Many activities in today's medical schools no longer have medical students ' education as their central reason for existence . 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 concert with these changing roles of faculty . The cost of medical students ' education is still calculated as if all faculty were hired primarily to teach medical students and their other activities were to support this “ central ” mission . Most medical schools still mix revenues without regard to intent and cannot accurately determine costs because they confuse expenses with costs . At the University of Florida College of Medicine , a group of administrators , chairpersons , and faculty developed a budgeting process now called mission-based budgeting . This is a three-step 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 the prospective budget for each mission . This process allows the institution to understand the intent of its revenues , to measure how productive its faculty are , to learn the true costs 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 develop a comprehensive database for assessment of faculty productivity in education .