Assessment of faculty productivity in academic departments of medicine in the United States: a national survey

Empowering Health Care Providers: A Collaborative Approach to Enhance Financial Performance and Productivity in Clinical Practice

Background

The combination of inadequate financial training, limited benchmarks, and mindset contribute to many physicians prioritizing revenue below quality, outcomes, and safety. This creates a challenge as hospital administrators aim to motivate clinicians to improve RVU generation and increase revenue.

Recent Findings

Creating physician/administrator teams that defines and explores the gap between observed and expected financial performance in parallel with appreciating the physician's practice preferences can create new opportunities for billing. The proposed 3 phase approach emphasizes nonjudgmental communication, education and partnership. The most common and effective opportunities for improvement include billing optimization, scheduling and system infrastructure modifications.

Implications for Practice

As reimbursement decrease, balancing revenue generation with physician satisfaction has become paramount. Promoting data drive bidirectional communication can lead to identifying previously unrecognized billing opportunities where change is driven by providers rather than by 1-dimensional institutional goals.

Medical School Regulatory Compliance Burdens for the Physician-Scientist

Medical school research faculty is increasingly required to complete more comprehensive and time consuming compliance steps for regulatory oversight. These relate to animal studies, information technology, biosafety, and human resources. For physician-scientists, the additional role in clinical care adds to these research areas with regulatory compliance in patient care and ever-growing web trainings. The sum of all these compliance regimes is a considerable time and cost burden, diminished research performance, and disengagement of faculty from colleagues, collaborations, and institutions. Many research and clinical compliance processes were put in place, often using legacy systems, in well-meaning attempts to address straightforward regulations in humane animal care, safe use of biological agents, and medical care delivery. However, their accumulation and negative impact on faculty performance demand time, energy, and resources that impact academic productivity. There are solutions to a relentlessly increasing regulatory load for research faculty, which involve vertical integration, convergence, and performance assessment in medical school and health system compliance regimes. ANN NEUROL 2024;96:417-422.

Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology

IMPORTANCE

Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care.

OBJECTIVE

To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce.

EVIDENCE REVIEW

Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions.

FINDINGS

A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology.

CONCLUSIONS AND RELEVANCE

The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients.

Providing 0.1 Full-Time Equivalent (FTE) Support to Fellowship Core Faculty Improves Faculty Involvement in Fellowship Education and Recruitment

In 2022, the American Council for Graduate Medical Education (ACGME) recommended that core faculty (CF) in medical subspecialty fellowships receive at least 0.1 full-time equivalent (FTE) salary support, with plans to enforce compliance in July 2023. After early feedback raised concerns about potential unintended consequences, ACGME deferred enforcement to July 2024. Hence, there is an urgent need to understand the ramifications of providing FTE support for CF. In 2020, the Yale hematology and medical oncology (HO) fellowship program began providing 0.1 FTE support to all CF. Perceptions regarding this were assessed via surveys distributed to all CF in 2021 and 2022 and to all HO fellows in 2021. The vast majority (83.3%) of CF survey respondents reported improved job satisfaction and an increased sense of involvement in the fellowship program as a result of the new 0.1 FTE-supported CF program. Most CF increased attendance at fellowship conferences, devoted more time to mentorship, and increased participation in recruitment. In free text comments, CF respondents described that providing 0.1 FTE support made them "feel rewarded," gave them "a sense of commitment" to the fellowship, and helped "offset clinical requirements." HO fellows reported "a positive impact" of the new program with faculty being "more present at lectures." The median number of times faculty were available to interview fellowship applicants rose markedly after introduction of the program. The FTE-supported CF program was viewed enthusiastically by fellows and faculty, resulting in increased CF involvement in fellowship education and recruitment.

Definitions and factors associated with emergency physician productivity: a scoping review

PURPOSE

There currently exists no standard productivity measure for emergency physicians. The objectives of this scoping review were to synthesize the literature to identify components of definitions and measurements of emergency physician productivity and to evaluate factors associated with productivity.

METHODS

We searched Medline, Embase, CINAHL, and ProQuest One Business from inception to May 2022. We included all studies that reported on emergency physician productivity. We excluded studies that only reported departmental productivity, studies with non-emergency providers, review articles, case reports, and editorials. Data were extracted into predefined worksheets and a descriptive summary was presented. Quality analysis was performed with Newcastle-Ottawa Scale.

