RVUs Have Ruinous, Vacuous, Unintended Consequences


I’ve written about Relative Value Units (RVUs) in prior blogs. True, most of my references have been orthogonal, sarcastic, and shallow. But underlying the comments is an ongoing concern. RVUs have become The Metric that defines our success and to a great degree our compensation.

Although originally designed to level the playing field between procedure-based care and the more noninvasive, cognitive (think: office visit) side, the fact is that RVUs are not only a poor marker of overall productivity, but they have changed the way we view ourselves and our profession. And that is why a recent article entitled "Physician Perception of the Impact of Productivity Measures on Academic Practice" (Arch. Int. Med. 2012;172:967-9) is so important.

© Olivier Tuffé -

"I will work harder."

The authors surveyed physicians in a department of medicine at a large medical center. The response rate (64%) was good; the results are devastating. To begin with, the adoption of an RVU-based system has increased the likelihood that faculty take on clinical activities and perform procedures for which there is only a marginal indication. Conversely, respondents reported decreases in the time spent with individual patients, in research, and in teaching. Remarkably, only 16% of respondents described themselves as satisfied after RVU productivity measures were instituted. Most telling, 94% were pessimistic about the future of academic medicine under a work-productivity model. 94%!!

Yes, there are limitations. The data are derived from a single center and we have to rely on self-reporting. Perhaps the most dissatisfied were more likely to respond. But there is also a strong message here, one that was not fully appreciated by the accompanying invited commentary which, if I were to summarize, was simply unsympathetic. It was not quite a "Wake up and smell the roses" retort, but it came close.

My sense is that physicians now see themselves like Boxer, a loyal worker from George Orwell’s Animal Farm who repeatedly states "I will work harder." Fast forward 67 years since publication of that classic, and many doctors are saying "I will work harder for RVUs." The effects will be felt soon enough: Clinical research productivity and teaching excellence will be the primary victims.

I plan to return to these topics soon; they worry me and should worry you. In the meantime, I must stop writing this blog and head out to the wards in order to ring up a few more of those "Ruinous, Vacuous, Unintended Consequences Units."

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