Faculty views of reimbursement changes and clinical training: a survey of award-winning clinical teachers.
BACKGROUND
Prominent authorities believe that managed care and governmental policies are compromising the clinical education of future physicians.


OBJECTIVE
This study sought the views of clinical teachers to quantify the extent to which managed care and governmental policies have changed clinical education.


METHODS
Questionnaires were mailed to faculty that U.S. medical schools had recognized for clinical teaching excellence. Measures included reports of change in quality of clinical teaching due to payment regulations, Liaison Committee on Medical Education (LCME) and Residency Review Committee (RRC) requirements, and institutional support for teaching; change in numbers of students-trainees in clinics; need to generate more clinical revenue; and change in enjoyment of teaching. Other measures about clinical teaching included faculty attitudes, institutional rewards, and teaching different levels of students. Characteristics of the respondents also were measured.


RESULTS
Faculty reported that payment regulations have affected clinical teaching negatively and that faculty need to generate more clinical revenue. Institutions tend to provide a supportive teaching environment but do not reward teaching financially. Intrinsic incentives for teaching increase as the level of student increases. Faculty reports did not differ by medical specialty or other faculty characteristics. Differences among medical schools occurred on all measures.


CONCLUSIONS
Clinical education is being negatively affected, but not yet critically. Continued clinical financial pressures on faculty will affect all levels of clinical education, particularly for medical students. Differences among institutions indicate that individual schools can moderate or exacerbate the impact of external forces on the teaching faculty. Medical schools should monitor increasing pressures on faculty and ensure that goals, processes, support, and rewards for clinical teaching are proportionate to those for clinical care.
Woolliscroft
James O
JO
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA. woolli@umich.edu
Harrison
R Van
RV
Anderson
M Brownell
MB
D000328:Adult; D000368:Aged; D001290:Attitude; D001363:Awards and Prizes; D004501:Education, Medical / Q000191:economics*; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011640:Public Policy; D012052:Reimbursement, Incentive; D012577:Schools, Medical / Q000191:economics; D014146:Training Support / Q000191:economics; D014481:United States