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ECONOMICS, EDUCATION, AND POLICY

A Mission-Based Productivity Compensation Model for an Academic Anesthesiology Department

From the Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York.

Address correspondence and reprint requests to David L. Reich, MD, Department of Anesthesiology, Mount Sinai School of Medicine, Box 1010, One Gustave L. Levy Place, New York, NY 10029-6575. Address e-mail to david.reich{at}mountsinai.org.

Abstract

INTRODUCTION: We replaced a nearly fixed-salary academic physician compensation model with a mission-based productivity model with the goal of improving attending anesthesiologist productivity.

METHODS: The base salary system was stratified according to rank and clinical experience. The supplemental pay structure was linked to electronic patient records and a scheduling database to award points for clinical activity; educational, research, and administrative points systems were constructed in parallel. We analyzed monthly American Society of Anesthesiologist (ASA) unit data for operating room activity and physician compensation from 2000 through mid-2007, excluding the 1-yr implementation period (July 2004–June 2005) for the new model.

RESULTS: Comparing 2005–2006 with 2000–2004, quarterly ASA units increased by 14% (P = 0.0001) and quarterly ASA units per full-time equivalent increased by 31% (P < 0.0001), while quarterly ASA units per anesthetizing location decreased by 10% (P = 0.046). Compared with a baseline year (2001), Instructor and Assistant Professor faculty compensation increased more than Associate Professor and Professor faculty (P < 0.001) in both pre- and postimplementation periods. There were larger compensation increases for the postimplementation period compared with preimplementation across faculty rank groupings (P < 0.0001). Academic and educational output was stable.

DISCUSSION: Implementing a productivity-based faculty compensation model in an academic department was associated with increased mean supplemental pay with relatively fewer faculty. ASA units per month and ASA units per operating room full-time equivalent increased, and these metrics are the most likely drivers of the increased compensation. This occurred despite a slight decrease in clinical productivity as measured by ASA units per anesthetizing location. Academic and educational output was stable.

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