Measuring Faculty Effort: A Quantitative Approach That Aligns Personal and Institutional Goals in Pathology at Yale

Abstract

US medical schools increasingly seek ways to reduce costs and improve productivity. One aspect of this effort has been the development of performance-based incentives for individual faculty. A myriad of such plans exist. Typically, they incentivize clinical revenue generation but vary widely in how teaching, investigation, and administrative contributions are recognized. In Pathology at Yale, we have developed a transparent metrically driven approach that recognizes all missions and allows faculty significant control over their career path. Although some metrics derive from traditional measures such as workload relative value units and one's level of grant support, the key concept underpinning our approach is to define one's contributions not in terms of the revenue generated, but rather on the effort devoted to each of our missions, benchmarked against national or local standards. Full-time faculty are paid a competitive rank-based salary and are expected to contribute at least 100% effort in support of the school's missions: clinical, research, education, administration, and professional service. Metrics define the effort assigned to each activity. Faculty achieving greater than 100% effort receive bonus compensation in proportion to their excess effort. By codifying explicitly how such effort is recognized into a single metric (% effort), we achieve a process that better aligns the professional and personal goals of faculty with the aims of the school. To facilitate its implementation, we have developed a web-based software platform called SWAY (Standardized Workload Analysis at Yale) that enables faculty to monitor their progress and record their activities in real time.

Keywords: SWAY; academic incentives; effort metrics; faculty compensation; medical school; percent effort accounting; performance-based compensation; standardized workload accounting Yale.

Figure 1.

Typical distribution of wRVUs across individual clinical faculty in Yale’s subspecialty pathology practice. Each bar represents a different faculty member (2004 data). wRVUs indicates work relative value units.

Figure 2.

Conversion of wRVUs to % effort—the relationship of wRVUs to % effort can be adjusted to reflect the on-service time expected of clinical faculty (eg, 70%) and related to the appropriate benchmarks for wRVU productivity. In this example, a 70% effort of an academic surgical pathologist in a general practice would be expected to generate 4500 wRVUs. wRVU indicates work relative value unit.

Figure 3.

A, Distribution of individual effort at Yale pathology, 2018. B, Effort segregated by clinical (MD and MD/PhD) versus nonclinical (PhD) faculty.

Figure 4.

SWAY summary screen. This display is what the chair or senior administrator would see, in that it lists all the faculty and allows selection of individual faculty for review. The screen that is available to each individual faculty member lists only their own metrics. The bar at the top, in which contributions to different aspects of the mission are color-coded, summarizes this. Selecting any specific mission allows the individual to review in more detail their data and also where permitted, enter new activities. SWAY indicates Standardized Workload Accounting at Yale.

Figure 5.

SWAY clinical effort screen. Selection of the clinical tab of the screen shown in Figure 4 opens this view of the individual faculty member’s accumulated wRVUs and its relationship to the wRVUs of other clinical faculty. The %effort awarded is shown at the top. This screen is available at any time and updated in real time throughout the academic year. The clinical activity can also optionally be presented on a per/month basis. SWAY indicates Standardized Workload Accounting at Yale; wRVUs, work relative value units.

Figure 6.

SWAY publication screen. Publications may be entered manually or automatically from PubMed using PMI/PMC IDs. Current publications not previously credited are in blue; past publications for which effort credit has already been received (in prior academic years) are in gray. SWAY indicates Standardized Workload Accounting at Yale.

Figure 7.

Examples of different % effort versus wRVU curves. A, In a practice where the clinical work is fairly homogeneous and equally available to all practitioners, curve could be a simple linear correlation. B, In another practice, one may set the baseline for 100% effort at a lower wRVU level, perhaps correlating with a low fixed salary relative to market. A greater portion of one’s effort (and compensation) would then derive from the bonus pool. C, Complex correlations are also possible, such as low % effort for minimal wRVU, then a very steep incentive for clinical work up to a threshold, but then capped at the high end to perhaps encourage other academic activities or encourage the sharing of cases with other faculty. The equations generating each curve were: (A) % effort = wRVU/60; (B) % effort = 2 × wRVU/(wRVU + 2000) × 100; (C) % effort = 200/((200 − 1) × EXP(−0.0011 × wRVU) + 1).