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Negotiating Research Time With The Chairman

B+JD Young Investigator Initiative May 13-15, 2005. Negotiating Research Time With The Chairman. Kurt P. Spindler, MD Professor & Vice Chair, Orthopaedics Director, Vanderbilt Sports Medicine & Ortho PCC Head Team Physician, Vanderbilt University. Introduction.

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Negotiating Research Time With The Chairman

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  1. B+JD Young Investigator Initiative May 13-15, 2005 Negotiating Research Time With The Chairman Kurt P. Spindler, MD Professor & Vice Chair, Orthopaedics Director, Vanderbilt Sports Medicine & Ortho PCC Head Team Physician, Vanderbilt University

  2. Introduction GOAL: Survival: Orthopaedic Clinician Scientist DEF: Scientist: Actively conducts either basic or clinical research ACADEMICS: Not exclusively research! • Education • Leadership Ortho Org -- AAOS, AOA MONEY: Only medium determine VALUE to organization

  3. Background: This is NOT EBM • Therefore, interpret based on my experience! • MEDICAL TRAINING: • Univ of Penn Med School 1985 • Univ of Penn Ortho Res 1990 • One yr McKay Lab Ortho Research 1987 • Cleveland Clinic Fndn Spts Med 1991 • FACULTY POSITIONS ~FOURTEEN YEARS Assistant  Associate  Professor

  4. Current Responsibilities 2005 EDUCATION • EBM • Sports Medicine RESEARCH • MOON • Tiss Eng ACL FAMILY CLINICAL • Sports Med. • Team Phys VU ADMIN • VSM • Ortho PCC

  5. Hx Funding Orthopaedic Research • TAX PROFESSIONAL EARNINGS (Clinical earnings) • Result cross-substitution within dept • Paid VA salary for ortho clin scientist • Funded lab costs -- salary and supplies • WHY IN PAST SUCCESSFUL? • Ortho overcompensated by insurance • Academic centers had unique ortho services • 2.5 days 1991 yields same as 5 days 2003, therefore, academic time plentiful • Majority inpatient practice

  6. Missed Opportunities • Little development endowment research funding • Few endowed Chairs! • Ortho clinician scientist • PhDs • Failure recognize 80% health care dollar -- NOT PROFESSIONAL FEES ! • Slow to develop academically acceptable partnerships with industry • Disproportionately low % funds from NIAMS and NIAMS low % NIH • No funding study section clinical research within NIAMS

  7. Present  Future • Compensate based on PRODUCTIVITY! • CLINICAL • OR: Billing/collection (not RVUs) • Clinic: Billing/collection/RVUs • RESEARCH • Grant dollars ( NIH vs other ) • Gift dollars • Peer-review publications • TEACHING??

  8. Department Infrastructure CostsBasic Science Lab • COSTS:Space, PhDs, salaries, equip • GENERAL 250-400 K ANNUALLY • Success depends NIH grant funding! • Endowments • Corporate support • CAVEAT:Programmatic focus  success • Limits generalizability faculty • Determine biologic vs biomechanic • Decide spine vs joints vs bone vs soft tissue • COLLABORATION WITHIN ACADEMIC DEPTS KEY!

  9. Successful Negotiationwith the ChairmanGOAL: Create WIN - WIN • MATCH YOUR GOALS AND ABILITIES WITH CHAIRMAN EXPECTATION! • ELEMENTS • Salary/bonus structure • Academic vs nonacademic track • Dept/leadership roles • Research: time, focus, funds • Clinical practice

  10. Research: STARTING • PROTECTED TIME (% or days) • FOCUS: Hypothesis Driven • Lead to grant(s) • Basic science and/or clinical outcomes • Fit with dept research infrastructure? • Establish collaborations university? • Develop new direction? • START-UP FUNDS • Technicians (%) and how long? • Development dollars project