RESULTS

After screening 5521 studies, 44 studies met full inclusion criteria. Components of the definition for emergency physician productivity included: number of patients managed, revenue generated, patient processing time, and a standardization factor. Most studies measured productivity using patients per hour, relative value units per hour, and provider-to-disposition time. The most studied factors influencing productivity included scribes, resident learners, electronic medical record implementation, and faculty teaching scores.

CONCLUSION

Emergency physician productivity is heterogeneously defined, but includes common elements such as patient volume, complexity, and processing time. Commonly reported productivity metrics include patients per hour and relative value units that incorporate patient volume and complexity, respectively. The findings of this scoping review can guide ED physicians and administrators to measure the impact of QI initiatives, promote efficient patient care, and optimize physician staffing.

Educational Relative Value Units as a Measure of Academic Productivity: A Systematic Review

INTRODUCTION

Academic Health Centers (AHCs) have complex, often competing missions. Many have developed mission-based management (MBM) systems to support their clinical and non-clinical missions. There are limited data on MBM use for their educational missions. Our scoping review explored how AHCs employed such systems.  Materials and methods: Arksey and O'Malley's six-stage framework guided our review. Based on pre-defined criteria, English language articles from PubMed, EMBASE, SCOPUS, and the Healthcare Administration Database published between 2010 and 2020 were loaded into a reference manager. The search included all health professions education schools. Articles were excluded if they were review articles, commentaries, or clearly did not involve funding for education. From the final list of selected articles, data were extracted using a data extraction sheet we developed. Two researchers reviewed each article again to ensure extracted data were reported consistently and with sufficient detail.  Results: Of the 1729 manuscripts identified, 35 met inclusion criteria. Sixteen (46%) contained data in some form but did not have a formal methods section describing the specific approach to data collection and analysis. Moreover, there was marked variability in how educational effort was quantified, what counted as educational effort (educational scholarship versus teaching) and the impacts of such quantification (departmental funding versus individual faculty incentives). None of the studies reported on the impact on faculty promotion. Faculty satisfaction with the system was reported in seven studies (20%) and was generally positive.

CONCLUSIONS

A systematic description of how systems were developed to support the educational mission was lacking. Clear goals, methods of development, uniform data on educational productivity and quality, and program evaluation were not defined by most articles. This lack of process clarity presents a challenge, but more importantly an opportunity for academic health centers to unify efforts and continue to further their educational mission.

DORA-compliant measures of research quality and impact to assess the performance of researchers in biomedical institutions: Review of published research, international best practice and Delphi survey

OBJECTIVE

The San Francisco Declaration on Research Assessment (DORA) advocates for assessing biomedical research quality and impact, yet academic organizations continue to employ traditional measures such as Journal Impact Factor. We aimed to identify and prioritize measures for assessing research quality and impact.

METHODS

We conducted a review of published and grey literature to identify measures of research quality and impact, which we included in an online survey. We assembled a panel of researchers and research leaders, and conducted a two-round Delphi survey to prioritize measures rated as high (rated 6 or 7 by ≥ 80% of respondents) or moderate (rated 6 or 7 by ≥ 50% of respondents) importance.

RESULTS

We identified 50 measures organized in 8 domains: relevance of the research program, challenges to research program, or productivity, team/open science, funding, innovations, publications, other dissemination, and impact. Rating of measures by 44 panelists (60%) in Round One and 24 (55%) in Round Two of a Delphi survey resulted in consensus on the high importance of 5 measures: research advances existing knowledge, research plan is innovative, an independent body of research (or fundamental role) supported by peer-reviewed research funding, research outputs relevant to discipline, and quality of the content of publications. Five measures achieved consensus on moderate importance: challenges to research productivity, potential to improve health or healthcare, team science, collaboration, and recognition by professional societies or academic bodies. There was high congruence between researchers and research leaders across disciplines.

CONCLUSIONS

Our work contributes to the field by identifying 10 DORA-compliant measures of research quality and impact, a more comprehensive and explicit set of measures than prior efforts. Research is needed to identify strategies to overcome barriers of use of DORA-compliant measures, and to "de-implement" traditional measures that do not uphold DORA principles yet are still in use.

