Editors' note: Child neurology in the 21st century: More than the sum of our RVUs

Abstract

It is clear that the care of children with neurologic disease is often complex, requiring substantial effort on the part of the provider and multidisciplinary team, and considerable time allocated to training future pediatric neurologists. According to recently published data from the Child Neurology Society (CNS) Task Force, burnout was reported in a significant number of faculty in all but 1 of 25 surveyed programs. Furthermore, the burnout seems to be related—at least in part—to unreachable work Relative Value Units (wRVUs) established by administrative staff. In this review, Dr. Zupanc and colleagues recount their experience with the CNS Task Force survey and report how heavily wRVUs are weighted when it comes to physician compensation and expectations. The authors argue that reliance on wRVUs as the sole measure of academic productivity is inherently flawed. Emphasis was placed on marrying the mission of hospital programs with expectations and compensation of child neurologists. If community outreach, education of future child neurologists, and clinical research are among the core responsibilities of faculty, it is self-evident that sufficient time and resources be dedicated to these pursuits. Dr. Wollack agrees that wRVU targets create hardships for child neurologists, who are often requested to generate far more wRVUs when compared with other pediatric subspecialty providers. Dr. Nash and colleagues underscore the importance of novel approaches to care delivery, such as a dedicated hospitalist model, which may alleviate some of the stresses created by the current wRVU system. As the number of child neurology providers dwindles, it is important now more than ever to rekindle institutional efforts to preserve this medical discipline. It is clear that the care of children with neurologic disease is often complex, requiring substantial effort on the part of the provider and multidisciplinary team, and considerable time allocated to training future pediatric neurologists. According to recently published data from the Child Neurology Society (CNS) Task Force, burnout was reported in a significant number of faculty in all but 1 of 25 surveyed programs. Furthermore, the burnout seems to be related—at least in part—to unreachable work Relative Value Units (wRVUs) established by administrative staff. In this review, Dr. Zupanc and colleagues recount their experience with the CNS Task Force survey and report how heavily wRVUs are weighted when it comes to physician compensation and expectations. The authors argue that reliance on wRVUs as the sole measure of academic productivity is inherently flawed. Emphasis was placed on marrying the mission of hospital programs with expectations and compensation of child neurologists. If community outreach, education of future child neurologists, and clinical research are among the core responsibilities of faculty, it is self-evident that sufficient time and resources be dedicated to these pursuits. Dr. Wollack agrees that wRVU targets create hardships for child neurologists, who are often requested to generate far more wRVUs when compared with other pediatric subspecialty providers. Dr. Nash and colleagues underscore the importance of novel approaches to care delivery, such as a dedicated hospitalist model, which may alleviate some of the stresses created by the current wRVU system. As the number of child neurology providers dwindles, it is important now more than ever to rekindle institutional efforts to preserve this medical discipline.