Current income profile for academic pediatric emergency medicine faculty

The pediatric subspecialty workforce: public policy and forces for change

Policy has not adequately addressed the unique circumstances of pediatric subspecialties, many of which are facing workforce shortages. Pediatric subspecialties, which we define to include all medical and surgical subspecialties, are discrete disciplines that differ significantly from each other and from adult medicine subspecialties. Concerns about a current shortage of pediatric subspecialists overall are driven by indicators ranging from recruitment difficulties to long wait times for appointments. The future supply of pediatric subspecialists and patient access to pediatric subspecialty care will be affected by a number of key factors or forces for change. We discuss 5 of these factors: changing physician and patient demographics; debt load and lifestyle considerations; competition among providers of subspecialty care; equitable reimbursement for subspecialty services; and policy to regulate physician supply. We also identify issues and strategies that medical and specialty societies, pediatric subspecialists, researchers, child advocates, policy makers, and others should consider in the development of subspecialty-specific workforce-policy agendas.

Regional after-hours urgent care provided by a tertiary children's hospital

BACKGROUND

Ambulatory presentation to a tertiary pediatric emergency department (ED) is not convenient for many families. Yet many primary care pediatricians (PCPs) desire after-hours urgent care for their patients as an alternative to extended office hours or care by general emergency medicine providers at community hospitals.

OBJECTIVE

To describe a regional, community-based pediatric urgent care network (PUCN).

METHODS

The PUCN consists of 4 models: 1) pediatric emergency medicine faculty in a community hospital ED; 2) general pediatricians in a community hospital ED; 3) general pediatricians in a freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent care center. Physician staffing at all 4 sites is managed by our tertiary children's hospital. Billing records were reviewed and a questionnaire was mailed to 55 PCP practices in our metro area.

RESULTS

Year 2001 visits totaled 37 143. Minor trauma, ear complaints, and viral illnesses accounted for 70% of visits. Current Procedural Terminology codes for visits, reflecting complexity levels 1, 2, 3, 4, and 5 were billed at the following frequency: 1%, 35%, 44%, 17% and 3%, respectively. A total of 2.2% of visits required admission or transfer. Mean collection rates ranged from 37% to 68% across the 4 sites. Break-even average hourly patient volumes ranged from 1.1 (site 4) to 1.9 (sites 1 and 3). A total of 110 PCPs, representing all 55 practices, responded to the questionnaire: 81% reported their patients used the PUCN often, 85% felt that communication between the PUCN and their practice was good, and 99% reported overall satisfaction with the network.

CONCLUSIONS

The PUCN effectively addresses the needs of regional PCPs; however, the cost-effectiveness of such a program depends on billing practices, local collection rates, and site-specific staffing patterns.

A simple plan--faculty compensation in an academic department of emergency medicine

An equitable and effective compensation system is essential to the smooth and productive operation of any academic department. While academic departments of emergency medicine must meet clinical, teaching, research, and administrative missions, they are disproportionately reliant on funds derived from clinical activities. The Department of Emergency Medicine at UCSD is a freestanding academic hospital department with responsibility and accountability for its own finances. The compensation system addresses the reliance on clinical income yet recognizes the other, largely underfunded, missions. All salaries are comprised of a base amount tied to the core clinical workload, scaleable stipends for academic rank, years of service, and administrative role, as well as a provision for clinical bonus and additional clinical workload. Faculty have the option of adjusting clinical workload with resultant formulaic modification of departmental salary support. Salary adjustment fosters the core value of clinical service and provides incentive for senior faculty to remain clinically active. The system has been in place for more than six years and has been associated with an excellent record of patient care, teaching, academic productivity, administrative service, faculty stability, and fiscal integrity.