Faculty Development and Infrastructure to Support Educational Scholarship: A Scoping Review on Author Development

PURPOSE

Medical educators are expected to produce educational scholarship, which can lead to career advancement and promotion. Institutions have developed author development programs, which vary in duration, instructional approach, and effectiveness. However, no summation of the evidence exists for academic medicine leaders to use as guidance for building similar programs. This scoping review characterizes faculty development programs that support educational scholarship and author development in academic medicine.

METHOD

The authors searched PubMed, Scopus, Google Scholar, and ProQuest (Healthcare Administration Database and Social Science Premium Collection) for articles published from inception to June 14, 2021. Articles that described formal instruction on scholarly writing for publishing were included. Data were analyzed by program participation, structure, content delivery, and outcomes.

RESULTS

Of 923 articles identified, 20 met inclusion criteria. The included studies covered 18 unique programs of which 1 was sponsored jointly by a university and professional society, 5 by professional societies, 5 by university or medical school organizations, and 7 by medical departments. Nine programs relied at least in part on volunteers. Instructional approaches included didactics (7 programs) and mentoring (5 programs) but mostly featured group-based work (11 programs). Expectations for participants ranged from participation to manuscript submission. The main funding sources were grants (8 programs) and internal funds (7 programs) from the sponsoring institution. Only 4 programs reported participation fees. The impact of these programs included scholarly work products, other measures of career advancement, and participant perceptions.

CONCLUSIONS

Author development programs require resource investment and a culture that values educational scholarship. Workshops, 1-on-1 mentoring, and peer writing groups are cornerstones of the experiential learning approach needed to build scholarship skills and can pay dividends in supporting the academic mission in medicine. These findings may benefit leaders in academic medicine who want to develop evidence-based programs in author development.

Trust but verify: An analysis of redundant publications from two major psychiatry journals in India

BACKGROUND

No analysis of redundant or duplicate publications, deemed unethical and unscientific, has been undertaken in psychiatric literature.

AIM

To analyze the proportion and patterns of redundant publications associated with index articles published in two major Indian psychiatry journals.

METHODS

Index articles were original papers published in the Indian Journal of Psychiatry and the Indian Journal of Psychological Medicine between 2015 and 2017. Using a systematic search strategy that combined author names and article keywords, we combed the literature to identify and characterize redundant publications related to these index articles. Redundant publications were classified into one of the following categories using a priori definitions: dual, suspected dual, salami slicing, meat extender, and extended sample publication.

RESULTS

From 324 index articles screened, a total of 27 articles (8.4%) were identified to have 32 associated redundant publications of the following types: dual (n = 3), suspected dual (n = 2), salami slicing (n = 22), meat extender (n = 3), and extended sample publication (n = 2). A majority of the redundant articles (n = 23, 71.9%) failed to clearly cross-reference the prior publication(s). We also identified nine non-redundant but related publications with no proper cross-referencing in five of them.

CONCLUSION

Redundant publications are a common practice in the psychiatry journals screened. Salami slicing is the most common form of redundancy, with no proper cross-referencing in most cases. Concerted efforts are needed to detect and deal with this concerning practice that undermines both science and ethics.

Scholarly Productivity Among Academic Foot and Ankle Surgeons Affiliated With US Podiatric Medicine and Surgery Residency and Fellowship Training Programs

Foot and ankle surgeons practicing within academic medicine balance clinical or surgical training, course instruction, administrative duties, and research. Along with clinical skills and patient volume, promotion within academia often relies on scholarly productivity. Previous research across specialties described this productivity using variables including publications, citations, and the h-index, a scale that quantifies the productivity and citation impact of published works, among academic ranks. As no studies examine the scholarly impact of foot and ankle surgeons with academic appointments, this study aimed to analyze the productivity and gender differences present in this specialty. A systematic review of academic-affiliated foot and ankle surgery residencies and fellowships was performed; and faculty members were screened for sex, academic rank, publication history, citations, h-index, and years in practice. Among 234 programs reviewed, 44 programs allowed for the analysis of 106 practitioners with an academic rank eligible for analysis. Overall, 78.3% of practitioners were male with the most common rank being assistant professor. Men published more documents and maintained higher citations as well as longer years in practice, and this was significant (p < .05). A significant difference was exhibited among all academic ranks (p ≤ .001). Multivariate regression revealed the publication history and years in practice are strongly correlated with the h-index of providers (p ≤ .001). Foot and ankle surgeons practicing in an academic setting may use the results of this study to gauge their productivity and identify benchmarks that similar providers have met at varying academic ranks.

