AMCs are experiencing increased pressure to balance budgets
and increase quality outcomes and productivity. AMCs must
also recruit, develop, and retain faculty, support the academic
mission, and support the wellness of healthcare providers.
Institutions must ensure that CPs are financially sustainable, administratively manageable, equitable, and
consistent with their goals and mission. Formulaic
approaches may not account for the personal needs and
motivations of clinical faculty, contributing to faculty
burnout and reduced motivation for clinical productivity. 2
Herzberg3 described extrinsic motivators including pay,
administrative policies, supervision, and interpersonal relations; extrinsic factors act primarily as negative motivators
if they are not adequate.
Therefore, excessive focus on pay can lead to a decrease in
performance. In contrast, intrinsic factors like the meaningfulness of work, a sense of achievement, professional growth,
and level of responsibility for the work are positive influences
leading to improved performance. 4
Gunderman5 notes that although American physicians
expect to be paid well, this does not mean they work merely
to collect a paycheck. He notes physicians go to work at
AMCs where pay is expected to be lower than private practice
as evidence that physicians value more than money.
While satisfaction is not totally dependent on salary, CPs do
impact how faculty approach their work. Zierler6 found that
the CP was a key factor in choosing a practice and impacted
the number of patients seen. Dissatisfaction was highest
among faculty at centers that were either planning to change
or had recently changed their CP. 6 The perceived stability
of a CP is a strong extrinsic driver of physician behavior and
important for success.
Defining a CP Model
Virginia Commonwealth University Health System (VCUHS) first
implemented its CP in 2012 with the following intrinsic goals:
F Align funding with effort allocation
F Bring physician compensation up to market levels
F Incentivize and reward clinical productivity
F Fund academic research
F Evaluate teaching and service consistently across
F Expect all faculty to contribute and be compensated
for institutional citizenship and teaching
F Improve patient access to care
The model is based on blended national benchmarks for
base salary and work Relative Value Unit (wRVU) productivity;
accounts for funded research, teaching, and administra-
tion; provides recognition for teaching and citizenship; and
includes incentives for clinical productivity.
Beginning in 2017, a Compensation Plan Working Group
comprising school of medicine, health system leadership, and
faculty was appointed to reexamine the CP for clinical faculty.
Goals of this ongoing evaluation are to assure that the plan
remains contemporary to market (particularly relative to other
AMCs), incentivizes key organization goals, and support financial sustainability for the organization.
As part of this process, an Institutional Review Board
(IRB)-approved anonymous survey was emailed to the clinical
faculty. Questions were primarily quantitative in design but
allowed for optional qualitative responses. The survey solicited measures of faculty satisfaction with the CP, perceptions
about communication and understanding of the plan, and
concerns and recommendations for changes.
At the time of the survey, 347 faculty participated in the
CP. There were 134 survey responses ( 37.9%); participants
represented all clinical departments; 26 ( 19.7%) were
tenured or tenure eligible; and 102 (76%) provided optional
From the survey, we identified six themes related to
satisfaction that were consistent across respondents.
These were considered in the context of institutional goals
Salary Balanced with Institutional Sustainability
F 34 ( 35.5%) reported no salary
F 101 (75.9%) considered the CP an
incentive to increase clinical work.
This correlates with measured
increases in wRVU production since
the plan began. However, wRVUs
remain below the projected median
for the number of clinical full-time
equivalents (F TEs). This disparity
between salary and wRVU goals is
a challenge to CP sustainability.
Participants were asked to rank
satisfaction with the CP as very
satisfied, satisfied, unsatisfied,
and very unsatisfied.
F Overall, 76 (59%) were satisfied
or very satisfied.
F Associate professors were the
most satisfied (66%).
F 57 ( 42.9%) reported an increase
in their total compensation for
F 30 ( 22.6%) reported a decrease. i S t