How is your "productivity" measured (especially in academics)

[deleted18755]

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Dear colleagues,

When I was interviewing for academic positions most had salaries (and bonus) tied to number of patients treated. However, from what I understand even in academics RVU's are starting to take center stage. The problem is there is no way the pediatrics/lymphoma 30ish Gy per patient guy can generate as many RVU's as the 80ish Gy per patient, with IMRT/IGRT, attending, even though arguably the former (at least peds) requires more work per patient (or at least the same).

For those of you in academics, is your productivity measured in patient volume or RVU generation (or some combination?). Also, is academic/teaching productivity assumed or are numbers of hours teaching, number of papers published, or something like that formally and objectively factored into some type of equation?

For those of you in private practice, is everything strictly RVU based? Does this work out since everybody treats all disease sites and therefore the higher RVU patients and lower RVU patients just even out, or are patient numbers (or some other metric) factored in as well?

Thanks!

 

[medgator]

One model I've seen in a large multi site private hospital system is a salaried group (starting salary based on years out from training, maxing near mean mgma) with productivity bonuses based on the dept as a whole and thus distributed as a whole

 

[seper]

I've worked for a bit as a university-salaried MD, and can only say that your concerns are sound. Productivity is measured in RVU's. Radiation oncologists with "lucrative" disease sites (prostate, radiosurgery, no palliation) are labeled as highly productive, and get promoted and incentivized as such. As a junior faculty, it's hard to do anything about it.

Dear colleagues,

When I was interviewing for academic positions most had salaries (and bonus) tied to number of patients treated. However, from what I understand even in academics RVU's are starting to take center stage. The problem is there is no way the pediatrics/lymphoma 30ish Gy per patient guy can generate as many RVU's as the 80ish Gy per patient, with IMRT/IGRT, attending, even though arguably the former (at least peds) requires more work per patient (or at least the same).

For those of you in academics, is your productivity measured in patient volume or RVU generation (or some combination?). Also, is academic/teaching productivity assumed or are numbers of hours teaching, number of papers published, or something like that formally and objectively factored into some type of equation?

For those of you in private practice, is everything strictly RVU based? Does this work out since everybody treats all disease sites and therefore the higher RVU patients and lower RVU patients just even out, or are patient numbers (or some other metric) factored in as well?

Thanks!

 

[Mandelin Rain]

From what I've heard, many academic positions have RVU targets of ~10,000. Almost impossible to hit if you're treating peds (even if you're working your fingers to the bone), while very easily hit if you treat prostate.

It's the private practicization of academia.

 

[Chartreuse Wombat]

The answer to the question depends on the model employed by the department in which you are employed. I realize that the statement is axiomatic but the statement deserves to be made to emphasize the fact that there are multiple models used.

To my knowledge there is no systematic review to inform the question but based on conversations with academics over three decades there are a few basic models.

1-Salary with no incentives. The practitioner is paid a salary regardless of productivity (academic, clinical or otherwise). This is rare but is in place in at least one large institution.
2-Base salary with "bonus". There are several variations but in most the Chair will determine the bonus based on criteria (explicit or implicit) that may include clinical effort measured as FTE, RVUs, publishing metrics, etc. The major difference that I have observed is between individual RVU targets and departmental RVU targets.

I believe that it is better for the Chair to use departmental targets. In certain health centers however individual targets are mandated by deans, COOs etc. Individual incentivization may be beneficial in certain contexts but the current RVU system is inherently unfair; incentivizing certain activities/disease sites as pointed out previously.

The joke is that once you have seen one academic health center, you have seen one academic health center. The models used across the US are very variable and within institutions differ greatly amongst departments (and even within departments).

In my view the wise Chair does not allow individual incentives and instead relies on departmental goals. The Chair meets with the faculty periodically to review FTE, RVUs and academic/scholarly productivity. Each year I receive a statement that indicates how much I "cost" the department (salary, benefits, dean's tax, etc) and how much I bring in from clinical activities, grants, etc. Usually the two numbers are different but averaged over several years they are similar.

I work in a department where the full professors and associate professors are paid basically the same (with assistant professors not too far below); to use a phrase in the current lexicon not much "income inequality". The time expectations (clinical FTE versus administrative) are different according to scholarly rank.

 

[BobbyHeenan]

A few years ago I had offers from two academic centers.

One truly academic position (support for clinical resarch, writing/conducting time, research days, etc) consisted of what Chartreuse Wombat mentioned in # 2 - salary with "bonus" based upon intra-departmental metrics/targets from the Chairman. There was some fuzzy math and subjectivity to it, but the metrics were based on RVU, grant funding, publications, protocol enrollment, and a few other variables as I recall.

The other was salary plus "bonus" based solely on RVUs and was more of an academic in name only position satellite gig.

 

[napoleondynamite]

I worked in academics for 2 years and it was straight salary, no bonuses other than a yearly cost-of-living adjustment that was a standard percentage of salary. After 5 years, all docs made the same (including the Chair). I didn't realize there was a privaticization trend in academia...odd.

 

[cdf95cro]

This is how we get our evaluative reporting annually. Reviewed metrics include: RVUs (or new treatment starts), grant support for salary, authorship, citations, h-index, admin committed time, "Team Score", trainee profile, etc, normed by percent effort, Dept., and career level. Our place is pretty transparent, IMHO...