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Clinical efficiency and resident education: a fine balance
  1. Victoria Leung1,
  2. Laura Quigley2,
  3. Wai-Ching Lam1,
  4. Rodrigo Cavalcanti3,
  5. Brian Hodges4,5
  1. 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  5. 5Department of Education, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Victoria Leung, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada M5S 1A8; victoriaC.leung{at}

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Demand for healthcare is growing at an unprecedented rate owing to an ageing population and the rising prevalence of chronic disease.1 In order to meet increasing demand with limited resources, clinical efficiency has become of utmost importance. Clinical efficiency balances quality of care against healthcare costs and has become a central tenet of high-functioning health systems.2 Increasing attention has been directed towards developing metrics that capture quality and costs of care and funding models to match. Although efforts to improve efficiency are important in today's fiscally limited, high-demand environment, top-level policies may have important unintended repercussions for frontline healthcare workers. Resident physicians, for instance, are a unique group of healthcare professionals, whose educational opportunity may be adversely affected by heightened attention to highly efficient care.

In the past decade, funding has changed from fee-for-service to non-traditional models that link reimbursement to the achievement of prespecified targets for health processes or outcomes. Examples include health-based allocation models, accountable care models and pay-for-performance.3 ,4 Governments have implemented wait time strategies to increase clinical volumes. In Ontario, Canada, the Wait Time Strategy dedicates resources to measuring and achieving improvements in wait times.5 Hospitals use this information to highlight inefficiencies, increase patient …

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