Physician-faculty perceptions towards teaching incentives: A case study at a children's hospital

PURPOSE

This exploratory study examines affiliate physician-faculty perceptions and attitudes regarding a teaching incentive programme at a free-standing children's hospital in the United States. We describe the compensation model and present faculty interpretations of its influence on the institutional culture.

METHODS

A case study methodology was applied to understand the sociological aspects of academic productivity interventions. In-depth interviews, direct observation of leadership meetings, teaching activity logs, organisational theoretical lens and survey results were used for methodological triangulation. Data from these multiple sources were coded and discussed between investigators iteratively to identify core themes.

RESULTS

Of the faculty eligible for the incentive, 32 engaged in in-depth interviews (N = 32/107; 30%) and 88 (interviewees included) in the survey (N = 88/107; 82%). Findings suggest that while the implementation made some strides in mitigating barriers for some, for others gaps were identified that suggest further exploration within this domain of study is warranted. The incentive implementation was perceived as strategic, intending to encourage the academic culture of the hospital, though participants commonly expressed confusion about the rationale behind the omission of teaching allocations in formal contracts. However, high satisfaction levels for the programme as a conduit to change were evident. There was a perception of a shift in the collective faculty morale that reflected an evolving institutional culture that increased enthusiasm for teaching. Finally, faculty noted their perception that institutions that employ teaching incentives could positively influence faculty recruitment.

CONCLUSION

We found a modest incentive-based reward for teaching activity was successful in informing the perceptions of faculty regarding their institution's academic prestige goals and teaching recognition. Such programmes, while requiring a small investment of time and resources by institutional leadership, can convey that the educational mission remains a priority in this era of increasing clinical and administrative pressure and an institutional culture that may positively influence faculty morale and dedication to teaching.

Can an Academic RVU Model Balance the Clinical and Research Challenges in Surgery?

OBJECTIVE

The purpose of this study is to identify perceptions of academic surgeons regarding academic productivity and assess its relationship to clinical productivity. We hypothesized that these perceptions would vary based on respondent characteristics including clinical activity and leadership roles.

DESIGN

This retrospective, survey-based study was performed from August 26, 2019 to September 26, 2019.

SETTING

The setting was academic surgical departments across the US.

PARTICIPANTS

The survey instrument was administered to faculty members of the Association of Program Directors in Surgery. A total of 105 academic surgeons responded.

RESULTS

Most respondents were Program Directors (59%) of general surgery programs. Of the participants, 30% identified as Professor, 36% as Associate Professor, and 15% as Assistant Professor. Respondents agreed that multiple academic pursuits or factors should count towards academic productivity including the following (in descending order): completing a first-authored manuscript (98.8%), completing a senior-authored manuscript (97.7%), chairing a national committee (94.1%), serving on a national committee (88.2%), completing a second-authored manuscript (88.0%), completing a first lecture (83.7%), completing a middle-authored manuscript (71.8%), completing a lecture (whether or not repeated) (70.9%), impact factor of journal (60.7%), and attendance at grand rounds (57.0%). Perspectives did not vary significantly based on surgeon demographics, clinical setting, or leadership role (p > 0.05).

CONCLUSIONS

Perceptions regarding what constitutes academic productivity and merit a reduction in clinical expectation are remarkably similar across multiple surgeon characteristics including demographics, academic title, leadership role, and practice environment.

Past, present and future of university hospitals

Objectives: Health care systems worldwide are changing and taking new forms. The old, more hierarchically oriented, model with individual institutional and bilateral interactions between primary, secondary, tertiary and quaternary care is being replaced by an integrated and dynamic network model. We aim to look at what role university hospitals will play in this future organization of health care.Method: In this paper, we look at the relevant literature on the history of academic medicine and university hospitals. Subsequently, we look at the challenges university hospitals are facing according to contemporary literature on the topic.Results: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18^th century. Currently, the sustainability of the model is under immense pressure. University hospitals are facing economic challenges, teaching challenges and research challenges. However, there is reason to believe that they can continue to play a role of importance in tomorrow's medicine. The organization of health care is undergoing two important changes. The first is the evolution towards a more dynamic and integrated network model. University hospitals can become an important hub within this network. The second change is an evolution towards evidence based medicine and translational research.Conclusion: Due to their unique tripartite mission, we argue that university hospitals can continue to play an important and critical role in promoting evidence-based medicine and speedy translation of new evidence.

