Liaison Committee on Medical Education
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2013-2014

ER-2

The present and anticipated financial resources of a medical education program must be adequate to sustain a sound program of medical education and to accomplish other programmatic and institutional goals.

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Annotation

The costs of conducting an accredited educational program leading to the M.D. degree should be supported from diverse sources (e.g., income from tuition, endowments, and earnings by the faculty, support from the parent institution, annual gifts, grants from organizations and individuals, appropriations by government). Evidence for compliance with this standard will include documentation of adequate financial reserves to maintain the medical education program in the event of unexpected revenue losses and demonstration of effective fiscal management of the medical education program's budget.

Database Questions

The following questions relate to standards ER-1 and ER-2.

  1. Complete the following table for the anticipated number of new medical students to be admitted in each of the indicated years. If the number is unknown, use “N/A.”

      2013 2014 2015 2016 2017
    # of New Students          

    NOTE: Unless the school states otherwise, the LCME and CACMS for Canadian schools will assume that the program uses the fiscal year of July 1 - June 30.

  2. Summarize trends in the funding sources available to the medical school, including an analysis of their stability. Using data from the Longitudinal Statistical Summary Report (LSSR) or the AFMC Canadian Faculty of Medicine Financial Survey for Canadian medical schools or other documentation, explain any substantive changes during the PAST THREE YEARS for the medical school in the following areas:

    1. Total revenues

    2. Operating margin

    3. Revenue mix

    4. Market value of endowments

    5. Debt service

    6. Outstanding debt

    7. Departmental reserves [Canadian schools: Reserve funds]

  3. Describe any substantive changes in financial resources anticipated by the medical school over the NEXT THREE YEARS in the following areas and explain the reasons for the anticipated changes:

    1. Total revenues

    2. Revenue mix

    3. Obligations and commitments

    4. Reserves (amount and sources)

  4. Describe any substantive changes in institutional resources anticipated by the medical school over the NEXT THREE YEARS in the following areas:

    1. Number of faculty

    2. Faculty mix

    3. Hospital and other clinical affiliations

    4. Graduate medical education programs

    5. Physical facilities

  5. Describe the medical school’s annual budget process and the budgetary authority of the medical school dean. Does the medical school have a consolidated budget process that includes all medical school departments, the clinical practice plan, and/or the health system? Describe the roles and membership of any committees involved in budget planning. Is the medical school’s budget approved by the governing board and/or officials of the parent university or, in the case of an investor-owned for-profit medical education program, by the corporate parent of the institution? Is the approval of the governing board required for setting tuition and fee rates for undergraduate medical students?

  6. Describe the ways in which the medical school’s governance, through its board of directors and its organizational structure, supports the effective management of its financial resources. Describe how lines of authority are defined, the internal controls that are in place, the degree of oversight provided by the state/parent/governing board in managing medical school resources, and the relationship between the dean and department chairs in managing departmental resources.

  7. Describe the role of medical school management and administrative systems (e.g., financial, human resources, student information, room inventory, and sponsored programs) in serving the information needs of the medical school leadership. Describe any plans to replace outdated systems and any improvements made since the last full survey visit. Describe the nature and frequency of the financial reports provided to the medical school dean. In the Appendix, provide three examples of recent reports.

  8. Describe the ways in which current and projected capital needs for the missions of the medical school are being addressed. Describe the medical school’s policy with regard to the financing of deferred maintenance of medical school facilities (e.g., roof replacement).

  9. Describe the extent to which financial reserves have been used to balance the operating budget in recent years.

  10. Summarize the key findings resulting from any external financial audits of the medical school (including medical school departments) performed during the most recently completed fiscal year.

  11. Provide a revenue and expenditures history for the current fiscal year (based on budget projections) and for each of the past three fiscal years. For U.S. medical schools, the format for the history and the data for the three completed fiscal years should be obtained from the “Rev_Exp_History” tab of the school’s completed LCME Part I-A Annual Financial Questionnaire. For Canadian medical schools, use the Canadian Faculty of Medicine Financial Summary as the data source, as appropriate. NOTE: The school must specify its fiscal year end as indicated in Part A.

  12. In the Appendix, provide a copy of the most recent LCME Part I-A Annual Financial Questionnaire, including the Signature Page and excluding the Scratch Pad page (a total of 8 pages). Also, please provide the school’s responses to the Web-based companion survey to the LCME Part I-A Annual Financial Questionnaire, the “Overview of Organization and Financial Characteristics.” For Canadian medical schools, provide a copy of the Canadian Faculty of Medicine Financial Summary, including the school’s response to the related “Overview of Organization and Financial Characteristics” survey.

  13. If tuition and fees comprise more than 50% of the medical school’s total annual revenues, describe the school’s plan to reduce dependence on tuition and fees.

Self-Study Questions

Discuss the adequacy of, the stability of, and the balance among the various sources of financial support for the medical education program and school (i.e., state and local appropriations, income from patient care, proceeds from endowments, tuition income, research income, hospital revenues). Discuss the implications of any downward trends in specific revenue sources. Describe the financial prospects for the medical school over the next several. Note if there are any departments in financial difficulty. Are there systems/policies in place to address departmental financial difficulties?

Describe how the school has positioned its clinical enterprise (faculty practice plan/organization and structure of healthcare system) for achieving optimal results in the local health care environment. Is planning related to the clinical enterprise occurring? Are medical school leaders involved in such planning so that the needs of the educational mission are considered? How effective is this planning in meeting institutional goals?

Describe how present and future capital needs are being and will be addressed. Is the financial condition of the school such that these needs are being and will continue to be met?

Survey Report Guide

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