It comes in a large white envelope each month. It’s marked confidential.
When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away.
It’s my monthly productivity report. Most employed doctors get these graphs.
These “dashboards” of value include your own productivity as well as many graphs on how you stack up with other doctors across the country. It shows your employer if you are a hard worker.
The measure of productivity we use is called the relative value unit or RVU.
Doing an ablation, cath, stent or valve replacement earns a bunch of RVUs.
Listening to patients, examining patients, counseling patients, hugging patients earns very few RVUs.
Doing important research, teaching colleagues, and reading the medical evidence earns zero RVUs.
Too often, in too many medical systems, RVUs have become the primary unit of success.
No, you can’t be a mean and nasty doctor. And no, you can’t be a totally unskilled doctor who has too many complications.
But short of those extremes, if you make few waves, have good templates on your electronic health record so documentation is complete, and do tons of procedures, you are valuable.
If, on the other hand, you like slow conservative medicine, or narrative notes rather than templates, or worse, if you are thoughtful and frank about silly policies, you become an outlier. If you do these things, your RVU tally usually does not reach the 75% of standard. Then trouble can come to you.
These trends are not so problematic for people close to the end of their career.
What’s really scary, though, is that this is the milieu in which a younger generation is learning the craft. I was shocked to learn that a major teaching center (will remain nameless) has its teaching faculty on 100% productivity compensation. Imagine that. Teachers of young people whose paychecks are determined by how many RVUs they generate.
This, my friends, is happening in many of the places you go to get health care.
It’s why I tweeted this yesterday.
I'm concerned about the practice of Medicine. "Productivity" is slowly but surely extracting care from healthcare. It's bad. Really bad.
— John Mandrola, MD (@drjohnm) October 16, 2017
Productivity and the RVU has no place in medical care. There needs to be a different system of valuing the care of people with disease.