LETTER RE: Incorporating students into clinic may be associated with both improved clinical productivity and educational value
Emile P.Roy, MD, Neurologist, Mount Nittnay Physician Group, State College, PA. Clin Prof, Dept of Neurology Penn State Milton S. Hershey Medical Center
Submitted January 17, 2018
The recent article by Tanner et al. concluding that medical students in outpatient clinic can improve productivity is surprising.[1] As a private practice neurologist who routinely interacts with medical students in the hospital and outpatient clinic, I believe that medical students adversely affect productivity. This study was done only in academic outpatient clinics. There was no mention of clinic hours, number of scheduled patients, or patient time intervals. Without more specific scheduling information, this study seems incomplete.
A full daily schedule has no free time for students. If there was no opening in the preceptor’s schedule, then they were looking for something to do while waiting for the student and running behind. Alternatively, the preceptor already had an open time slot to do work while waiting for the student. In that case, their schedule was not full. If preceptors were “completing prior notes or interpreting procedures” waiting for the student, that only increases net invoices for that time period, as those tasks would have to be done anyway.
Interacting with students in the hospital typically requires more time, which results in a late arrival to the outpatient clinic, decreasing daily productivity (RVU generation). RVU generation is paramount to a neurologist’s income. The majority of surveyed neurologists list RVUs as a main basis of compensation.[2] Burnout in neurology is high[3] and finishing late by increased work load or teaching is a major contributor to this,[4] particularly if compensation shrinks. Therefore, the positives from teaching come with a high cost – a direct negative effect on compensation. A future study, including inpatient as well as private practice outpatient clinic, would be interesting.
Disclosure: The author reports no disclosures
References:
1. Tanner JA, Rao KT, Salas RE, et al. Incorporating students into clinic may be associated with both improved clinical productivity and educational value. Neurol Clin Pract 2017;7:474-482.
2. The 2017 Neurology Compensation and Productivity Survey. https://reporting.qualtrics.com/AAN/ [Accessed January 18, 2018]
3. Busis NA, Shanafelt TD, Keran CM, et al. Burn out, career satisfaction, and well-being among U.S. neurologists in 2016. Neurology 2017;88:797-808.
4. Miyasaki JM, Rheaume C, Gulya L, et al. Qualitative study of burn out, career satisfaction, and well-being among U.S. neurologist in 2016. Neurology 2017;89:730-1738.
The recent article by Tanner et al. concluding that medical students in outpatient clinic can improve productivity is surprising.[1] As a private practice neurologist who routinely interacts with medical students in the hospital and outpatient clinic, I believe that medical students adversely affect productivity. This study was done only in academic outpatient clinics. There was no mention of clinic hours, number of scheduled patients, or patient time intervals. Without more specific scheduling information, this study seems incomplete.
A full daily schedule has no free time for students. If there was no opening in the preceptor’s schedule, then they were looking for something to do while waiting for the student and running behind. Alternatively, the preceptor already had an open time slot to do work while waiting for the student. In that case, their schedule was not full. If preceptors were “completing prior notes or interpreting procedures” waiting for the student, that only increases net invoices for that time period, as those tasks would have to be done anyway.
Interacting with students in the hospital typically requires more time, which results in a late arrival to the outpatient clinic, decreasing daily productivity (RVU generation). RVU generation is paramount to a neurologist’s income. The majority of surveyed neurologists list RVUs as a main basis of compensation.[2] Burnout in neurology is high[3] and finishing late by increased work load or teaching is a major contributor to this,[4] particularly if compensation shrinks. Therefore, the positives from teaching come with a high cost – a direct negative effect on compensation. A future study, including inpatient as well as private practice outpatient clinic, would be interesting.
Disclosure: The author reports no disclosures
References:
1. Tanner JA, Rao KT, Salas RE, et al. Incorporating students into clinic may be associated with both improved clinical productivity and educational value. Neurol Clin Pract 2017;7:474-482.
2. The 2017 Neurology Compensation and Productivity Survey. https://reporting.qualtrics.com/AAN/ [Accessed January 18, 2018]
3. Busis NA, Shanafelt TD, Keran CM, et al. Burn out, career satisfaction, and well-being among U.S. neurologists in 2016. Neurology 2017;88:797-808.
4. Miyasaki JM, Rheaume C, Gulya L, et al. Qualitative study of burn out, career satisfaction, and well-being among U.S. neurologist in 2016. Neurology 2017;89:730-1738.