Effects of assessing the productivity of faculty in academic medical centres: a systematic review

Akl, Elie A.; Meerpohl, Joerg J; Raad, Dany; Piaggio, Giulia; Mattioni, Manlio; Paggi, Marco G.; Gurtner, Aymone; Mattarocci, Stefano; Tahir, Rizwan; Muti, Paola; Schünemann, Holger J.

doi:10.1503/cmaj.111123

Cited by 69 publications

(64 citation statements)

References 19 publications

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“…For example the ACS surgeon is additionally responsible for complex counseling, end of life care, ICU coverage, consult responsibility, and trauma amongst other aspects of care. Arguments against RVUs for productivity measurement come from academic physicians and surgeons, whose time is spent in the education of trainees, research pursuits, or innovation, none of which can be captured or acknowledged in a system that only recognizes RVU-defined productivity 15,16 . This RVU dichotomy simply does not reflect ACS work.…”

Section: Discussionmentioning

confidence: 99%

Does relative value unit–based compensation shortchange the acute care surgeon?

Schwartz¹,

Hui

Velopulos³

et al. 2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND Studies have demonstrated that relative value units (RVUs) do not appropriately reflect cognitive effort or time spent in patient care, but RVU continues to be used as a standardized system to track productivity. It is unknown how well RVU reflects the effort of acute care surgeons. Our objective was to determine if RVUs adequately reflect increased surgeon effort required to treat emergent versus elective patients receiving similar procedures. METHODS A retrospective analysis using The American College of Surgeons’ National Surgical Quality Improvement Program 2011 data set was conducted. The control group consisted of patients undergoing elective colectomy, hernia repair, or biliary procedures as identified by Current Procedural Terminology. Comparison was made to emergent cases after being stratified to laparoscopic or open technique. Generalized linear models and logistic regression were used to assess specific outcomes, controlling for demographics and comorbidities of interest. The RVUs, operative time, and length of stay (LOS) were primary variables, with major/minor complications, mortality, and readmissions being evaluated as the relevant outcomes. RESULTS A total of 442,149 patients in the National Surgical Quality Improvement Program underwent one of the operative procedures of interest; 27,636 biliary (91% laparoscopic; 8.5% open), 28,722 colorectal (40.3% laparoscopic, 59.7% open), and 31,090 hernia (26.6% laparoscopic, 73.4% open) operations. Emergent procedures were found to have average RVU values that were identical to their elective case counterparts. Complication rates were higher and LOS were increased in emergent cases. Odds ratios for complications and readmissions in emergent cases were twice those of elective procedures. Mortality was skewed toward emergent cases. CONCLUSION Our data indicate that the emergent operative management for various procedures is similarly valued despite increased LOS, more complications, higher mortality risk, and subsequently increased physician attention. Our findings suggest that the RVU system for acute care surgeons may need to be reevaluated to better capture the additional work involved in emergent patient care.

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Section: Discussionmentioning

confidence: 99%

Does relative value unit–based compensation shortchange the acute care surgeon?

Schwartz¹,

Hui

Velopulos³

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…The authors noted, however, that "two of these programs provided a credit for time spent teaching and the third set an expectation for faculty participation in educational activities," thus explicitly attempting to mitigate the impact of the productivity demands (p. 257). Another group reviewed eight studies that linked compensation to productivity measures (clinical, research, and teaching) and found that the plans "appeared to improve productivity in research activities, possibly improved clinical productivity but had no effect in the area of teaching" [16] (p. 5). By contrast, a more recent study in a large urban academic internal medicine department that had recently implemented clinical productivity work targets found that 86% of faculty reported being less likely to engage in activities that did not directly count toward productivity targets, and 75% specifically reported a decrease in time spent teaching.…”

Section: Historical Factorsmentioning

confidence: 99%

Time to Teach: Addressing the Pressure on Faculty Time for Education

et al. 2017

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“…Participant No. 1 said: "The response to the Non-Educational requirements is what exists at the moment and it is somehow forced into medical 4 Iran Red Crescent Med J. 2017; 19 (7):e57566.…”

Section: Establishing a New Residency Programmentioning

confidence: 99%

“…Providing adequate faculty members has been very obvious in medical schools. Medical members are increasingly considered as the most important capital of medicine schools (2) because of their specific responsibilities beside common roles that all faculties have (3,4). Thus, every faculty of medicine needs sufficient numbers of qualified members in order to accomplish the assigned tasks (5).…”

Section: Introductionmentioning

confidence: 99%

A Conceptual Model to Estimate Staffing Requirements of Medical Faculties of Medical Sciences Universities in Iran

Kashkalani

Maleki

Tabibi

et al. 2017

Iran Red Crescent Med J

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Background: No specific model has been developed so far to determine the number of clinical faculty members required for medical schools as the most important and most costly workforce. Objectives: Since any action in this regard needs to understand the current status, this study aimed to identify the factors and variables involved in staffing of medical schools in Iran. Methods:This was an analytical descriptive study conducted with qualitative approach in early 2016. Participants included 15 educational deputies of Medical Sciences Universities in Iran who were selected through purposeful intensity sampling. Data were collected using in-depth interviews and analyzed using inductive qualitative content analysis via seven-stage framework analysis. Results: Five categories of factors were identified to affect the number of clinical faculties in Medical Sciences Universities of Iran, namely "faculties' functions and range of work", "characteristics of faculty members", "features of the faculties' service delivery location", "department/major properties", and "dominating objectives and policies". Conclusions: A variety of subjective and inaccurate factors are considered for estimating the required number of clinical faculties in Iran among which only a few are the same as criteria for other faculties. The prerequisites that organize the factors and components in the form of a system are: clearly determining the responsibility of clinical education space and then, defining relatively identical financial incentives for various functions of faculty members.

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Effects of assessing the productivity of faculty in academic medical centres: a systematic review

Cited by 69 publications

References 19 publications

Does relative value unit–based compensation shortchange the acute care surgeon?

Does relative value unit–based compensation shortchange the acute care surgeon?

Time to Teach: Addressing the Pressure on Faculty Time for Education

A Conceptual Model to Estimate Staffing Requirements of Medical Faculties of Medical Sciences Universities in Iran

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