1. Assessing the Economic Efficiency of Physician On-call Payments
- Author
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Barton L. Guthrie, Mahesh B. Shenai, and Leon Moores
- Subjects
Economic efficiency ,media_common.quotation_subject ,Neurosurgery ,Subspecialty ,compensation ,03 medical and health sciences ,0302 clinical medicine ,Healthcare delivery ,Medicine ,030212 general & internal medicine ,Fair market value ,on call ,Valuation (finance) ,media_common ,Actuarial science ,business.industry ,General Engineering ,Payment ,fair market value ,Professional association ,Public Health ,Other ,subspecialty call ,relative value unit ,business ,030217 neurology & neurosurgery ,Relative value unit - Abstract
On-call services provided by physicians are critical to the function of a robust healthcare delivery system, but such services are not generally accounted for by standard physician productivity metrics, such as the work relative value unit (wRVU). There is significant diversity on how physicians are compensated, if at all, for these on-call services. Simultaneously, there exists a considerable shortage, particularly in the surgical subspecialties, for on-call coverage - most commonly in rural and underserved communities. While we agree that "call" services should undergo standardized valuation, we suggest that the wRVU is an ill-posed metric for this purpose as its primary role is to value discrete physician services provided to patients. In contradistinction, "call" is a physician service to a hospital - the disproportionate beneficiary of the service. We maintain that systemic and regulatory factors undervalue physician on-call compensation relative to the hospital's value chain and lead to call shortages that impact patient care and foster inequity. Finally, we urge subspecialty professional organizations to develop guidelines for call valuation.
- Published
- 2018