Since last summer, our division directors and division and department administrators have worked to develop, and in some cases update, department-wide principles to guide a quantitative definition of a clinical full-time equivalent/employee (cFTE). A clear cFTE definition for each division and service area is a tool to measure clinical productivity, perform a gap analysis for measuring capacity and setting access goals and engage in negotiations with our health systems. Developing time-based cFTE principles is an important background step that will inform but not define the compensation model, because individual success in the compensation model will be calculated through a combination of salary support, protected effort and clinical activity.
Salary support for research, education, administrative and non-billable clinical activities are intended to protect effort and subsequently reduce clinical effort or cFTE. Our department and division-based administrative teams are developing reports to show how salary and effort is supported, which provides insight into our level of activity within each of our missions and how we are paying for these activities.
As I wrote in my introductory post two weeks ago, we all engage in unremunerated activities, such as teaching, committee work, scholarship and even some types of clinical care; there is little doubt that the loss of these activities would harm our system. In recognition of this need, I anticipate a set-aside of approximately 20% effort for unremunerated scholarly, creative or citizenship-focused activities that would be applied to a full-time clinician. This support will be scaled, based on other types of external funding, so that it is sustainable and all faculty have the opportunity to participate in a rich academic, mission-based career.
In most, but not all, cases clinical activity for providers is defined by nationally benchmarked relative value units (RVU). The RVU is the preferred metric for most types of clinical practice because it is ‘blind’ to payer, making it consistent with our goals of providing socially just care and benefits from normalization against robust national databases from academic medical practices. My goal is not to absolutely define clinical assignments, because these will remain division-based decisions. Your division still must fulfill all service obligations, and division directors and clinical directors have the flexibility to create clinical schedules as demand dictates. Centrally we will measure activity against RVU benchmarks provides, which provides an opportunity to earn incentives to doing extra clinical work.
Developing the data and structure necessary to accurately report salary support, protected effort and clinical activity is still a work in progress and will continue to develop over the coming month. Throughout the next fiscal year we will be modeling these data for each participating member of the DOM compensation plan. Your participation and feedback will be critical to getting this step correct.
Please check back next week (5/22) for Part 4: (likely to be) Frequently Asked Questions