Ethical conflicts of the relative value unit system

Ethical conflicts of interest can arise when productivity-based compensation models, particularly relative value units, intersect with clinical decision making in dermatology. Relative value units were designed to standardize physician work and serve as a metric for physician productivity and efficiency; however, they may influence how clinicians navigate treatment choices by prioritizing quantity over quality and incentivizing overuse. These dynamics can increase physician burnout and raise important concerns related to beneficence and justice. We outline these ethical considerations and propose strategies to maintain patient-centered care within productivity-driven systems.