Staff compensation schemes show partial success
MedWire News: Compensation schemes aimed at boosting productivity among the faculty at academic medical centers have limited success, a systematic review has concluded.
The analysis of eight published studies found that such schemes improve productivity in the areas of research and possibly in clinical practice, but have little impact in the area of teaching or administration.
"Departments planning on introducing a strategy to assess productivity need to carefully consider the associated challenges, the uncertain benefits and the potential unintended effects," observe Elie Akl (State University of New York at Buffalo, New York, USA) and co-authors writing in the Canadian Medical Association Journal.
The researchers undertook a systematic review of the effects on productivity of compensation strategies introduced at academic medical centers. Their literature search identified 531 full-text articles of which nine articles, reporting on eight studies, were deemed eligible for inclusion.
The studies were published between 1999 and 2008 and focused on four areas of productivity: clinical (eight studies), research (six), teaching (six), and administrative (four).
The overall quality of evidence was low, Akl et al remark, and methods used to assess productivity varied across the studies. The most frequent approach used the "relative-value unit," a rating scale determined by departmentally based standards and billable hours.
In terms of design, all studies were conducted at a single institution: four were performed within primary care, two in anesthesiology, one in the school of medicine, and one in the center's schools of medicine, nursing, and dentistry.
Akl and co-authors report that all six studies looking at clinical productivity found a significant improvement in terms of clinical revenue, the work component of relative-value units, patient satisfaction, and other departmental standards.
Additionally, five of six studies reported increases in research productivity, in terms of funding and publications.
There was no reported change in teaching productivity in terms of educational output and no improvements in administrative productivity or promotion processes. Notably, compensation increased at both group and individual levels, particularly among junior faculty.
The researchers conclude that best way to measure productivity remains unclear, particularly since faculty may have little or no control over their productivity because of factors such as clinic population, scheduling, staffing and nonclinical demands. Additionally, the implementation of a productivity assessment strategy may be hampered by the lack of timely and accurate billing data.
"Large controlled observational or before-after studies with careful handling of confounding (through matching and adjustment) could provide higher quality evidence," they write.
"Also, a central repository of strategies, processes and measurement tools would be ideal to assist academic leaders in designing their own programs."
By Joanna Lyford