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Comment & Response
November 2020

Refining Assumptions About Specialty Compensation Rates—Reply

Author Affiliations
  • 1Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles
JAMA Surg. 2020;155(11):1085-1086. doi:10.1001/jamasurg.2020.3028

In Reply We thank Xiao and Rathi for their insightful comments on our article.1 In brief, we used 2017 fee-for-service Medicare data to calculate compensation rates (measured in work relative value units [RVUs] per minute) for 42 medical and surgical specialties. We found a relatively narrow range, with less than a 2-fold difference between the highest and lowest specialties. Our subsequent analyses suggest why this may be the case. First, physicians perform a great diversity of services: general surgeons, for example, billed more than 4000 distinct current procedural terminology (CPT) codes. Second, and perhaps more importantly, physicians spend a large fraction of their time on activities that are compensated at relatively low, fixed rates. Most surgical specialties have more of their time allocated to preoperative and postoperative care as opposed to time performing surgery. Finally, we performed several analyses looking at the potential effect of errors in RVU time valuations. When we accounted for the fact that operative times and postoperative length of stay values may be inaccurate, the compensation rates of surgeons compared with medical clinicians rose by a relatively small margin.

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