Objectives: Teaching ability and clinical operations ef铿乧iency are important aspects of physician performance that are increasingly linked to productivity compensation. We evaluated the relationship between teaching performance and patient throughput times.
Methods: Our setting is an urban, academic, level-1 trauma center with an annual census of 65,000. In 2006, 铿乿e domains of instructional quality were measured for each faculty member using an 18-item resident survey. These domains were: Competency and Professionalism, Commitment to Knowledge and Instruction, Inclusion and Interaction, Patient Focus, and Openness to Ideas. Each provider鈥檚 average score across respondents for each domain was regressed upon patient throughput times using a multivariate, random effects model assuming gamma distributed errors. Faculty serving part of 2006 were excluded. Encounters without direct resident assistance were excluded.
Results: 38,526 encounters across 24 faculty members were identi铿乪d. These were randomly separated into estimation and validation datasets. The estimation dataset was used to develop the model; the validation to protect against over 铿乼ting. After adjusting for patient acuity, age, time of arrival and ED census, two of the 铿乿e instructional domains were found to signi铿乧antly correlate with patient treatment times in both datasets. The greater a physician鈥檚 Commitment to Knowledge and Instruction, the longer his/her throughput time, with each interval increase on the domain scale associated with a 7:15 minute increase in throughput time (95% CI: 4:10, 10:40). Conversely, increased receptivity of new ideas was associated with a 4:44 minute decrease in throughput (95% CI, 2:44, 6:44).
Conclusions: Faculty performance in speci铿乧 domains of instructional quality has signi铿乧ant but varied associations with patient throughput times. As pay-for-performance plans become more common, it is important to understand the relationship between competing demands facing ED faculty.
