Signs of progress in faculty compensation? Learning objectives 3/5/2014

Transcription

1 Signs of progress in faculty compensation? Incentives for research, teaching, and service through measurement of academic RVUs Marjorie Greenfield MD Kimberly Gecsi MD Sandra Dayaratna MD Learning objectives Describe different incentive systems What is measured? Is program departmental, hospital-wide, or through a medical school? Is compensation integrated with clinical incentives? What are the sources of funds used for incentive pay? What tools are available to create scores? List benefits and potential pitfalls Describe a systematic approach to developing an academic incentive system No conflicts to report 1

2 In the next hour... Brief background Experiences with developing an academic activity unit (AAU) bonus system Implementation of AAU systems Break outs by table: to discuss one aspect of incentive plans Report back (if time permits) Data from these breakouts will be used to develop a survey Benefits of measuring and compensating academic productivity Current academic salary structures? Future of academic medicine? Incentives are powerful motivational tools for attracting and retaining top talent, enhancing key indicators, increasing employee productivity, and, ultimately, enhancing mission-based parameters (Reece) Reece EA Adapting industry-style business model to academia in a system of performance-based Incentive compensation. Acad Med - 01-JAN-2008; 83(1) Calls for recognition and reward for teaching and other academic pursuits False starts and other challenges Examples of programs: non-clinical and integrated 2

3 U.S. medical schools had failed in trying to elevate the status of teaching A new system was needed to ensure that efforts in teaching would be rewarded for the time and effort it requires. Encouraged equal weight for all medical work Clinical Research Teaching systematic review of 12 programs that tracked and compensated physicians for productivity Clinical productivity- RVU increases of 20-30% in 8 studies Scholarly productivity- increases in extramural funding shown in 2 studies ranging from 22-36% over 4 years Education quality- Teaching scores did not change (3) Andreae et al. Physician compensation programs in academic medical centers. Health Care Manage Rev, 31 (3), 2006 Mission based management AAMC report published in Details the educational work that faculty might contribute -Demonstrates the development of an RVU system for educational efforts 3

4 2002 review of 41 medical schools that used metric systems to quantify faculty activity and productivity in teaching Challenges: Faculty skepticism Misguided search for one perfect metric Over-complexity Expectation that the metric will erase all ambiguity How do medical schools use measurement systems to track faculty activity and productivity in teaching? Mallon & Jones, Acad Med 77(2), Family Medicine Department at SUNY Buffalo Points for clinical work, teaching and research Faculty provided 2% of their salary for the incentive pool Results: An increase in clinical productivity, teaching and scholarship. They struggled with faculty buy-in and ensuring the accuracy of their information. Implementing a comprehensive relative-value- based incentive plan in an academic family medicine department. Cramer, Ramalingam etal. Acad Med, 75 (12), SIU Surgery Dept 1998: Academic Performance Incentive Program (APIS) 33 physicians 5% of practice income to fund program Credits were assigned to educational, research and service activities Results: Average of $784/month bonus High satisfaction with program Those that were clinically productive were also academically productive The impact of a program for systematically recognizing and rewarding academic performance. Williams et al., Acad Med 78(2),

5 UPMC Anesthesia dept 2004: integrated merit system 30% of salary performance based Faculty could be 100% clinical or up to 80% academic. Faculty with >20% academic time needed to support their at risk salary with academic activities Results: 1. Clinical and academic FTE allocation didn t change 2. Clinical work output for both types of faculty increased 3. Faculty increased academic productivity especially in publications Integration of academic and clinical performance-based faculty compensation plans: a system and its impact on an anaesthesiology department. Sakai et al., BJA 111(4), 2013 Milad et al, published a plan for faculty compensation in the Green Journal in Flexible plan that rewards behavior consistent with the goals of the institution. Plan for compensation full-time physicians involved in medical education. Milad et al. Obstet Gynecol. 93, 1999 Non Scientific Poll of 11 APGO Members: Presence of Academic Incentives in Ob-Gyn State Type of Program Presence of Program NY 2 univ None MA I comm and 2 None univ PA 1 comm and 2 None univ CA 1 comm Yes WV 1 univ Yes OH 1 univ Yes Raise with increase in faculty rank was noted as a form of academic incentive by several of the respondents. 5

6 AAU bonus system development UH MacDonald Women s Hospital/CWRU Chair charged Director of Education with developing scoring system for academic bonus Literature search Ortho incentive Needs assessment and buy in Survey of faculty (Anonymous, IRB approved) 6

