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Original Investigation
April 15, 2020

Assessment of the Contribution of the Work Relative Value Unit Scale to Differences in Physician Compensation Across Medical and Surgical Specialities

Author Affiliations
  • 1David Geffen School of Medicine, Department of Surgery, University of California, Los Angeles, Los Angeles
JAMA Surg. Published online April 15, 2020. doi:10.1001/jamasurg.2020.0422
Key Points

Question  How do work relative value unit (wRVU) compensation rates vary across medical and surgical specialties?

Findings  In this cross-sectional study, most specialties had wRVU compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant.

Meaning  Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.

Abstract

Importance  The work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures have been blamed for pay differences across specialties, but to our knowledge, a comprehensive assessment is lacking.

Objective  To assess how compensation rates built into work RVUs contribute to differences in physician compensation across specialties.

Design, Setting, and Participants  This cross-sectional analysis examined 2017 Part B fee-for-service Medicare data. The data were analyzed from May 1 to May 30, 2019.

Main Outcomes and Measures  A specialty-wide compensation rate (wRVUs/min) was generated for 42 medical and surgical specialties defined as the sum of wRVUs for all billed current procedural terminology codes divided by the presumed time to perform those services. This measure accounted for the volume and diversity of services each specialty provides. Sensitivity analyses were performed to assess the association of errors in wRVU time estimates with average compensation rates.

Results  The final sample included 42 specialties and 6587 distinct Current Procedual Terminology (CPT) codes. The number of CPT codes attributed to a specialty ranged from 575 (medical oncology) to 4346 (general surgery). Compensation rates ranged from 0.029 wRVUs/min (pathology) to 0.057 wRVUs/min (emergency medicine). Most specialties (34/42 [81.0%]) had compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant. This narrow range reflects the fact that most specialties had more than 60% of time allocated to activities outside the intraservice period. Assuming that time values for surgical procedures are significantly overestimated increased the difference in average compensation between surgical and medical specialties to 23.4%.

Conclusions and Relevance  Compensation rates assumed in wRVU valuations are small contributors to differences in physician compensation. Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.

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    1 Comment for this article
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    I don't think so
    Gordon Banks, PhD MD | Willamette Valley Neurology
    "In our analysis...compensation rates for surgeons are still only marginally higher than medical specialties." So this means that neurosurgeons are working 3 times as hard as primary care physicians? It can't just be the payer mix. There are factors such as length of training, amount of night call, stress of long operations, and often shortened career due to intervening physical problems that prevent a surgeon from operating that justify a higher salary. But the unfairness of the RVU system, which rewards procedures far more than E&M is clear to any objective observer. My dermatologist got paid more for less than 10 minutes worth of freezing off actinic keratoses with liquid nitrogen, which requires very little skill, than my internist for doing a comprehensive E&M visit with me which took the better part of an hour and required a lot of heavy thinking (and a lot more charting after the visit). I can't see this as fair.
    CONFLICT OF INTEREST: None Reported
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