Monday, September 21, 2009


The problem of finding time for teaching and having that time “honored” as valuable to the institution has been an ongoing concern for academic medical departments; but perhaps never more than now. Some departments have begun exploring adapting the familiar clinical metric, RVU’s or relative value units as a way to place comparable value on time taken by physicians in their roles as teachers and researchers.

In a 2007 article in J Am Coll Radiol (see link below) the authors state: "Despite the importance of teaching, research, and related activities to the mission of academic medical departments, no useful and widely agreed-on metrics exist with which to assess the value of individual faculty members’ contributions in these areas.

They go on to describe the use of RVUs as a common metric. In their model, all academic activity is quantified and weighted based on "estimates of effort, impact, and value to the department" (Mezrich,R & Nagy, PG. 2007). In the category of teaching, for example, classroom teaching and student feedback are factored into the equation, while clinical teaching is factored into clinical productivity. It is an article well worth reading if you are considering an RVU-based system. Their experience details the complexity of the process and the importance of linking departmental goals to the weighting system

In theory it sounds good, but how do you truly account for time spent preparing new interactive seminars, case-based teaching sessions, facilitating PBL or the development of innovations like online teaching modules. How do you account for time for providing feedback, writing evaluations and mentoring students and residents? Can we deconstruct teaching into RVUs… Should we? What do you think?

For ohiolink users

For citation and abstract


Anonymous said...

I'm skeptical. I read the article and for many of the areas, service and publications, it made sense. But for teaching, it just didn't take into account the complexity of the activity. Maybe you can't take into account the difference between developing a new topic and giving the same great lecture for the 6th time, but it seems like it should. Perhaps some recognition is better than none. I guess good teachers, advisors and mentors will continue. This system will at least protect them from being "punished" for making that choice.

Anonymous said...

A bad idea, don't go there!

Anonymous said...

Time teaching or preparing for teahcing = time taken away from clinical productivity (direct patient care) and research productivity. Please account for this time by RVUs or Otherwise.
"Recognition" is simply not enough.

Anonymous said...

NO - because the metric we are measured on at CCF is NET REVENUE.

Robert said...

RVU's are a ridiculous, absolutely irrational attempt to measure productivity for punitive purposes only and serves no useful, honest purpose

Neil said...

When we distil a highly complex and dynamic activity and thought process down to a number we are just pandering to the bean counters who don't want to take enough time to understand what we do.
We can argue about the details of what is or is not included in calculating this number but that would be distracting - e.g. the authors of this article spent many hours on this process and we can easily find fault with their model.
The very fact that we are discussing creating such a model means the value of education is being called into question.
Once you create a model - physicians are smart enough to figure out the loopholes and game the system to get a higher score. (the flagrant abuse of the EMR to game the E/M coding system comes to mind immediately).
So there is a serious risk that just having a framework for measuring the value of education will change what we do - instead of doing what we think is the right way to educate.
We already have created a monster by having residents rate teaching attendings on a likert scale...lets not go any further down this slippery slope.

Anonymous said...

We have had an educational RVU system since 1996 and it works very well to serve its purpose as a way to identify and reward core teaching activities. There is a set of formulas which have been developed and modified over time to adapt to changes in what we do and what we value. Preparation time for developing a new presentation and curriculum development time are among items for which there is a formula. Clearly clinical RVUs are paid at a higher rate than educational RVUs but our system does enable faculty members to make discretionary decisions regarding how they want to spend some of their discretionary time in teaching within core educational areas. I doubt that this serves as a motivating reason why our faculty teach as most of them are here for that purpose, but it is viewed as an acknowledgement of their teaching efforts within core student, resident, faculty development and CME categories.

Anonymous said...

I vote for RVU, particularly given that the medical school has been open for 5 years and the current system of accounting for and acknowledging educational efforts is not sufficient. We are mainly measured on RVU when compared to our peers. Persons who teach more will see fewer patients in any half day and thus bill fewer clinical RVU, so I think that providing educational RVU to accuont for bedside teaching that goes on in parallel with seeing patients is great. So if you are 100% clinical and have learners daily, this will help boost your RVU.

The educational RVU may not have as much meaning when blocks of time are provided for teaching, since the clinical RVU denominator can be adjusted (i.e. if you are 20% education and 80% clinical already, your denominator is already adjusted).

I suppose anyone can game the system- but at least there will be a system to game.

Anonymous said...

I dissent from the idea of establishing RVU's. There are plenty of physicians (look at many PD's) who are excellent teachers, but with a very low publication rate.
It is very arbitrary to establish scores to the publications, as there are plenty of very mediocre peer reviewed articles published every day just for the sake of "academic productivity", but according to their system, being a peer reviewed article would get a high score (even journals with high impact publish poor quality stuff).
I believe that it should be accounted the time spent preparing lectures, the quality of the presentations, the amount of teaching given, as well as Neil said, the -unfortunate Likert scale assessments- given by residents, along with of course, number of publications and abstracts.
In fact, some staff may have abstracts that are actually presented by residents, but that may be the very first poster or abstract a resident has ever made, and that should be accounted given that it may be the factor that changes a resident academic profile and behavior.
Putting numbers in the academic productivity can be in fact cruel, cold, and as Neil said, physicians can use alternative ways of going through the loopholes...just by simply sending an indiscriminate amount of "letters to the editor" to NEJM, it can immediately increase and artificially make somebody appear as "published" when in fact their contribution to literature is actually valueless.
I believe that simply permitting the staff put in a real and clean way what they really did (such as in the APR's) is better and less threatening.

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