Behavioral economics in neonatology-balancing provider wellness and departmental finances

Abstract

High work relative value units (wRVU) per clinical full-time-equivalent (cFTE) productivity by Neonatologists have played a key role in enhancing departmental revenue in Pediatrics. However, such high productivity is not sustainable due to recent changes in trainee schedules and global daily codes and is likely to impact physician morale and wellness. Incentives based on wRVU benchmarks have the capacity to promote desirable behavior such as better documentation and in-person attendance in delivery room resuscitation and consults but comes at a cost of physician time providing care. An alternate method of funding academic Pediatric departments using time- or point-based staffing models, a reduction in productivity benchmarks for academic neonatologists through more accurate reporting of effort and physician leadership that promotes transparency and mutual respect are warranted to improve neonatologist well-being and morale.

Fig. 1. Bar graph of benchmark wRVUs (work relative value units) in various Pediatric subspecialties per clinical full-time equivalent (cFTE).

Academic benchmark data are based on 3-year average using clinical practice solutions center (CPSC) and Association of Administrators in Academic Pediatrics with some modifications used by the UC Davis Department of Pediatrics as benchmarks. The non-academic benchmarks are a 3-year average of several sources such as Medical Group Management Association (MGMA) with some modifications specific to UC Davis Health.

Fig. 2. The vicious cycle of high wRVU/cFTE generation by academic neonatologists and impact on physician wellbeing and morale.

High census and acuity along with support for medical directorships from the hospital generate revenue for the department of Pediatrics.

Fig. 3. Trends in median compensation (base and total) for Assistant professors in Neonatology and wRVU benchmarks for a full time cFTE.

There is a 23% increase in median total salary with an 15% decrease in median wRVU benchmark. Based on Association of Administrators in Academic Pediatrics (AAAP) national data—with permission.

Fig. 4. Principles of behavioral economics in healthcare.

Motivation to achieve a desired target or behavior can be intrinsic or extrinsic (financial or non-financial). A target or behavior that is meaningful and worthwhile to the physician may bring personal workplace satisfaction leading to intrinsic motivation. A financial incentive that is reasonably large and providing immediately for achieving a target that neither too easy nor too hard to attain with effort is likely to motivate physicians.

Fig. 5. Qualities, attributes and skills needed to be a physician leader in Neonatology and Pediatrics.

Traditional attributes (left section) such as being visionary, vigilant (to changes in birth rates, infant demographics and technological advances), financial wisdom, talent acquisition and management need to be combined with humility, adaptability (to challenges such as COVID-19), transparency and communication with respect (right side of the figure) to be an effective leader.