PubMed · 469422
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J T Mooresmith. 1979. Required reporting by physicians.. https://pubmed.ncbi.nlm.nih.gov/469422/
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Changes in health care delivery necessitate modification in dermatology training. While the residents at The University of Alabama at Birmingham were planning their 1995-1996 curriculum, several questions regarding the most appropriate allocation of time and resources arose. Interest in other residency curricula prompted the development of a national survey of dermatology residents. Our purpose was to provide comprehensive data regarding the didactic, clinical, surgical, and other aspects of today's U.S. dermatology residency training from the perspective of the residents. It is hoped these data will assist dermatology residency programs with evaluation of their current curricula. A comprehensive 31-question multiplechoice survey was mailed to 631 residents in 70 U.S. dermatology residency programs. Results were tabulated and median values and percentages of responses were obtained. A Wilcoxon rank-sum test, a chi-square analysis, and logistic regression analysis were performed on survey items on the basis of residents' satisfaction with the training program. Two hundred forty-eight responses (39%) were returned with all years of training well represented. Median values and percentages obtained outlined the didactic, clinical, surgical, and other aspects of dermatology residency training. Seventeen percent of residents believed they were not being adequately trained. Satisfaction with training was noted with more didactic faculty involvement, consultations and research, and surgical procedures performed per month. Residents with enriched didactic, clinical, and surgical training experiences are more satisfied with their training programs.
Beginning in 1991-92, the Department of Medicine at The University of Alabama (UAB) changed its practices for allocating funds made available through the dean's office and for handling professional practice revenues. The specific goals of this new "plan for responsibility-center management" were--and remain--(1) to increase financial flexibility so the chair can reward productivity, strengthen existing programs, and better respond to departmental and institutional needs and opportunities; (2) to encourage the UAB tradition of responsible entrepreneurism at the levels of division directors and individual faculty; (3) to increase extramurally funded program-building at the division level; and (4) to relate the costs of practice directly to total patient care revenues. The plan's intent is to provide rewards, incentives, and recognition for the contributions of individual faculty. The author describes in detail the operation of the plan and the traditions and assumptions underlying it (e.g., the first requirement is to have good employees), and evaluates its effects, strengths, and weaknesses after three full fiscal years. He explains how the plan was introduced and implemented, documents the outstanding gains in the department's financial resources, both short- and long-term, and describes past and ongoing difficulties (for example, the effect of historic UAB decisions regarding the funding of graduate medical education, the extreme decentralization of clinic operations and patient care billing activities, and the question of how fast the shift to capitated managed care will be). He concludes that the plan appears to be a successful effort at broadly-based productivity enhancement, but that evaluation is ongoing.
The primary policy option that has been suggested to states over the years for shifting care for Medicaid beneficiaries away from hospital sites and toward office sites has been to raise Medicaid fees to physicians on the assumption that this increases the geographic availability of office-based care, which then naturally attracts Medicaid clients away from hospital sites. This study uses Medicaid claims data from the state of Alabama to assess the role of geographic provider availability relative to other factors in families' decisions to select a hospital or an office for an illness visit to a primary care or to a specialist physician. The authors examined the last ambulatory visit for an illness made by continuously enrolled children under age 8 in the first half of 1991. The authors found that both higher Medicaid office practice density and the presence of larger Medicaid office practices were associated with choice of an office for ambulatory care, whereas the presence of larger Medicaid hospital practices were associated with choice of a hospital for care. Controlling for provider availability, hospital users were less likely to have sought previous care for illness during the year, and were more likely to be rural residents, to have traveled away from their home counties for care, and to be eligible for Medicaid through Aid to Families with Dependent Children, rather than through the program's income expansions. We conclude that increased office-based provider availability must be coupled with improved access tor new, remote, and very low income families if Medicaid clients are to be expected to voluntarily shift their choice if site for ambulatory care.