Is it Right to Measure the Productivity of Senior Clinician/Educators by Relative Value Units?

Abstract

A doctor's performance is measured by the relative value unit (RVU), originally considered to be the fairest method to measure productivity. However, there is a category of clinician, the clinician/educator, who dedicates himself or herself to graduate medical education, and for which the RVU system does not take into account that most important element: teaching. There are no RVUs for spending 10 minutes at a bedside teaching medical interns how to differentiate systolic from diastolic murmurs, or how to measure jugular venous pressure. There are no RVUs for spending an hour with a large group of residents for clinical reasoning seminars. And there are no RVUs for inspiring a perplexed medical student who was drawn to the medical profession for its humanistic core. Generating a rational differential diagnosis requires meticulous history taking and thorough physical examination, yet in the 21st century some of this is being replaced by excessive ancillary testing. Despite the fact that this “new” method seems to be more efficient in looking for a definitive diagnosis, is it more cost effective than teaching the physician-in-training to generate a sound differential diagnosis based on clinical reasoning before exposing patients to unnecessary radiation? We do not know. A thriving clinician/educator—a master teacher—is someone who has the passion to inspire residents and who possesses a unique teaching style that commands their attention. Someone who can demonstrate to students how to elicit the right information from their patients, and how to use that to attain exceptional medical knowledge and develop sound clinical judgment. Unfortunately, these master teachers must work harder than anyone else, and, on paper, they receive lower RVUs than their peers who have not spent much time teaching. Perhaps, instead of developing new ways to pay these master teachers, the RVU system should be modified to account for their value, allowing institutions to recognize the true master teacher. This would be an incentive for doctors to provide the type of care that is truly important to patients and graduate medical education. A while ago, I attended the Society of Critical Care Medicine conference where Dr Paul Rogers, the vice chair of education at the University of Pittsburgh, was the honorary lecture speaker. He proposed giving out education credit units to allocate monetary resources to the medical educational department. Academic RVU to measure academic productivity also has been proposed in academic radiology departments. I believe that each academic institution should both identify a number of master teachers according to the size of the residency training program and provide them with full time equivalent (FTEs)/education credit units/academic RVUs that are proportionate to their time spent teaching and mentoring junior clinicians/educators. These master teachers are a valuable asset for the institution in attracting medical students during residency recruitment, as well as in reassuring those students that they will receive an excellent graduate medical education. Obviously, they are the academic leaders that nurture independent, competent, and skilled future physicians. To offer them the appropriate education credit units is an investment for the department that will pay dividends in the future.