Mission-based budgeting: Removing a graveyard

Many activities in today's medical school no longer have medical student's education as their reason for existance. Faculty are hired primarily to provide clinical service or to make discoveries, with the role of educator of secondary importance. Budgeting in medical schools has not evolved in cocert with these changing roles of faculty. The cost of medical student's education is still calculated as if all faculty were hired primarly to teach medical students and their other activites were to support this "central" mission. Most medical schools still mix revenues without regard to intent and cannot accurately determine costs because they confuse expences with costs. At the Uiversity of Florida College of Medicine, a group of administration, chairpersons, and faculty developed a budgeting process now called mission-based budgeting This is a three process: (1) revenues are prospectively identified for each mission and then aligned with intended purposes; (2) faculty productivity, i.e., faculty effort and its quality, is measured for each of the missions; and (3) productivity is linked to prospective budget for each mission. This process allows the institution to understand the intent of its missions, to make wise investment decisions (subsidies), and to justify to various constituents its use of revenues. The authors describe this process, focusing particularly on methods used to develo a comprehensive database for assessment of faculty productivity in education.