1. Enhancing Faculty Performance Mark L. Friedell, MD Orlando Health APDS San Antonio April 20, 2010

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4. Orlando Health Program l 60 years old – growth began in 1995 l Originally 2 chiefs, now 4 l Non-university to hybrid to university l Full and part-time faculty l 800 bed hospital (ORMC) –Level 1 trauma center –Integrated women and children's hospitals l Satellite hospital (Dr. Phillips)

6. Full-Time Faculty l Originally just a PD l Now 15 surgeons –5 Trauma/SCC Surgeons –2 General Surgeons –2 MIS/Bariatric Surgeons –3 Surgical Oncologists –3 Vascular Surgeons

7. Full-Time Faculty Responsibilities l M & M l Grand Rounds l Skills Lab l Pig Lab l Director of Trauma l Basic Science Curriculum l Resident Research l Overall oversight of program

8. Part-Time Faculty l Originally just individual surgeons and small groups l Now 3 groups –General Surgeons – 6 (4 prior residents) –Pediatric Surgeons – 4 (1 prior resident) –Colorectal Surgeons – 5 (2 prior fellows)

9. Part-Time Faculty PROS –Provide large breadth and depth of cases –Teaching in OR, on wards and in clinic –Provide excellent feedback about residents (when given)CONS –Little control over them for: »Evaluations »Didactic teaching »Attendance at conferences »Scholarly activity

10. Part-Time Faculty l Carrots –Annual $$ –Get just one or two surgeons in each group to do composite evaluations, attend important department meetings and give mock orals –Teacher of the Year –Offer full-time status (with practice buy-out)

11. Part-Time Faculty l Sticks –Withholding $$ –Resident evaluations of attendings/rotations (could back-fire) –Threaten to withdraw resident coverage »MLP replacement would be costly »Must have a backup plan first

12. Attending Resignation l Harshest and least technically-adept surgeon in the group l Poor evaluations from residents – surgeon became infuriated when given them l No resident coverage when he is on call l When his patients have problems residents respond only to an emergency situation

13. $$$$$$$$$$$$$ l General Surgery Group –Teaching Stipend –MDACCO Stipend l Pediatric Surgery Group –Medical Director, Children’s Trauma Services Stipend –Medical Director, Pediatric Surgical Education Stipend –Director, Surgical Liaison Services Stipend

14. $$$$$$$$$$$$$ l Colorectal Surgery –Salary and benefits for 3 fellows –Stipend for the program director

15. Part-Time Faculty Contract Addendum l Participate in research projects with residents l Participate in the recruitment and selection of residents l Provide assistance with goals and objectives and curriculum revisions l Participate in the annual review of the program l Give formal lectures

16. l Ensure clinical education of residents l Attendance at some department conferences (M&M, grand rounds) and faculty meetings l Participate in department mock oral examinations l Ensure resident compliance with duty hours l Complete resident evaluations (in a timely fashion). Part-Time Faculty Contract Addendum What they actually do

17. Alliance of Independent Academic Medical Centers How to compensate PT faculty for educational work? (Feb, 2010) l No payments l Lump sum to the practice in keeping with federal guidelines l Teaching stipends based on time spent on educational activities (away from practice) l “Teaching RVU” model

18. APDS List Serve Criteria needed for attendings to participate on a teaching service (i.e., have resident coverage): 1. Adherence to the six ACGME Core Competencies 2. Completion of a minimum of 75% of Resident Evaluations (including written comments) 3. Completion of the Annual Program Evaluation

19. APDS List Serve 4. Participation in an annual faculty evaluation meeting; the faculty member will agree to participate in a structured program to improve their teaching scores 5. Teaching faculty will agree to meet with PD outside of the scheduled annual faculty evaluation when needed in response to a low score notification on the electronic evaluation system 6. Participation in residency selection process 7. Allow resident participation in substantial portion of operative procedures

20. List Serve Comments l “I like the list; I wish all of our faculty would do all of these things. What is done with faculty who are not compliant?” l “While the list is good in theory, I wonder if you set the bar too high you might alienate some good, hard-working volunteer faculty that just can’t keep up with the paperwork demands. Then who loses?” l “I would not settle for less than 100% compliance with evaluations.”

21. ACS Surgeons as Leaders Vignette 2008 You are the PD of a free-standing surgical residency at an 800-bed multispecialty community hospital. The program depends upon a busy surgical group for a breadth and depth of cases for the residents. These surgeons receive a stipend to “teach” in the operating room. Most are unwilling to participate in conferences (such as M&M and Grand Rounds) or faculty meetings. Resident evaluations are rarely completed on time. The hospital administration is proud of its excellent surgical residency yet also aware of the shortcomings of these private practitioners. However, it is reluctant to alienate these surgeons because of the business they bring to the hospital and their importance to the residency. You are told to do your best to get them to meet all of the obligations they contractually agreed to when they accepted the teaching stipends, particularly since there is an upcoming RRC visit next year.

22. Question What approaches can be used to motivate your PT faculty? l Get the administration behind you first l Throw more money at them l Engage another equally competent group as possible alternative l Hire more full-time faculty l Give them perks

23. Conclusions l No magic answers for this complex problem l 100% compliance by PT faculty is unrealistic l Money placates but does not get them to do everything you want l Bringing them in full-time will not guarantee greater compliance l Try to find another group of surgeons l Hire more full-time faculty if possible

24. Conclusions l Use composite resident evaluations from one or two members of the group l Work closely with the private groups via: –A recent resident graduate –The practice manager l Working with part-time faculty requires a PD to “pick his/her battles”: –Bimonthly faculty meetings –Annual program review –Mock Orals –M&M attendance if case is presented –Evaluations

25. Most Recent Crisis l PT attending concerned that his cases are being presented “too often” at M&M. He never goes to conference and only knew about the presentations because the residents routinely inform faculty members before cases are presented. l The veiled threat was that he would resign from the faculty. l Residents concerned because he provides great cases for them. l Need PD intervention