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Time-Based Productivity Measures for Academic Anesthesiologists

Time-Based Productivity Measures for Academic Anesthesiologists. John R. Feiner, M.D. Associate Professor UCSF Department of Anesthesia and Perioperative Care. Background. Both private and academic practices have debated different systems to fairly: Divide clinical workload

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Time-Based Productivity Measures for Academic Anesthesiologists

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  1. Time-Based Productivity Measures for Academic Anesthesiologists John R. Feiner, M.D. Associate Professor UCSF Department of Anesthesia and Perioperative Care

  2. Background • Both private and academic practices have debated different systems to fairly: • Divide clinical workload • Credit clinical workload • Distribute bonuses based on clinical productivity

  3. Academic Practices • Most academic practices have used an “Availability” system • Faculty are “credited” a day’s work when scheduled for a “Clinical Day” no matter how much clinical work is actually performed

  4. The Clinical Day • Does the “Clinical Day” really reflect clinical work? • How much variation in day length is acceptable before we abandon the idea that “every clinical day is equal”

  5. Day (non-call) Locations

  6. Figure 1 Legend • The graph is a random week in May, 2001 • The y axis shows the length of the work day: the total amount of time spent providing anesthesia care (from the billing record) • Each open circle shows individual anesthesiologists in a “day” location--anesthesiologists on call were excluded • Extreme variation in work day length is notable

  7. “General OR” Only

  8. Figure 2 Legend • The graph is exactly the same as Figure 1 except: • Each open circle shows individual anesthesiologists assigned to work in the general OR at UCSF Moffitt-Long Hospital--subspecialties are excluded! • The extreme variation in work day is still present

  9. Specialty Services

  10. Figure 3 Legend • The x-axis shows the various subspecialties in the UCSF system at UCSF Moffitt-Long and Mt. Zion Hospitals • The y axis shows the average length of the work day ± SD (time spent providing anesthesia care) averaged over last year, 7/1/2000 through 6/30/2001 • Differences between services are apparent, but variation (high standard deviation) within is service is notable

  11. Individual’s “Day”

  12. Figure 4 Legend • Subspecialty services are shown on the x-axis • The y axis shows the average work day (measured by total credit) • Both individual anesthesiologists (open circles), and mean ± SD for the service are shown • Variation within the service is more prominent than any apparent differences between services--the variation shown in the random days (Figs. 1 and 2) do not “average out” over an entire year

  13. “Over”

  14. Figure 5 Legend • Subspecialty services are shown on the x-axis • Our system use the same clinical commitment as the clinical day system, with 8 hours expected each day • Instead of “Clinical Days” over a faculty member’s clinical commitments (%FTE), excess work is measured as hours over the commitment • The y-axis shows hours over clinical commitment, both for the service (mean ± SD) as well as individual anesthesiologists (open circles) • Significant variation is demonstrated within services, and differences between services • The difference between services represent significant understaffing on some services

  15. “Call” Hours After 18:00, Before 7:00, weekends and holiday

  16. Figure 6 Legend • Subspecialty services are shown on the x-axis • The y-axis shows hours performing anesthesia after 6:00 p.m., before 7:00 a.m. weekends and holidays, both for the service (mean ± SD) as well as individual anesthesiologists (open circles) • This definition provides a measure of “call” performed, whether assigned to call or not • Despite attempts to “even out” the scheduled call within services, substantial variation appears throughout each subspecialty, with some difference between subspecialties

  17. Productivity: “Credit” • The majority of credit is the time spent providing anesthesia • Our system still allows adjustments to credit • Additional 15 minutes for starting a case • 30% bonus for “call” credit

  18. Who is Rewarded? • In a “Clinical Day” (Availability) system, the shortest day is rewarded most • Staff get the same “credit” but more time • In a “productivity” based system, the “longest” day is rewarded most

  19. Motivations • Motivations follow rewards • If the greatest reward is for the shortest day, staff are motivated to work less

  20. Advantages: Choice • Productivity System: • Researchers may prefer a shorter day • Younger faculty may want more work if tied to bonuses • “Clinical Day” • Who would want the longer day?? • Who would go home first??

  21. Advantages: Finances • More homeostatic: if credit goes up, then billing (relative to the number of faculty) is increasing • If bonuses/profit sharing is to be based on a productivity measure, then this relationship is essential • This relationship does not necessarily exist for the “Clinical Day”: if a service has lower volume, days will be shorter, not necessarily fewer

  22. Advantages: Specialties • Allows comparisons between subspecialties • Has decreased (not eliminated) debates between various specialties about “credit” • Increased case volume in a subspecialty group is automatically compensated

  23. Advantages :Benchmarking • Increased workload is not necessarily due to more days: it may be due to longer days • Will you really know how hard your faculty is working without looking at the time?

  24. Advantages: Hospital • The fact that anesthesiologist are not compensated unless performing anesthesia is important in debates with: • Surgery department • Hospital administration • The “motivational” aspects of a productivity system are key

  25. Problems with a Time-Based System • Difficulties with services which are not time-based: • Preop • OB • Pain • ICU has time-based component

  26. Conclusions • The length of the “Clinical Day” is too variable: It does not measure productivity • A time-based productivity system tends to reward faculty working the hardestA “Clinical Day” system rewards the shortest day

  27. References • Feiner JR, Miller RD, Hickey RF: Productivity versus availability as a measure of faculty clinical responsibility. Anesthesia and Analgesia 2001; 93: 313-8 • Abouleish AE, Zornow MH, Levy RS, Abate J, Prough DS: Measurement of individual clinical productivity in an academic anesthesiology department. Anesthesiology 2000; 93: 1509-16

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