Increased Patient Access
and Productivity vs.
Sixty-eight faculty (51.5%) reported for
the previous year they were concerned
they might not be “happy” with a
salary based on reduced wRVUs (i.e.,
doing less clinical work and receiving
less compensation). While not demonstrating actual decreased productivity,
this concern can be a barrier to institutional goals of increased patient
access and productivity.
Seniority and Rank Agnostic in CP but Not to Faculty
Faculty noted the lack of recognition of seniority or academic
rank in the CP as a reason for
dissatisfaction. In academic
medicine, promotion and tenure
are important career milestones.
Academic achievements benefit
the institution in grant funding
and institutional recognition. One
argument for not including rank
in a wRVU-modeled CP is that the
cost or payment for performance
of a procedure is not based on
physician experience or academic
rank. The Compensation Plan
Working Group considered sev-
eral models to account for rank
in setting compensation levels.
These models all had an unacceptable negative financial impact
on junior faculty. Future work will
explore ways to balance academic
tenets with financially stable
Provider Wellness and the “Fourth Aim”
Health care has focused on the Triple Aim of enhancing patient experience, improving population health, and reducing costs. Over several
years, AMCs have adopted the “Quadruple Aim,” the Fourth Aim being
wellness of the provider. 7
There are multiple factors associated with a CP that impact this aim.
A productivity model creates additional perceived barriers to time off,
which can be lost wRVU time, reducing compensation. Faculty may not
take allocated days off, which can lead to increased stress, decreased
productivity, and high cost of buyout on separation for unused vacation
days (see “Teach the Teachers”).
Faculty dissatisfactions that impact wellness included clinic inefficiencies, lack of governance over clinical settings, high patient “no-show” rates,
and scheduling difficulties hindering productivity. Faculty also noted that
significant clerical and administrative work are not compensated. Disparities in support staff levels was also a concern.
Rather than money being a primary driver of satisfaction, faculty noted
that the focus on compensation was a cause of burnout. One faculty
member called the plan “a symbol of how little the institution cared about
faculty.” Faculty used terms including “rat race,” “unhealthy workplace,”
“unhappy,” and “hourly factory workers clocking in” to describe the impact
of the plan.
Many practice factors faculty identified as important for their satisfaction were consistent with institutional goals. Health systems need to
improve access and efficiency, listen to provider/front-line suggestions,
and design workflow to allow physicians and other providers to do what
they are trained for and enjoy doing—seeing patients.
Compliance, insurance, and documentation requirements add to physician
workload, often without clear evidence of improved patient care. Physicians
recognize that for many specialties, work required for quality patient care
does not generate wRVUs. While wRVU metrics include a percentage of
non-face-to-face time, this is not well understood by physicians and may
not account for all the time required to care for the patient. Communicating with clinicians to learn how to provide the best care both advances the
institutional mission and provides intrinsic satisfaction to faculty.
To account for time off, Virginia Com-
monwealth University (VCU) CP is
based on 46 weeks of work per year,
not 52. While this is fundamental to
our benchmark development, faculty
did not widely understand it. Health
systems should work to ensure
faculty understand calculations
underlying compensation, including
allowance for time off, and recog-
nize the importance of encouraging
days off to help balance work and
personal time. i S t