AUA 2023: Panel Discussion: Fair Pay for Non-RVU Measured Work

( During the Society of Academic Urology meeting at the 2023 American Urological Association’s Annual Meeting, Dr. James McKiernan led a panel discussion centered around supporting academic health system faculty in their pursuit of work that is not directly compensated by the health system, i.e. non-clinical, non-revenue generated work. Dr. McKiernan started by reviewing the history of the work relative value unit (wRVU). He highlighted several advantages of the wRVU system, including competitive compensation for academic faculty, objective and transparent pay. In addition, the wRVU structure encourages patient access and minimizes access disparities by the payor. However, for academic medical centers, it may discourage faculty from the “triple mission,” particularly education and research. Given that education and research is often the factor that attract clinician’s to an academic setting, the wRVU model can contribute to reduced satisfaction and increased burnout rates.

Dr. McKiernan then introduced the concept of the academic RVU, or aRVU, which is an objective measure that attempts to quantify and compensate faculty for non-revenue generating work. While Columbia does not specifically utilize the aRVU structure, this model provides guidance for academic programs who are looking for a way to incentivize this important work. Dr. McKiernan shared his institutional model, implemented at Columbia, to reward scholarly activity, academic and administrative participation, and overall well-being.

Next. Dr. Hunter Wessels, Chair of Urology at University of Washington provided his thoughts on the topic. He started by sharing variable incentive based on type of focus that presents a structural problem for urologists who have a focus outside of pure-clinically focused faculty. Dr. Wessels underscored that diversity is important within the department – a balance of surgeon scientists and high-volume surgeons are integral to ensuring sustainability and appropriate funds flow in a urology department. To some degree, the non-clinical endeavors of a department are offset by individuals who are clinically high performing. Additionally, cash salary is only one aspect of compensation; call schedules, benefits, vacation, clinical/administrative support, diversity, and culture all play an important role.

Dr. Li-Ming Su presented a novel compensation model from the University of Florida, that divides compensation into four parts. Part A is focused on time commitment and base salary, Part B is focused on funded roles that reduce clinical effort, Part C is focused on metrics to qualify for an incentive, and Part D is focused on incentive calculation. He did underscore the importance of the core clinical expectations, such as closing charts, completing documentation, etc. Dr. Su then presented incentive structures the reward non-clinical roles, such as awards or titles, that often can help in a resource limited system.

Lastly, Dr. Ganesh Palapattu closed out the panel by adding to the prior discussion by sharing the Michigan model of faculty fulfillment to protect the academic mission. He emphasized the importance of department chairs and leaders valuing and supporting faculty members, to optimize career satisfaction. Additionally, Dr. Palapattu shared the how the Michigan bonus structure takes into account a clinician’s profit/cost to the department, their academic productivity and citizenship, and other factors.

Presented by: James M. McKiernan, MD, Columbia University; Ganesh Palapattu, MD, University of Michigan; Li-Ming Su, MD, University of Florida; Hunter B. Wessels, MD, University of Washington

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023