E. W. Nelson1, M. C. Mone1, C. Ward1, S. R. Finlayson1 1University Of Utah,General Surgery/Surgery,Salt Lake City, UT, USA
Introduction: In response to internal and external pressures to be sustainable, equitable, and transparent, faculty pay models in academic surgery have been evolving. This review examines the transition from a purely incentive based model to a scale based pay plan and the effects on clinical productivity as measured by relative value units (RVUs) as well as possible impact on recruitment, attrition, compensation, and sustainability.
Methods: Over a three year transition period (7/2015-6/2018) an academic division of general surgery converted from a purely incentive based pay model to a scale based model. Beginning on July 1, 2015, faculty salaries of 18 academic general surgeons were renegotiated and fixed at or near the average of the previous four fiscal years, July 2011 – June 2014. Two full time VA faculty and three faculty with administrative positions were not included. Over the next 18 months, a graduated scale based on rank and years in rank was developed using 50th % AAMC salary guidelines with refinements for subspecialties based on national standards including AMGA, SVC, and MGMA. When the scale was implemented on Jan 1, 2017, all faculty salaries above scale were frozen at that level and salaries below scale were adjusted half way to scale with eventual adjustment to full scale pending financial sustainability for the entire group. For comparison, incentive based years included fiscal years 2011 to 2015 and pay scale years were fiscal years 2016-2018. When calculating RVU averages per year, years worked by surgeons included partial years based on date of hire and separation.
Results: On January 1, 2017, when compared to the salary scale, twelve faculty (6 males and 6 females) had previous salaries that were below scale and had annualized adjustments half way to scale. Overall, adjustments averaged $15,345 with a maximum of $60,000. Additional salary adjustments for males averaged $11,403 and $19,087 for females. Between fiscal year 2011 and fiscal year 2018 the division grew by 160%, from 10 (8 males and 2 females) to 26 (16 males and 10 females). New faculty salaries were determined on scale based on previous academic rank and years in rank. Over the same period, 5/30 faculty left the division only one of whom had been placed on the salary scale; two recruited to other academic programs, two into private practice, and one transferred to another division. Based on the growth in faculty size, total divisional RVU’s grew from 65,063 in 2011 to 164,096 in 2018. However, when comparing incentive based years to pay scale years, per faculty average RVU’s/year decreased by 5.5% (7347 vs 6943).
Conclusion: Transition from an incentive based salary plan to a scale based model has had only modest effect on surgeon yearly RVU productivity and faculty attrition. While the transition to full scale of all faculty awaits financial sustainability, exceptional diverse growth through recruitment has been maintained.