title: Differential clinical workloads among faculty at a major academic health center.
abstract: OBJECTIVE
  The authors analyzed patient care (1981-1995) and financial data (1991-1996) to determine if differential workloads existed at a major academic health center.
  
  
  BACKGROUND
  Academic health centers differ markedly from community-based medical centers, but they are required to compete with others who have a more circumscribed mission and a responsibility for providing less complex care. Changes in health care systems may lessen incentives to generate clinical revenue and may adversely affect educational and research programs.
  
  
  METHODS
  Patient care data at the University of Michigan Health System were analyzed by discipline for level of activity from 1981 to 1995 and were compared to professional and institutional financial data from 1991 to 1995.
  
  
  RESULTS
  Surgeons represented 11% of the total full-time physicians throughout the period of the study (94 of the 836 Medical Center physicians, 1995). They accounted for 33% of hospital admissions (11,616 of 35,101) and 16% of outpatient visits (92,364 of 568,738). Since 1981, surgeons experienced a 249% increase in total operative workload (6799-16,909 procedures), representing a 30% increase in operations/surgeon (138-180 operations). Surgical efforts in 1995 accounted for 29% of the total professional fee revenue and $240 million of the $512-million 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 health centers studied. Many proposals for financing health care delivery systems have the potential to exacerbate this differential. Restructuring of academic health centers must address this fact, lest their academic mission and scholarly activity be compromised.
authors.affiliation: Department of Surgery, University of Michigan Medical School, University Hospital, Ann Arbor 48109-0329, USA.
authors.forename: G B
authors.initials: GB
authors.lastname: Zelenock
authors.forename: J C
authors.initials: JC
authors.lastname: Stanley
authors.forename: R A
authors.initials: RA
authors.lastname: More
authors.forename: L J
authors.initials: LJ
authors.lastname: Greenfield
authors.forename: C J
authors.initials: CJ
authors.lastname: Shanley
authors.forename: L A
authors.initials: LA
authors.lastname: Jacobs
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000704:Analysis of Variance; D005180:Faculty, Medical / Q000706:statistics & numerical data*; D005249:Fees and Charges; D013502:General Surgery / Q000191:economics / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000191:economics / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D008824:Michigan; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012109:Research Support as Topic; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*