Clinical practice of medical school faculties: an AAMC survey of problems and issues

This study reports the results of a survey by the Association of American Medical Colleges (AAMC) to identify the salient problems and issues regarding medical school faculty clinical practice in the views of faculty members and administrators in academic medical centers. The population surveyed consisted of university vice-presidents for health affairs, teaching hospital directors, and medical school deans, department chairmen, and faculty representatives. A content analysis of the narrative responses revealed that the apportionment of faculty time to create the appropriate institutional balance among teaching, research, and service missions was the most frequently mentioned concern. Other dominant themes included threats to the patient base needed for teaching and research and/or to future income posed by the new competitive and reimbursement environment and changes required in modes of faculty practice to respond to the new environment. The latter included the need for organizing practice activities into a "true group practice," a change that would accommodate growing demands of purchasers for integrated systems of care. Hospital directors were particularly concerned with issues of faculty-hospital relationships. Results of the survey provide an agenda for a recently formed AAMC ad hoc Committee on Faculty Practice, which will propose initiatives by the AAMC to assist its member institutions in responding to the issues raised.