Rewarding teaching faculty with a reimbursement plan

Abstract

OBJECTIVE:To develop a system for measuring the teaching effort of medical school faculty and to implement a payment system that is based on it.DESIGN: An interventional study with outcomes measured before and after the intervention. SETTING:A department of internal medicine with a university hospital and an affiliated Veterans Administration hospital. INTERVENTION:We assigned a value in teaching units to each teaching activity in proportion to the time expended by the faculty and the intensity of their effort. We then calculated total teaching units for each faculty member in the Division of General Internal Medicine and for combined faculty effort in each subspecialty division in the Department of Medicine. After determining the dollar value for a teaching unit, we distributed discretionary teaching dollars to each faculty member in the Division of General Internal Medicine and to each subspecialty division according to total teaching units. MEASUREMENTS AND MAIN RESULTS:The distribution of discretionary teaching dollars was determined. In the year after the intervention, there was a substantial redistribution of discretionary teaching dollars among divisions. Compared with an increase in total discretionary dollars of 11.4%, the change in allocation for individual divisions ranged from an increase of 78.2% to a decrease of Ϫ 28.5%. Further changes in the second year after the intervention were modest. The distribution of teaching units among divisions was similar to the distribution of questions across subspecialties on the American College of Physicians In-Training Examination ( r ‫؍‬ .67) and the American Board of Internal Medicine Certifying Examination ( r ‫؍‬ .88). CONCLUSIONS:It is possible to measure the value of teaching effort by medical school faculty and to distribute discretionary teaching funds among divisions according to the value of teaching effort. When this intervention was used at our institution, there were substantial changes in the amounts received by some divisions. We believe that the new distribution more closely approximates the desired distribution because it reflects the desired emphasis on knowledge as measured by two of the most experienced professional groups in internal medicine. We also believe that our method is flexible and adaptable to the needs of most clinical teaching departments.

Satisfaction, Motivation, and Retention in Academic Faculty Incentive Compensation Systems:

“…[1][2][3][4][5][6][7][8] A 2006 systematic review of implemented incentive compensation system (ICS) programs in academic units concluded that incentive compensation was associated with positive financial impact and increased professional productivity in clinical and scholarly activity. 9 Despite the intuitive benefit of rewarding performance with incentive pay, the application of self-determination theory to compensation systems suggests that the autonomous motivation of an individual can be harmed by an ICS.…”

Commentary: The Relative Research Unit: Providing Incentives for Clinician Participation in Research Activities

“…3,4 Similarly, approaches exist to calculate and compensate teaching productivity for clinician-educators via a relative teaching unit or RTU model. 5 To our knowledge, however, a model to compensate non-researcher-clinicians for participating in clinical and translational research initiatives does not exist, yet is sorely needed. Indeed, without providing incentives for clinicians to participate in research activities, it is unlikely that they will do so in the numbers needed to fully realize the investments being made to advance medical science and health care delivery.…”

Preparation Time for Preclinical Pathology Educational Activities in Medical Schools: a Survey of Pathology Educators

“…United States medical schools have adopted different approaches to assessing the amount of work performed in medical student education, ranging from a simple count of contact hours to complicated models involving relative value units (RVUs) similar to that used to quantify clinical workload. [1][2][3][4][5][6][7][8][9][10][11][12][13] As opposed to instruction on rounds or in clinic, more preparation is often required for teaching preclinical medical students. Some institutions that measure academic workload incorporate preparation time in their estimates, although the practice is not universal.…”

“…Some institutions that measure academic workload incorporate preparation time in their estimates, although the practice is not universal. 1,2,5,6,7,9,10,11,13 and the amount recognized varies markedly (ranging from one to 15 hours per student contact hour). 1,2,5,6,11 In the literature, attention has focused on time accounting for clinical education, with few studies concentrating on preclinical (specifically didactic and pathology) medical teaching.…”