University of Virginia Library

I. BASIC CONSIDERATIONS

Certain basic considerations must be kept in mind in determining the best policy for organization
of private practice in the University Hospital and for remuneration of the Clinical Staff
Among these considerations are the following

1. The reasons for existence of the University Hospital are production of well-trained physicians,
research and medical service.

2. In order to provide proper instruction, there must be an adequate supply of patients and,
to set a good example for the students, they must be given the best possible type of medical
care.

3. The institution is recognized by the people of the State as a center at which superior
medical service can be obtained and it would not be in the best interest of the institution
or the public to deny such service to those who can afford to pay for it. Therefore,
provision for the care of private, as well as ward, patients is necessary.

4. Clinicians, like other members of the faculty, should be compensated for time and effort
devoted to teaching and research and on approximately the same basis as preclinical faculty
members. The source of additional income must be private practice because, viewing
the problem realistically, there is no hope of establishing a salary scale on State funds
comparable to the income which may be available from private practice or at other medical
schools.

5. Income from private practice should not be used as it has been to maintain hospital equipment
or services essential for the care of the hospitalized patients. The 20 per cent deduction
now in force is a reasonable charge for employment of extra secretaries and office
nurses and purchase of supplies and equipment for care of private ambulatory patients.

6. The demand for and interest in teaching and research will never be the same for all members
of the clinical staff. Some will devote the major share of their time and interest to
teaching and research and others to private practice. It does not seem reasonable that
those who are members of this group and spend a greater portion of their time and efforts
in private practice should be compensated out of all proportion to those who devote more
of their time to teaching, research and administrative activities which are of equal importance
to the School. It should be recognized, however, that stresses incident to assumption
of responsibility for life and death, day and night, regardless of academic sessions,
constitutes a hazard to life and longevity to which only the clinician is subjected

7. There are recognized advantages and disadvantages in the association with a medical school
and teaching hospital. The advantages are more apparent to some than to others and only
those who choose this type of life, realizing its restrictions and limitations in terms of
financial return, can remain happy in it. Those who feel that a larger income and greater
amount of freedom are more important considerations should not confine themselves to such
an environment but should take advantage of the opportunity to practice independently and
earn larger amounts without the restrictions which are inherent in institutional practice.
As a corollary, however, it should be recognized that medical schools and teaching hospitals
are of necessity in competition with each other and clinicians of high attainment cannot be
attracted or retained on incomes out of all proportion to those available at similar institutions.

8. The administration of the University should make a vigorous effort to increase and staff
and to overcome inadequacies in facilities so that the burdens may be properly distributed
and a pleasant working environment provided.

9. The question of salaries cannot be divorced entirely from the whole problem of the organization
of private practice in the Hospital. Further attention should be given to the development
of methods of practice which will give the best service to patients yet conserve the
time and energy of the staff. The fact that steps in this direction may require more cooperation
between individual physicians and departments in the conduct of practice must be recognized

10. Promotion in academic rank should be based on academic achievement rather than capacity to
earn in private practice and earning allowance from practice should not be related directly
to rank.