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RESEARCH LETTER | Health Care Reform

Developing a Model for Attending Physician Workload and Outcomes

Henry J. Michtalik, MD, MPH, MHS; Peter J. Pronovost, MD, PhD; Jill A. Marsteller, PhD, MPP; Joanne Spetz, PhD; Daniel J. Brotman, MD
JAMA Intern Med. 2013;173(11):1026-1028. doi:10.1001/jamainternmed.2013.405.
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With increased economic pressures on hospitals, limitations on resident physician hours, and payment reductions for preventable harms, hospitals seek to increase productivity while improving the quality of patient care. Frequently, relative value units and patient encounters are used to track physician productivity and establish national benchmarks.1,2 However, productivity varies based on a range of characteristics that are not generally reported, limiting the accuracy of comparisons across institutions. Also, comprehensive process and outcome measures from different stakeholders' perspectives need to be established to align diverse health care interests, ensure widespread acceptability, and provide comprehensive goals.3 In the present study, we (1) identify an actionable measure of attending physician workload; (2) characterize factors accounting for differences in workload; and (3) identify a congruent set of measures that would be valued by disparate stakeholders.

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Figure. Summary of physician, hospital, team, and patient characteristics affecting attending physician workload. HS indicates house staff (residents, fellows); NPP, nonphysician practitioner.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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