For those who don’t know, every piece of work that a doctor performs is quantified and measured.
The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and specialty.
For instance, in an RVU-based salary structure, if a 15-minute office visit is assigned an RVU value of 0.7, and a doctor is paid $35 per RVU, that visit will add $24 to a physician’s yearly salary.
Just for comparison’s sake, a colonoscopy, which may take twice the time, is valued at close to 6 RVUs, which is 8-times the value given to a 15-minute primary care office visit.
But I digress.
The reason I bring this up is that Boston Globe columnist Sam Allis talks about the issue, and interviews a few select Harvard physicians about its flaws. Physician-author Jerome Groopman, of How Doctors Think fame, rightly notes that the system does not value some of the truly important things that doctors do: “There are no RVUs for spending an hour with a grieving family, or a colleague who wants you to lend him your brain on a case. There are no RVUs for sitting with a confused third-year medical student. There are no RVUs for the humanistic core of medicine that drew me into this profession in the first place.”
I would also add that although there are RVUs for talking over the phone with a patient, or communicating via e-mail, they are rarely paid for by Medicare or insurers, and hence, worthless.
Perhaps instead of searching for ways to re-invent systems to pay doctors, modifying the RVU system to value, and having the insurers to recognize, this type of work will go a long way to incentivize doctors to provide the type of care that’s truly important to patients.
Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine
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