A nationwide assessment of perceptions of research-intense academic careers among predoctoral MD and MD-PhD trainees

Introduction:

While previous studies have described career outcomes of physician-scientist trainees after graduation, trainee perceptions of research-intensive career pathways remain unclear. This study sought to identify the perceived interests, factors, and challenges associated with academic and research careers among predoctoral MD trainees, MD trainees with research-intense (>50%) career intentions (MD-RI), and MD-PhD trainees.

Methods:

A 70-question survey was administered to 16,418 trainees at 32 academic medical centers from September 2012 to December 2014. MD vs. MD-RI (>50% research intentions) vs. MD-PhD trainee responses were compared by chi-square tests. Multivariate logistic regression analyses were performed to identify variables associated with academic and research career intentions.

Results:

There were 4433 respondents (27% response rate), including 2625 MD (64%), 653 MD-RI (15%), and 856 MD-PhD (21%) trainees. MD-PhDs were most interested in pursuing academia (85.8%), followed by MD-RIs (57.3%) and MDs (31.2%). Translational research was the primary career intention for MD-PhD trainees (42.9%). Clinical duties were the primary career intention for MD-RIs (51.9%) and MDs (84.2%). While 39.8% of MD-PhD respondents identified opportunities for research as the most important career selection factor, only 12.9% of MD-RI and 0.5% of MD respondents shared this perspective. Interest in basic research, translational research, clinical research, education, and the ability to identify a mentor were each independently associated with academic career intentions by multivariate regression.

Conclusions:

Predoctoral MD, MD-RI, and MD-PhD trainees are unique cohorts with different perceptions and interests toward academic and research careers. Understanding these differences may help to guide efforts to mentor the next generation of physician-scientists.

Scholarly Productivity and Impact: Developing a Quantifiable, Norm-based Benchmarking Methodology for Academic Emergency Medicine

BACKGROUND

Quantifying and benchmarking scholarly productivity of emergency medicine faculty is challenging. While performance indicators including publication and citation counts are available, use of indicators to create normative references has lagged. The authors developed methodology to benchmark emergency medicine academician scholarly productivity (e.g., publications over time) and impact (e.g., citations per publication over time) against an appropriate reference group.

METHODS

The methodology includes: 1) define time frame and scholarly metrics; 2) identify representative population; 3) reconcile alternative author names; 4) use analytic tool to identify scholarly output; 5) build database containing metrics; and 6) create benchmarking statistics, including subsamples. This study included emergency medicine faculty from 2011 to 2015, with total peer-reviewed publications and citations per publication as scholarly metrics.

RESULTS

In the United States at the time of the search (2016) there were 200 academic emergency departments, 186 with public faculty listings, which yielded 6,727 academicians. For each academician, the authors calculated statistics about peer-reviewed publications and average citations per publication from 2011 to 2015 and created benchmarking rulers using percentile ranks. Productivity by year of graduation with terminal degree was compared within each subsample, finding that newly graduated faculty demonstrated higher productivity than their within-rank peers who graduated earlier. Finally, benchmarking tables were created that allow comparison of peer-reviewed publication counts and citations per publication for individual academicians against the norm.

CONCLUSIONS

This benchmarking method can serve as a model for norm-based scaling of scholarly productivity for emergency medicine. This has important implications for performance review, promotion and hiring, and evaluating group productivity.

Measuring individual physician clinical productivity in an era of consolidated group practices

BACKGROUND

As physician groups consolidate and value-based payment replaces traditional fee-for-service systems, physician practices have greater need to accurately measure individual physician clinical productivity within team-based systems. We compared methodologies to measure individual physician outpatient clinical productivity after adjustment for shared practice resources.

METHODS

For cardiologists at our hospital between January 2015 and June 2016, we assessed productivity by examining completed patient visits per clinical session per week. Using mixed-effects models, we sequentially accounted for shared practice resources and underlying baseline characteristics. We compared mixed-effects and Generalized Estimating Equations (GEE) models using K-fold cross validation, and compared mixed-effect, GEE, and Data Envelopment Analysis (DEA) models based on ranking of physicians by productivity.

