1. Empowering Surgical Faculty Ronald F Martin, MD 20 April 2010 APDS, San Antonio, TX

2. Marshfield Clinic/St Joseph's Hospital u 760+ physician clinic (~350 at hub) u 505 bed tertiary referral hospital u Level 2 ACS COT Trauma center u Programs in Surgery, Pediatrics, Internal Medicine, Med/Ped, Psychology, Family Medicine, Dermatology, Transitional Year, Palliative Care (fellow), Pharmacy

3. Marshfield, WI u Geographic center of Wisconsin u 18,000 population- steady u Predominant industry Marshfield Clinic- health care –Other industries, farming and manufacturing

4. Surgery program u Established 1975 u 2 categorical residents per year u No preliminary residents u No University on site –Academic affiliation with UW Madison –WARM medical students 3 rd and 4 th year

5. Program Status u Change in Program director Jan 2008 –4 year accreditation (2 yrs in) –Minimal citations –Difficulty recruiting staff and residents –A perception of serious morale problems within department

6. A “forensic” analysis u Approximately 2 months –Met with every person at every site directly involved with the program –Reviewed every document and report on goals, objectives and performance –Reviewed all budgets

7. What was learned u Most members of the department were less than fully aware of – Their described performance objectives by the department –The “external” rules governing the department –The basis for administrative decisions

8. What else was learned u Virtually no one could articulate a rationale for the budget u Serious misconceptions among faculty about performance and compensation were more toxic to morale than was recognized u Resident performance was generally overestimated by faculty

9. What was done u Final bilateral acceptance of the program director was contingent on –Developing an agreement among the faculty –Developing an agreement between Med Ed and the Program

10. The “soft” stuff u Multiple sessions with the faculty were scheduled: –Education as to the “rules and constraints” and situational awareness –Developed mechanism to re-write all documents for performance in ways that allowed metrics and analysis* –Decision to re-format entire curriculum to allow for assessment of resident and faculty performance

11. The “hard” stuff u Pooled all teaching compensation* –*Does not mean all receive equal amounts and does not include extra- departmental funding u Set criteria for inclusion in pooled compensation –Conference attendance, scholarly activity, evaluation, teaching agreements, and timeliness of all above

12. More hard stuff u Division of education surrenders right to differentially compensate u Global teaching budget re-negotiated annually u Program director provides an accounting and selects/deselects recipients for compensation u Program Director takes significant pay cut

13. What happened u We negotiated a nearly cost/revenue neutral solution that allowed –Purchase of a CBT program to augment conferences –Slightly increased median teaching compensation (non-PD) –Augmented Assistant PD support –Integrated new medical student program

14. What happened (cont) u We have seen –A significant increase in real time involvement by faculty in non-RVU acitivity –a significant upwards trajectory of ABSITE score and other std metrics – better morale among residents and faculty u We have significantly improved our ability to recruit residents and some faculty (not trauma)

15. The take home lessons u Faculty feel empowered when –They know what is expected of them –They know how it is measured –They had a say in determining the goals and metrics –They are compensated for something of perceived value

16. Free advice u Seek input from your faculty u Explain why their desires can’t come true (when they can’t) u Try to convince them that they are better off standing together than standing alone u PDs take the first financial hit

17. More free advice u Determine what you value u Reward what you value –Even if the reward is small it will probably still get you what you want u If you stand up for your faculty they will most likely stand up for you

18. Thanks!