Relationship between market competition and the activities and attitudes of medical school faculty
E. G. Campbell, J. S. Weissman and D. Blumenthal
Division of General Internal Medicine, Massachusetts General Hospital, Boston 02114, USA. ecamp@sol.mgh.harvard.edu
CONTEXT: Growth in health care market competition and the concomitant
increasing dependence of academic health centers on clinical revenues may
require medical school faculty to increase patient care activity, perhaps
at the expense of research and teaching. However, the relationship between
health care market competitiveness and the activities and attitudes of
medical school faculty has not been established. OBJECTIVE: To examine the
relationship between market competitiveness and the activities and
attitudes of medical school faculty members. DESIGN: Mailed survey of 3394
life-science faculty in the 50 universities that received the most funding
from the National Institutes of Health in 1993. SETTING: Medical schools in
research-intensive universities. PARTICIPANTS: A total of 2167 faculty
responded to the survey (response rate, 64%). We analyzed the responses of
1671 medical school research faculty located in markets of differing health
care competitiveness, ranging from least competitive (stage 1) to most
competitive (stage 4) markets. MAIN OUTCOME MEASURES: The number of
publications in refereed journals in the last 3 years, the average number
of hours per week of teaching contact, whether faculty in clinical
departments had patient care responsibilities, and measures of departmental
community, cooperation, and conflict. RESULTS: Clinical researchers in
stage 1 and 2 markets published more scientific articles than those in
stage 3 markets (14.5 vs 12.6, P=.04) or in stage 4 markets (14.5 vs 12.0,
P=.03). Among 96 young faculty (professional age-<10 years) in clinical
departments, 11 (44%) of those in stage 1 and 2 markets had patient care
duties compared with 32 (56.1%) of young faculty members in stage 3 markets
(P=.04) and 12 (85.7%) of those in stage 4 markets (P=.01). The percentage
of senior faculty in clinical departments (n=691) with patient care
responsibilities did not differ significantly by market stage. Compared
with faculty in less competitive markets, faculty in stage 4 markets
perceived lower levels of departmental cooperation and higher levels of
conflict. CONCLUSIONS: Increased competitiveness of health care markets
seems to hinder the capacity of academic health centers to conduct clinical
research and to foster the careers of young clinical faculty.
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