title: The business of academic plastic surgery.
abstract: BACKGROUND
  Given the changes in health care economics and the changes in increasing rates of uninsured and undercovered patients in the United States, the revenue stream for all physicians, and particularly those in academic medical centers, is subject to fluctuations that make it difficult to fund the missions of education and research. Often, academic plastic surgeons are required to use clinical revenue to supplement efforts in research and education. A large margin on clinical revenue that was present perhaps 10 or 20 years ago has been eroded by many socioeconomic factors, making it difficult to provide optimal training in academic environments for our residents.
  
  
  METHODS
  In an attempt to ascertain "best in show," a survey was sent to 89 plastic surgery programs that requested information regarding faculty salaries, relative value units, National Institutes of Health support, ancillary revenue support for taking call, and the number of faculty within individual programs.
  
  
  RESULTS
  Fifty-three programs responded with completed data.
  
  
  CONCLUSIONS
  The following practices directly contribute to stable financial environments: external support for call coverage, recruitment support, and gain sharing associated with health system profitability. Coverage agreements with outside facilities can be lucrative if properly negotiated. Paid medical directorships for administrative/clinical oversight are helpful. Payor mixes with high percentages of commercial, managed care, and self-pay (aesthetic) and low percentages of Medicaid are beneficial. Practices with a healthy mix of aesthetic surgery add strength.
authors.affiliation: Philadelphia, Pa. From the University of Pennsylvania.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
mesh_terms: D006801:Humans; D008389:Marketing of Health Services / Q000458:organization & administration*; D015397:Program Evaluation / Q000379:methods*; D013518:Surgery, Plastic / Q000191:economics*; D011795:Surveys and Questionnaires