Balanced Clinical and Academic Work:
A Challenging Dilemma?
Teaching the next generation of providers and participating
in research that advances patient care and scientific discovery are vital to AMCs. Contributions in these areas are not
directly considered in a productivity-based CP unless they
are funded. A Virginia Commonwealth University (VCU) plan
includes a percentage of base salary allocated to citizenship and teaching. Sixty-two ( 47.3%) faculty noted they had
declined a service activity because of concern for missing
wRVU-generating time. Likewise, 52 (39%) declined a teaching
opportunity. Overall, 81 (60.9%) considered trying to find nonclinical funded work. Concern was expressed that, although
all faculty received salary support for citizenship and teaching, not everyone participated equally in these activities.
VCU faculty want recognition for their work and to trust that
those doing the work receive salary support. The Compensation Plan Working Group updated our plan to define specific
activities required to receive the teaching and citizenship portion of base salary. This increases transparency, and because
all faculty are expected to participate in teaching and service
activities, this change should not penalize any individual
Financial Awareness and Plan Understanding
It is vital that faculty understand the finances of the healthcare system and academic institution. Our faculty were asked
to rate their understanding of the finances of the School of
Medicine (SOM) and the clinical practice plan on a scale of 0
(not at all) to 100 (very well). Responses ranged from 0 to 100
with a mean of 40. 2 and a median of 33. One-hundred-sixteen
(86%) thought that information on how finances work would
be beneficial to faculty. Faculty wanted to understand how
to increase their input into the plan, who has authority and
governance over the plan, the components of the plan, and
how the plan works. Without this understanding, it is difficult
to expect the plan to incentivize behaviors that are important
to the institution.
From a management standpoint, the institution needs the
CP to be reliably calculated, inclusive, easy to administer,
and sophisticated enough to work for a variety of provider
types. Related to national benchmarks used for calculations,
faculty noted disparities between proceduralists and
non-proceduralists and pediatric versus adult providers, as well
as reimbursement for the same diagnosis by various physician
types. Faculty expressed interest in monthly reports of calculated productivity and funds flow through the health system.
Faculty are a vital part of an AMC,
without whose expertise, energy,
and commitment we cannot achieve
institutional goals. Institutions
must prioritize financial stability
to support strategic planning for
growth and development, but
must also support the wellness of
providers and retention of excellent
faculty. CP design and maintenance
must find equipoise between the
needs of the faculty and those of
the institution. Adjustments to the
CP must be only part of the effort
to improve efficiency, engagement, clinical competence, and
credentialing. Communication is
critical. Finally, we must ensure
that the goals and mission of both
the health system and the AMC are
considered in decision making and
are well understood and supported
by leadership and faculty.
We are grateful for the candid
feedback of our faculty, who are
experts in their fields and com-
mitted to the academic mission
and care of our patients. They are
helping us gain a greater appre-
ciation for values that need to be
addressed in an academic group
practice compensation plan.
Elizabeth Ripley, M.D., M.S., RAC,
is professor of medicine, Division of
Nephrology, senior associate dean, Office
of Faculty Affairs, at Virginia Commonwealth University and Medical College
of Virginia Physicians. Darrell A. Griffith,
M.P.H., CMPE, is senior associate dean
for finance and administration at the Virginia Commonwealth University School
of Medicine and executive director at
the Medical College of Virginia Physicians. Thomas Yackel, M.D., M.P.H.,
M.S., M.B. A., is professor of medicine
at Virginia Commonwealth University
and president of the Medical College of
Virginia Physicians. Peter Buckley, M.D.,
is professor of psychiatry and executive
vice president for medical affairs at
Virginia Commonwealth University Health
System and dean at the Virginia Commonwealth University School of Medicine.
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