  11. Research: INTERMEDIATE • SUBMIT GRANTS • Initial projects establish prelim data or model • Projects • Internal: dept, med center, univ • External: OREF, NIH, Arthritis, NSF • COLLABORATION PHDS IMPORTANT • Realize much less than 50% grants funded! • PERSISTENCE!! • VIEW CSDP AAOS Website Funding Timeline

  12. Clinical Practice • 60-90% Revenue generation = surgery • Develop new subspecialty? • Replace prior faculty? • Assist in expanding practice? • Trauma call? • Team coverage? • Partner cross-cover patients? • Competition: • Internal: unacceptable • External: size and strength

  13. Roles and/or Leadership Dept? • EDUCATIONAL COURSES: Time/funding? • Residents: basic or clinical science • Grad students? • Medical students? • DIRECTOR • Clinical division • Teams • Lab

  14. Compensation • SALARY BASED ON? • Productivity • Revenue collected: clinical + grants • Academic rank or tenure • LENGTH OF SUPPORT YEARS? • CONFLICT: DEAN vs HOSP • Dept: requires nontenured faculty primarily clinical and education • Hosp:  ortho clinical activity = margin • Dean: wants NIH grants for indirect dollars ( > 50% ) • 20% or single day lost clinically productive unbalances EQUALITY in compensation within faculty

  15. Academics vs Private Practice • BASIC SCIENCE RESEARCH only viable in academic environment  COSTS! • PRACTICE PROSPERITY BOTH DEPENDS: • Control cost of practice since smaller margins • Share percentage ancillary income (rehab, MRI, XR, outpt surg) • UNIQUE COSTS PRACTICE ACADEMICS • Cost inefficiency teaching • “Dean’s” tax • Usually less control operations

  16. Proposed Solution • Align faculty compensation to PRODUCTIVITY • Mutually agreed ACADEMIC GOALS! • Open formula compensation • Regular reviews by chairman • % Ancillary margins compensate academics • Realize new millenium TRIPLE THREAT rare • Clinical practice • Education • Research • Chairman Triple Threat and Business Skills!

  17. Consensus CSDP Committee 2005 • Minimum ONE year research training • Basic science = laboratory • Clinical outcomes = recommend MPH • RESEARCH • Hypothesis-driven • FOCUS – no hobby projects • Small grants model or prelim data • GOAL R01 NIH – decade-long pursuit • Develop TEAM approach – collaborations with PhDs

  18. ReviewSheet • SALARY • Base = ________ define formula = ________ • Bonus = ________ How to achieve = ________ • ACADEMIC RANK • Nontenure track option? ________ • Tenure track = ______ yrs + requirements tenure = ______ • RESEARCH • Time as % ( ) or days ( ) and length yrs = _______ • Development funds = _______ • Lab/PhDs = ________ • Collaboration available = ________ • Grants and dates you expect to submit ________________

  19. Review Sheet (continued) • CLINICAL PRACTICE • Subspecialty = ________ new or expanding or pre-existing • Clinic time = ________ = Operative time = _________ • ER/Trauma call = ________ • Other outside responsibilities = ______________________ • LEADERSHIP • Directorship division or lab = _________ • Educational teaching course(s) = ___________ • MISCELLANEOUS • _____________________ • _____________________ • ACTION PLAN:_______________________________________

  20. Why Preserve Clinician Scientist? • CRITICAL BIOLOGIC REVOLUTION ORTHOPAEDICS • Tissue Engineering/Regeneration • Repair of “nonunion” • Replacement damaged or missing structure • Academic Collaboration Goal = Patient! • Orthopaedic clinician scientist • PhDs • LEAD EVIDENCE-BASED MEDICINE (EBM) APPROACH • RCTs evaluate emerging technologies • Education of orthopaedic community • Enlighten Orthopaedic Community and NIAMS at NIH develop funding study sections for clinical outcomes research. • Infrastructure for evaluation research advances for EBM • Required for orthopaedics to practice EBM

  21. CAVEAT Don’t use this knowledge against me!

  22. Your success is our future! This is no whale tale!

  23. Thank you

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