7 Faculty survey Activities of Value to the Department Participating in resident interviews or oral examinations Writing or giving oral national examination (ABOG, NBME) Edit or review articles (peer review) Recognition for teaching (resident or student teaching award, Case Scholarship in teaching award) Writing book chapters/reviews Active participation/leadership in Case or M ed School committee Providing timely written evaluations of residents and students Presenting grand rounds at UH Providing constructive written evaluations of residents and students Posters at national/international meetings Presenting invited grand rounds/presentation at another institution Precepting students or residents in the private office NIH or other grant organization grant review Active participation/leadership in hospital committee Writing articles in peer reviewed journals Presentations at national/international meetings Leadership role in national/international organization "Bedside" teaching of residents/students in the hospital or clinic Lectures to residents/students/other trainees Valuable Neutral Not Valuable Faculty survey Activities to Increase in the Department Part icipat ing in resident int erviews or oral examinat ions Lect ures t o resident s/ st udent s/ ot her t rainees Act ive part icipat ion/ leadership in hospit al commit t ee Providing t imely writ t en evaluat ions of resident s and st udent s Present ing grand rounds at UH Providing const ruct ive writ t en evaluat ions of resident s and st udent s Act ive part icipat ion/ leadership in Case or Med School commit t ee &quot ;Bedside&quot ; t eaching of resident s/ st udent s in t he hospit al or clinic Recognit ion f or t eaching (resident or st udent t eaching award, Case Scholarship in t eaching award) Writ ing or giving oral nat ional examinat ion (ABOG, NBME) Precept ing st udent s or resident s in t he privat e of f ice Present ing invit ed grand rounds/ present at ion at anot her inst it ut ion NIH or ot her grant organizat ion grant review Edit or review art icles (peer review) Writ ing book chapt ers/ reviews Writ ing art icles in peer reviewed journals Post ers at nat ional/ int ernat ional meet ings Present at ions at nat ional/ int ernat ional meet ings Increase Not Increase 2007 Complex scoring system Included points for teaching, service, and research/publications, weighted for activities that the department needs, but including all activities that the department values. Adjudication committee: Faculty elected small working committee of representatives to clarify points and try to assign fairly 7

8 Scoring sheet Credit provided for jobs not otherwise compensated 8

9 Results AAU bonuses have been given for past 4 years. Funding: varied sources (pharmaceutical research money, clinical bonus to department) Range: from a few hundred dollars to over $5000 Feedback Overall: wide participation, support for program Scoring is time-consuming Hard to make fully fair Not all contributions are counted Delay in release of funds may have diminished incentive Not clear will be funded every year 9

10 Breakouts by table Pros and cons for faculty of an academic incentive program How should contributions be measured? Points per activity, thresholds, self report vs. dept. records Funding: How do we pay for this? Barriers to implementation of academic incentive program and approaches to overcoming How do you know if it is working? Recommended reading: -Andreae MC Physician compensation programs in academic medical centers. Health Care Manage Rev - 01-JUL-2006; 31(3): Cramer JS, Ramalingam S, Rosenthal TC, and Fox CH, Implementing a Comprehensive Relativevalue-Based Incentive Plan in an Academic Family Medicine Department. Academic Medicine v 75 n2 December 2000, p Detsky AS, Baker MA, How to Run a Successful Academic Practice Plan JAMA v298 n7 August 2007 p Hilton C, Fisher W, Lopez A, Sander C. A relative-value-based system for calculating faculty productivity in teaching, research, administration, and patient care. Acad Med. 72(9); Sept 1997, Irby DM, Cooke M, Lowenstein D, Richards B. The academy movement: a structural approach to reinvigorating the educational mission. Acad Med. 79(8); Aug 2004, Mallon WT and Jones RF. How do medical schools use measurement systems to track faculty activity and productivity in teaching? Acad Med 2002 Feb; 77(2): Milad et al. Plan for compensation full-time physicians involved in medical education. Obstet Gynecol. 93, Nutter et al. Measuring faculty effort and contributions in medical education. Acad Med, 75: Reece EA Adapting industry-style business model to academia in a system of Performancebased Incentive Compensation. Acad Med - 01-JAN-2008; 83(1): -Reiser SJ. Linking Excellence in Teaching to Departments Budgets. Acad Med 70 (4), 1995: Sakai T, Hudson M, Davis P, and Williams J. Integration of academic and clinical performancebased faculty compensation plans: a system and its impact on an anaesthesiology department. Brit J of Anaesthesia. 111 (4): (2013) -Williams RG, Dunnington GL, and Folse JR. The impact of a program for systematically recognizing and rewarding academic performance. Acad Med 78(2), For more information Marjorie.Greenfield@uhhospitals.org Kimberly.Gecsi@uhhospitals.org 10

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