Work Relative Value Units (wRVUs) Undervalue the Clinical Effort Associated with Teaching Cases: An ACS-NSQIP Analysis

Abstract

Introduction: Work relative value units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses clinical effort indexed to operative time, termed wRVU index (wRVU per minute). We hypothesize that there is a significant decrease in the calculated wRVU index among teaching cases. Methods: We queried the ACS-NSQIP database for 7 core EGS (per AAST) procedures and records were stratified into emergent vs non-emergent, and teaching vs non-teaching cases. We used multivariable generalized linear models to determine factors associated with increased operative time and a decreased wRVU index. Results: Among 953,976 cases from 2005-2010, the median OR time was 66 vs 49 mins (p < 0.001) when comparing teaching vs non-teaching cases for emergency procedures and 94 vs 62 mins (p < 0.001) for non-emergency procedures respectively. For all cases, the median wRVU index was 0.16 vs 0.21 (p < 0.001) when comparing teaching vs non-teaching cases. There was a positive association between teaching cases and decreased wRVU index for all cases (multivariable regression β-coefficient -0.058; 95% CI -0.060, -0.056; p < 0.001). Conclusion: The wRVU index was 24% lower for teaching cases when compared with non-teaching cases for 7 core EGS procedures even after accounting for patient-specific factors. This finding highlights the need for further evaluation of the current wRVU-based compensation model for teaching faculty to account for non-reimbursed clinical effort inadequately captured with the current remuneration framework.