Reader response: Incorporating students into clinic may be associated with both improved clinical productivity and educational value

The recent article by Tanner et al.¹ concluding that medical students in outpatient clinic can improve productivity is surprising. As a private practice neurologist who routinely interacts with medical students in the hospital and outpatient clinic, I believe that medical students adversely affect productivity. This study was done only in academic outpatient clinics. There was no mention of clinic hours, number of scheduled patients, or patient time intervals. Without more specific scheduling information, this study seems incomplete.

A full daily schedule has no free time for students. If there was no opening in the preceptor's schedule, then preceptors were looking for something to do while waiting for the students and running behind. Alternatively, the preceptor already had an open time slot to do work while waiting for the student. In that case, the schedule was not full. If preceptors were “completing prior notes or interpreting procedures” waiting for the student, that only increases net invoices for that time period, as those tasks would have to be done anyway.

Interacting with students in the hospital typically requires more time, which results in a late arrival to the outpatient clinic, decreasing daily productivity (relative value unit [RVU] generation). RVU generation is paramount to a neurologist's income. The majority of surveyed neurologists list RVUs as a main basis of compensation.² Burnout in neurology is high³ and finishing late by increased workload or teaching is a major contributor to this,⁴ particularly if compensation shrinks. Therefore, the positives from teaching come with a high cost—a direct negative effect on compensation. A future study including inpatients as well as private practice outpatient clinics would be interesting.