Racial Differences in Work Relative Value Units for Outpatient Pediatric Dermatology Visits

Measures of clinical productivity may tilt financial incentives toward providing care to specific patient populations, reinforcing inequitable care. Race, sex, and age have been shown to influence differences in work relative value units (wRVUs) generated during adult dermatology encounters. We sought to identify the association of patient race and sex with wRVUs generated by outpatient pediatric dermatology encounters. A total of 22,434 encounters among 10,063 unique patients were included; most encounters were with female (12,639 [56.3%]) and White (13,036 [58.1%]) individuals. The mean (SD) wRVUs per encounter was 1.57 (0.76). Visits with Asian patients, Black patients, and patients of other races generated 0.21 (95% confidence interval [CI] = 0.16-0.25), 0.19 (95% CI = 0.16-0.22), and 0.14 (95% CI = 0.10-0.17) fewer wRVUs per encounter, respectively, than pediatric outpatient dermatology visits with White patients (P < .001 for all). There was no significant association between sex and wRVUs per encounter. Laser treatment for vascular lesions was a mediator for the observed differences in wRVUs by race (60.5% [95% CI = 45.8-75.1%] for Asian race, 62.4% [95% CI = 52.9-71.9%] for Black race, and 53.3% [95% CI = 31.7-74.9%] for other races). Variations in wRVUs by patient race may create inadvertent incentives at the health systems level to prioritize certain groups.