RESULTS

A mixed-effects model adjusting for shared practice resources reduced variation in productivity among providers by 63% compared to an unadjusted model. Mixed-effects productivity rankings correlated strongly with GEE rankings (Spearman 0.99), but outperformed GEE on K-fold cross validation (root mean squared error 2.66 vs 3.02; mean absolute error 1.89 vs 2.20, respectively). Mixed-effects model rankings had moderate correlation with DEA model rankings (Spearman 0.692), though this improved upon exclusion of outliers (Spearman 0.755).

CONCLUSIONS

Mixed-effects modeling accounts for significant variation in productivity secondary to shared practice resources, outperforms GEE in predictive power, and is less vulnerable to outliers than DEA.

IMPLICATIONS

With mixed-effects regression analysis using otherwise easily accessible administrative data, practices can evaluate physician clinical productivity more fairly and make more informed management decisions on physician compensation and resource allocation.

Medical research productivity in the Arab countries: 2007-2016 bibliometric analysis

Background

The aim of this study was to assess recent trends in medical research productivity in Arab countries.

Methods

We collected bibliometric data for the world countries, Arab countries, and Arab institutions for 2007-2016, using Essential Science Indicators, Journal Citation Reports, and Web of Science database. We collected the number of published papers overall and per year, citations per paper, and number of papers published in top quartile and top 10% journals. For the 10 most productive institutions, we additionally collected the number of papers with correspondence authors affiliated with the institution.

Results

The Arab world produced 189 papers per one million people, about a quarter of the value for other world countries. Four Arab countries (Qatar, Tunisia, Lebanon, and Kuwait) produced more than 695 papers per one million people, exceeding the world average. The average number of citations per paper was 9.2; it rose to more than 15 for papers with international collaboration. At the institutional level, the number of citations showed upward trends, with six institutions having an average citation per paper higher than that of all Arab countries. For the 10 most productive institutions in Arab countries, the percentage of papers involving international collaborations ranged from 42% to 79%; of these, 9% to 29% were led by authors from the same institution. For these 10 most productive institutions, the percentage of papers published in the top quartile journals and with a lead/corresponding author from the institution ranged from 7 to 32%; that percentage drops to 1% to 10% for papers published in top 10% journals.

Conclusions

Although medical research output in Arab countries at both the country and the institution levels has increased over the past 10 years, it is still lagging behind the rest of the world. The percentage of papers involving international collaborations was relatively high, but the majority of these papers were led by authors from outside the local institution, particularly when published in the top 10% journals.

Implementation of electronic charting is not associated with significant change in physician productivity in an academic emergency department

Objectives

To compare physician productivity and billing before and after implementation of electronic charting in an academic emergency department (ED).

Materials and methods

This retrospective, blinded, observational study compared the 6 months pre-implementation (January to June 2012) with the 6 months post-implementation 1 year later (January to June 2013). Thirty-one ED physicians were recruited, with each physician acting as his/her own control in a before-after design. Productivity was measured via total number of encounters and “productivity index” defined as worked relative value units divided by the clinical full-time equivalent. Values for charges, encounters, and productivity index were determined during each study period and separately for procedures, observational stays, and critical care.

Results

No differences were found for total productivity index per month (758 [623-876] pre-group vs. 756 [673-886] post-group; P = 0.30). There was, however, a 9% decrease in total encounters per month (138 [101-163] pre-group vs. 125 [99-159] post-group; P = 0.01). Significant decreases were seen across all observation stay categories. Conversely, significant increases were seen across all critical care categories. There was no difference in total charges per month.

Discussion

This is one of few studies to demonstrate minimal disruption in physician productivity after transitioning to electronic documentation. The reasons for these findings are likely multi-factorial.

Conclusion

In this study, implementation of electronic charting was not associated with decreases in productivity or billing for total ED care, but may be associated with increases for critical care and decreases for observational stays.

Using Organizational Philosophy to Create a Self-Sustaining Compensation Plan Without Harming Academic Missions

PROBLEM

Academic physician reimbursement has moved to productivity-based compensation plans. To be sustainable, such plans must be self-funding. Additionally, unless research and education are appropriately valued, faculty involved in these efforts will become disillusioned, yet revenue generation in these activities is less robust than for clinical care activities.

