norrie's disease, and one case of panophthalmitis. Two patients with histologically verified malignant melanoma and two patients with retinoblastoma had been incorrectly diagnosed as having secondary glau coma (three patients) and Coats' disease (one pa tient).—George B. Bartley *UKE Hamburg: Institut für Pathologie, Martinistrasse 52, D-20246 Hamburg, Germany.
• Compensation to a department of medicine and its faculty members for the teaching of medical students and house staff. Shea S*, Nickerson KG, Tenenbaum ], Morris TQ, Rabinowitz D, O'Donnell K, Perez E, Weisfeldt ML. N Engl J Med 1996; 334:162-7.
A
LTHOUGH HEALTH CARE REFORM HAS CAUSED
teaching hospitals and academic medical centers to focus more closely on the finances of clinical care, little information has been available on the costs associated with teaching medical students and resi dents. This study was conducted to determine the amount of time spent teaching by members of a department of medicine at an academic center and to calculate the reimbursement for such activities. The teaching of fellows and participation in continuing medical education programs were excluded from the analysis. During the 1992-1993 academic year, 188 full-time faculty members spent a total of 46,086 hours teaching (mean ± standard deviation, 245 ± 178 hours per faculty member). Approximately three fourths of the time was spent teaching house staff and one fourth teaching medical students. In a multivariate analysis, it was determined that senior faculty members (P = .02), members of certain subspecialty divisions (P < .001), and women (P = .05) contrib uted more than the average number of teaching hours. An additional 56 non-full-time faculty mem bers contributed a total of 5,684 hours teaching (approximately 11% of the total teaching load). The net reimbursement to the department, after the cost of fringe benefits was excluded, was less than $16 per hour of teaching. Faculty members at the institution in question are expected to generate all or most of VOL. 121, NO. 4
their salary through research or clinical activities. The authors concluded that "cost-containment efforts have the potential to jeopardize fragile social con tracts at academic health centers whereby the faculty participates in teaching by contributing unreimbursed or underreimbursed time." Editor-in-Chief Jerome P. Kassirer, in an accompanying commentary (Tribula tions and rewards of academic medicine—where does teaching fit? N Engl J Med 1996;334:184-5), asserted that "teaching is . . . one of our most important obligations" and reiterated a proposal that the costs of medical education should be borne broadly by placing a tax on all health insurance premiums.—George B. Bartley 'Division of General Medicine, PH 9 East, 622 W 168th St., New York, NY 10032.
• Health policy report. Politics and public health. Iglehart JK*. N Engl J Med 1996;334:203-7.
T
HE GOALS OF THE CLINTON ADMINISTRATION TO
"reinvent government" and of the Republican Congress to eliminate the federal deficit have impor tant implications for the Public Health Service and other federal health agencies, such as the National Institutes of Health, the Centers for Disease Control, the Agency for Health Care Policy and Research, and the office of the Assistant Secretary for Health. This article succinctly reviews the history of the Public Health Service (which was instituted by Congress in 1798 to care for sick seamen who arrived at American ports); the plans to consolidate the multifarious and narrowly targeted Public Health Service categorical grant programs into a handful of general programs; the influences of the House and Senate Appropria tions Committees on health care policy; the effects of congressional decisions on biomedicai research and disease surveillance and control through the National Institutes of Health and the Centers for Disease Control, respectively; the intense political overtones that could shape the future of health services re search; and the potential effects of changes in leader ship in key congressional committees. The author noted that the Republicans in Congress have demon strated an appreciation for the value of biomedicai research by approving funding for the National Insti-
ABSTRACTS
469
• Compensation to a department of medicine and its faculty members for the teaching of medical students and house staff. Shea S*, Nickerson KG, Tenenbaum ], Morris TQ, Rabinowitz D, O'Donnell K, Perez E, Weisfeldt ML. N Engl J Med 1996; 334:162-7.
A
LTHOUGH HEALTH CARE REFORM HAS CAUSED
teaching hospitals and academic medical centers to focus more closely on the finances of clinical care, little information has been available on the costs associated with teaching medical students and resi dents. This study was conducted to determine the amount of time spent teaching by members of a department of medicine at an academic center and to calculate the reimbursement for such activities. The teaching of fellows and participation in continuing medical education programs were excluded from the analysis. During the 1992-1993 academic year, 188 full-time faculty members spent a total of 46,086 hours teaching (mean ± standard deviation, 245 ± 178 hours per faculty member). Approximately three fourths of the time was spent teaching house staff and one fourth teaching medical students. In a multivariate analysis, it was determined that senior faculty members (P = .02), members of certain subspecialty divisions (P < .001), and women (P = .05) contrib uted more than the average number of teaching hours. An additional 56 non-full-time faculty mem bers contributed a total of 5,684 hours teaching (approximately 11% of the total teaching load). The net reimbursement to the department, after the cost of fringe benefits was excluded, was less than $16 per hour of teaching. Faculty members at the institution in question are expected to generate all or most of VOL. 121, NO. 4
their salary through research or clinical activities. The authors concluded that "cost-containment efforts have the potential to jeopardize fragile social con tracts at academic health centers whereby the faculty participates in teaching by contributing unreimbursed or underreimbursed time." Editor-in-Chief Jerome P. Kassirer, in an accompanying commentary (Tribula tions and rewards of academic medicine—where does teaching fit? N Engl J Med 1996;334:184-5), asserted that "teaching is . . . one of our most important obligations" and reiterated a proposal that the costs of medical education should be borne broadly by placing a tax on all health insurance premiums.—George B. Bartley 'Division of General Medicine, PH 9 East, 622 W 168th St., New York, NY 10032.
• Health policy report. Politics and public health. Iglehart JK*. N Engl J Med 1996;334:203-7.
T
HE GOALS OF THE CLINTON ADMINISTRATION TO
"reinvent government" and of the Republican Congress to eliminate the federal deficit have impor tant implications for the Public Health Service and other federal health agencies, such as the National Institutes of Health, the Centers for Disease Control, the Agency for Health Care Policy and Research, and the office of the Assistant Secretary for Health. This article succinctly reviews the history of the Public Health Service (which was instituted by Congress in 1798 to care for sick seamen who arrived at American ports); the plans to consolidate the multifarious and narrowly targeted Public Health Service categorical grant programs into a handful of general programs; the influences of the House and Senate Appropria tions Committees on health care policy; the effects of congressional decisions on biomedicai research and disease surveillance and control through the National Institutes of Health and the Centers for Disease Control, respectively; the intense political overtones that could shape the future of health services re search; and the potential effects of changes in leader ship in key congressional committees. The author noted that the Republicans in Congress have demon strated an appreciation for the value of biomedicai research by approving funding for the National Insti-
ABSTRACTS
469