General Pediatric Clinic Practice Management: Results of a Survey of Academic Departments

Abstract

The purpose of this survey is to provide an overview of hospital-based general pediatric clinics (GPCs) from the perspective of the practice manager. Academic pediatric departments located in the United States were surveyed to gather information regarding a number of issues relevant to the operation of their GPCs. These issues include educational efforts related to practice management, personnel allocation, financial performance, organizational formats, administrative arrangements, and access to primary care services for children of poor families. Of 131 surveys, 94 were returned (72% response rate). There were an average of 15,486 visits per year to GPCs, and the number of visits overall has increased by 11.9% during the past 5 years. Educational efforts related to practice management vary greatly within GPCs; less than half report any. The overall staff ratios per faculty physician are similar to those in nonteaching practices but differ in composition because of training activities inherent to GPCs. There is an average loss of $250,000 per clinic at GPCs. Organizational formats vary considerably; the majority of physician directors have no line-management authority for nursing and clerical staff. Survey results confirm that GPCs serve a large number of poor children with 41.3% funded by Medicaid and 16.0% unable to pay out-of-pocket expenses. GPCs are generally not used to teach practice management, tend to lose money, and have little faculty involvement in their management.