APPROACH

Faculty at the Department of Medicine, University of Florida Health, elected a committee of junior and senior faculty and division chiefs to restructure the compensation plan in fiscal year (FY) 2011. This committee was charged with designing a new compensation plan based on seven principles of organizational philosophy: equity, compensation coupled to productivity, authority aligned with responsibility, respect for all academic missions, transparency, professionalism, and self-funding in each academic mission.

OUTCOMES

The new compensation plan was implemented in FY2013. A survey administered at the end of FY2015 showed that 61% (76/125) of faculty were more satisfied with this plan than the previous plan. Since the year before implementation, clinical relative value units per faculty increased 7% (from 3,458 in FY2012 to 3,704 in FY2015, P < .002), incentives paid per faculty increased 250% (from $3,191 in FY2012 to $11,153 in FY2015, P ≤ .001), and publications per faculty increased 15% (from 2.6 in FY2012 to 3.0 in FY2015, P < .001). Grant submissions, external funding, and teaching hours also increased per faculty but did not reach statistical significance.

NEXT STEPS

An important next step will be to incorporate quality metrics into the compensation plan, without affecting costs or throughput.

The Academic RVU: Ten Years Developing a Metric for and Financially Incenting Academic Productivity at Oregon Health & Science University

PURPOSE

Established metrics reward academic faculty for clinical productivity. Few data have analyzed a bonus model to measure and reward academic productivity. This study's objective was to describe development and use of a departmental academic bonus system for incenting faculty scholarly and educational productivity.

METHOD

This cross-sectional study analyzed a departmental bonus system among emergency medicine academic faculty at Oregon Health & Science University, including growth from 2005 to 2015. All faculty members with a primary appointment were eligible for participation. Each activity was awarded points based on a predetermined education or scholarly point scale. Faculty members accumulated points based on their activity (numerator), and the cumulative points of all faculty were the denominator. Variables were individual faculty member (deidentified), academic year, bonus system points, bonus amounts awarded, and measures of academic productivity. Data were analyzed using descriptive statistics, including measures of variance.

RESULTS

The total annual financial bonus pool ranged from $211,622 to $274,706. The median annual per faculty academic bonus remained fairly constant over time ($3,980 in 2005-2006 vs. $4,293 in 2014-2015), with most change at the upper quartile of academic bonus (max bonus $16,920 in 2005-2006 vs. $39,207 in 2014-2015). Bonuses rose linearly among faculty in the bottom three quartiles of academic productivity, but increased exponentially in the 75th to 100th percentile.

CONCLUSIONS

Faculty academic productivity can be measured and financially rewarded according to an objective academic bonus system. The "academic point" used to measure productivity functions as an "academic relative value unit."

A Multifaceted Organizational Physician Assessment Program: Validity Evidence and Implications for the Use of Performance Data

Objective

To provide validity evidence for a multifaceted organizational program for assessing physician performance and evaluate the practical and psychometric consequences of 2 approaches to scoring (mean vs top box scores).

Participants and Methods

Participants included physicians with a predominantly outpatient practice in general internal medicine (n=95), neurology (n=99), and psychiatry (n=39) at Mayo Clinic from January 1, 2013, through December 31, 2014. Study measures included hire year, patient complaint and compliment rates, note-signing timeliness, cost per episode of care, and Likert-scaled surveys from patients, learners, and colleagues (scored using mean ratings and top box percentages).

Results

Physicians had a mean ± SD of 0.32±1.78 complaints and 0.12±0.76 compliments per 100 outpatient visits. Most notes were signed on time (mean ± SD, 96%±6.6%). Mean ± SD cost was 0.56±0.59 SDs above the institutional average. Mean ± SD scores were 3.77±0.25 on 4-point and 4.06±0.31 to 4.94±0.08 on 5-point Likert-scaled surveys. Mean ± SD top box scores ranged from 18.6%±16.8% to 90.7%±10.5%. Learner survey scores were positively associated with patient survey scores (r=0.26; P=.003) and negatively associated with years in practice (r=−0.20; P=.02).

Conclusion

This study provides validity evidence for 7 assessments commonly used by medical centers to measure physician performance and reports that top box scores amplify differences among high-performing physicians. These findings inform the most appropriate uses of physician performance data and provide practical guidance to organizations seeking to implement similar assessment programs or use existing performance data in more meaningful ways.

Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial

BACKGROUND

No-shows, or missed appointments, are a problem for many medical practices. They result in fragmented care and reduce access for all patients.

OBJECTIVE

To determine whether telephone reminder calls targeted to patients at high risk of no-show can reduce no-show rates.

DESIGN

Single-center randomized controlled trial.

PARTICIPANTS

A total of 2247 primary care patients in a hospital-based primary care clinic at high risk of no-show (>15 % risk) for their appointment in 7 days.

INTERVENTION

Seven days prior to their appointment, intervention arm patients were placed in a calling queue to receive a reminder phone call from a patient service coordinator. Coordinators were trained to engage patients in concrete planning. All patients received an automated phone call (usual care).

MAIN MEASURES

Primary outcome was no-show rate. Secondary outcomes included arrival rate, cancellation rate, reschedule rate, time to cancellation, and change in revenue.

KEY RESULTS

The no-show rate in the intervention arm (22.8 %) was significantly lower (absolute risk difference -6.4 %, p < 0.01, 95 % CI [-9.8 to -3.0 %]) than that in the control arm (29.2 %). Arrival, cancellation, and reschedule rates did not differ significantly. In the intervention arm, rescheduling and cancellations occurred further in advance of the appointment (mean difference, 0.35 days; 95 % CI [0.07-0.64]; p = 0.01). Reimbursement did not differ significantly.

CONCLUSIONS

A phone call 7 days prior to an appointment led to a significant reduction in no-shows and increased reimbursement among patients at high risk of no-show. The use of targeted interventions may be of interest to practices taking on increased accountability for population health.

The effect of a monetary incentive for administrative assistants on the survey response rate: a randomized controlled trial

BACKGROUND

There is sufficient evidence that monetary incentives are effective in increasing survey response rates in the general population as well as with physicians. The objective of this study was to assess the impact of a monetary incentive intended for administrative assistants on the survey response rate of physicians in leadership positions.

METHODS

This was an ancillary study to a national survey of chairs of academic Departments of Medicine in the United States about measuring faculty productivity. We randomized survey participants to receive or not receive a $5 gift card enclosed in the survey package. The cover letter explained that the gift card was intended for the administrative assistants as a "thank you for their time." We compared the response rates between the 2 study arms using the Chi-square test.

RESULTS

Out of 152 participants to whom survey packages were mailed to, a total of 78 responses were received (51 % response rate). The response rates were 59 % in the incentive arm and 46 % in the no incentive arm. The relative effect of the incentive compared to no monetary incentive was borderline statistically significant (relative risk (RR) = 1.36, 95 % confidence interval (CI) 0.99 to 1.87; p = 0.055).

CONCLUSION

Monetary incentives intended for administrative assistants likely increase the response rate of physicians in leadership positions.

Prediction of junior faculty success in biomedical research: comparison of metrics and effects of mentoring programs

Measuring and predicting the success of junior faculty is of considerable interest to faculty, academic institutions, funding agencies and faculty development and mentoring programs. Various metrics have been proposed to evaluate and predict research success and impact, such as the h-index, and modifications of this index, but they have not been evaluated and validated side-by-side in a rigorous empirical study. Our study provides a retrospective analysis of how well bibliographic metrics and formulas (numbers of total, first- and co-authored papers in the PubMed database, numbers of papers in high-impact journals) would have predicted the success of biomedical investigators (n = 40) affiliated with the University of Nevada, Reno, prior to, and after completion of significant mentoring and research support (through funded Centers of Biomedical Research Excellence, COBREs), or lack thereof (unfunded COBREs), in 2000–2014. The h-index and similar indices had little prognostic value. Publishing as mid- or even first author in only one high-impact journal was poorly correlated with future success. Remarkably, junior investigators with >6 first-author papers within 10 years were significantly (p < 0.0001) more likely (93%) to succeed than those with ≤6 first-author papers (4%), regardless of the journal’s impact factor. The benefit of COBRE-support increased the success rate of junior faculty approximately 3-fold, from 15% to 47%. Our work defines a previously neglected set of metrics that predicted the success of junior faculty with high fidelity—thus defining the pool of faculty that will benefit the most from faculty development programs such as COBREs.