A privately financed fellowship model for management training of physicians.

This paper describes the ongoing need for physician executives and reviews current opportunities for training physicians in management. The authors discuss existing sources of funding and highlight one management training program that uses various mechanisms of a new funding model that can increase the number and diversity of learning opportunities, not only in management but also in all disciplines where training traditionally has been underfunded. The basic mechanism of this new model is as follows: a privately funded program uses a locum tenens arrangement whereby a physician fellow works in a community-based private practice in order to produce both compensation for work done and funding for training at an academic institution. Finally, the authors suggest that academic institutions and managed care organizations might consider such a model as one means of using clinical income to expand management training within the contexts of their existing academic missions and patient care commitments.

A method for constructing case-mix indexes, with application to hospital length of stay.

This article presents the methodological development of an index for case-mix adjustment of hospital data exemplified by our construction of an index for studying length of stay. We describe the development and evaluation of this index, including internal and external validation procedures, and show an example of its use in a policy-relevant context by applying it to the analysis of length-of-stay differences between investor-owned and voluntary hospitals. Some advantages of this approach to adjusting for case mix are applicability to many hospital or patient output measurements/diagnostic scheme situations; usefulness in reducing heterogeneity in other case-mix adjustments, e.g., the Diagnosis-Related Group (DRG) approach; interpretation possibilities; production of a single score for each patient/hospital; statistical approach allowing more accurate and reliable interpretation of hospital and patient output measurements, ability to deal with hospital deaths; and consideration of the complete set of secondary diagnoses. We also suggest other possible uses of this approach.

An organized locum tenens service and the cost of free time for rural physicians.

Dissatisfaction with the conditions of rural practice perpetuates the geographic maldistribution of physicians. This study evaluates the economic productivity of physicians who participated in an organized locum tenens (LT) service that was designed to improve practice conditions for rural physicians by making time off more feasible and less costly. The productivity of LT physicians, expressed as their average daily billing, was compared with the amount charged to rural clinics for the LT service and with the revenue billed by the clinic physicians during the same month. The clinics were charged $375/$439/day, compared with $584/day billed by the clinic physicians (p less than 0.01). The revenue billed by 85 per cent of the LTs exceeded the amount charged for their services; the revenue billed during 80 per cent of the coverage episodes also exceeded the $375/day level. When LT billing was expressed as a percentage of clinic physician billing LT productivity was found to be significantly higher in solo practices, as compared with partnership practices (97 per cent vs. 73 per cent, p less than 0.01). Assuming that a physician's overhead remains constant when he leaves, the cost of leaving a practice with LT coverage was almost invariable less than the cost of leaving without coverage. The finding justifies cautious optimism about using LTs to increase free time and improve practice conditions for rural physicians.