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Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis
Ugoeze Nwokedi1, Edward A Graviss2, Duc T Nguyen3
1Department of Graduate Medical Education, Parkview Health, Fort Wayne, Indiana, USA.
American Journal of Surgery
|October 8, 2023
Summary
Work-relative-value-units (wRVUs) do not account for intraoperative teaching. A new wRVU index shows a 24% decrease in teaching cases, indicating the current framework needs re-evaluation for accurate faculty effort assessment.
Area of Science:
- Surgical Education
- Health Economics
- Medical Practice Management
Background:
- Work-relative-value-units (wRVUs) are standard for measuring faculty effort in surgery.
- The current wRVU system does not adequately capture the additional workload from intraoperative teaching.
- Accurate assessment of faculty effort is crucial for fair compensation and resource allocation.
Purpose of the Study:
- To introduce and evaluate a novel metric, the wRVU per minute (wRVU index), to account for intraoperative teaching.
- To test the hypothesis that teaching cases have a significantly lower wRVU index compared to non-teaching cases.
- To assess the impact of intraoperative teaching on the calculated faculty effort using the wRVU index.
Main Methods:
- Utilized the ACS-NSQIP database, analyzing 7 core Emergency General Surgery procedures.
- Stratified cases into teaching vs. non-teaching and emergent vs. non-emergent categories.
- Employed multivariable generalized linear models to identify factors influencing operative time and wRVU index.
Main Results:
- Analysis included 953,967 cases from 2005 to 2010.
- The median wRVU index was significantly lower for teaching cases (0.16) compared to non-teaching cases (0.21, p < 0.001).
- A positive association was found between teaching cases and a decreased wRVU index.
Conclusions:
- The wRVU index was 24% lower in teaching cases versus non-teaching cases, even after controlling for patient factors.
- This finding underscores the inadequacy of the current wRVU framework in reflecting the true effort involved in teaching cases.
- Further investigation into refining the wRVU system to incorporate teaching activities is warranted to ensure equitable faculty effort valuation.
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