Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis
Work-relative-value-units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses an indexed effort, wRVU per minute (wRVU index). We hypothesize that there is a significant decrease in the cal...
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| Veröffentlicht in: | The American journal of surgery 2024-01, Vol.227, p.117-122 |
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| creator | Nwokedi, Ugoeze Graviss, Edward A. Nguyen, Duc T. Pei, Kevin Y. |
| description | Work-relative-value-units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses an indexed effort, wRVU per minute (wRVU index). We hypothesize that there is a significant decrease in the calculated wRVU index among teaching cases.
We queried the ACS-NSQIP database for 7 core Emergency General Surgery procedures and records were stratified into teaching vs non-teaching, and emergent vs non-emergent procedures. We utilized multivariable generalized linear models to determine factors associated with increased operative time and decreased wRVU index.
Data were available for 953,967 cases from 2005 to 2010. For all cases, teaching vs non-teaching, the median wRVU index was 0.16 vs 0.21 (p |
| doi_str_mv | 10.1016/j.amjsurg.2023.09.051 |
| format | Article |
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We queried the ACS-NSQIP database for 7 core Emergency General Surgery procedures and records were stratified into teaching vs non-teaching, and emergent vs non-emergent procedures. We utilized multivariable generalized linear models to determine factors associated with increased operative time and decreased wRVU index.
Data were available for 953,967 cases from 2005 to 2010. For all cases, teaching vs non-teaching, the median wRVU index was 0.16 vs 0.21 (p < 0.001). There was a positive association between teaching cases and decreased wRVU index for all cases.
The wRVU index was 24% lower for teaching cases when compared to non-teaching cases despite controlling for patient-specific factors. This finding highlights the need for further evaluation of the current wRVU framework.
•Intraoperative teaching increases OR time.•Surgeon productivity is measured in wRVUs.•wRVU index accounts for length of procedure.•In this ACS-NSQIP analysis, wRVU index was 24% lower for teaching cases.•Current wRVU framework undervalues teaching efforts.•wRVU index provides additional evidence for “educational RVU”.</description><identifier>ISSN: 0002-9610</identifier><identifier>ISSN: 1879-1883</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2023.09.051</identifier><identifier>PMID: 37806890</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Academic Medical Centers ; Acute Care Surgery ; Appendectomy ; Cholecystectomy ; Emergency procedures ; Faculty ; Generalized linear models ; Health care policy ; Humans ; Laparoscopy ; Physician compensation ; Postoperative Complications ; Productivity ; Statistical models ; Surgeons ; Surgery ; Surgical training ; Teaching cases ; United States ; Variables ; wRVU</subject><ispartof>The American journal of surgery, 2024-01, Vol.227, p.117-122</ispartof><rights>2023</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c341t-1d24888f85754cdd032a42d06b5142336c574daec5990749c069525d27f40ac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2900637590?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,778,782,27911,27912,64370,64372,64374,72224</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37806890$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nwokedi, Ugoeze</creatorcontrib><creatorcontrib>Graviss, Edward A.</creatorcontrib><creatorcontrib>Nguyen, Duc T.</creatorcontrib><creatorcontrib>Pei, Kevin Y.</creatorcontrib><title>Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Work-relative-value-units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses an indexed effort, wRVU per minute (wRVU index). We hypothesize that there is a significant decrease in the calculated wRVU index among teaching cases.
We queried the ACS-NSQIP database for 7 core Emergency General Surgery procedures and records were stratified into teaching vs non-teaching, and emergent vs non-emergent procedures. We utilized multivariable generalized linear models to determine factors associated with increased operative time and decreased wRVU index.
Data were available for 953,967 cases from 2005 to 2010. For all cases, teaching vs non-teaching, the median wRVU index was 0.16 vs 0.21 (p < 0.001). There was a positive association between teaching cases and decreased wRVU index for all cases.
The wRVU index was 24% lower for teaching cases when compared to non-teaching cases despite controlling for patient-specific factors. This finding highlights the need for further evaluation of the current wRVU framework.
•Intraoperative teaching increases OR time.•Surgeon productivity is measured in wRVUs.•wRVU index accounts for length of procedure.•In this ACS-NSQIP analysis, wRVU index was 24% lower for teaching cases.•Current wRVU framework undervalues teaching efforts.•wRVU index provides additional evidence for “educational RVU”.</description><subject>Academic Medical Centers</subject><subject>Acute Care Surgery</subject><subject>Appendectomy</subject><subject>Cholecystectomy</subject><subject>Emergency procedures</subject><subject>Faculty</subject><subject>Generalized linear models</subject><subject>Health care policy</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Physician compensation</subject><subject>Postoperative Complications</subject><subject>Productivity</subject><subject>Statistical models</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical training</subject><subject>Teaching cases</subject><subject>United States</subject><subject>Variables</subject><subject>wRVU</subject><issn>0002-9610</issn><issn>1879-1883</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkVtrFDEUgIModlv9CUrAF19mPJkkM4kvsixaC8ULLfgY0uRMN-PsTJtkVvrvTdnVB1-EkHDCdy6cj5BXDGoGrH031HY3pCXe1g00vAZdg2RPyIqpTldMKf6UrACgqXTL4IScpjSUkDHBn5MT3ilolYYVmX7M8SeNONoc9kj3dlyQLlPIqdwe4-Ejb5G6MUzB2ZFi388xU5vS7ILN6OmvkLc0o3XbMN1SZxOm93Q90fXmqvpy9f3iG7WTHR9SSC_Is96OCV8e3zNy_enj9eZzdfn1_GKzvqwcFyxXzDdCKdUr2UnhvAfeWNF4aG8kEw3nrZOd8Bad1Bo6oR20WjbSN10vwDp-Rt4eyt7F-X7BlM0uJIfjaCecl2Qa1QnFZTkFffMPOsxLLOMWSgO0vJMaCiUPlItzShF7cxfDzsYHw8A8-jCDOfowjz4MaFN8lLzXx-rLzQ7936w_Agrw4QBg2cY-YDTJBZwc-hDRZePn8J8WvwGe952T</recordid><startdate>202401</startdate><enddate>202401</enddate><creator>Nwokedi, Ugoeze</creator><creator>Graviss, Edward A.</creator><creator>Nguyen, Duc T.</creator><creator>Pei, Kevin Y.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202401</creationdate><title>Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis</title><author>Nwokedi, Ugoeze ; Graviss, Edward A. ; Nguyen, Duc T. ; Pei, Kevin Y.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c341t-1d24888f85754cdd032a42d06b5142336c574daec5990749c069525d27f40ac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Academic Medical Centers</topic><topic>Acute Care Surgery</topic><topic>Appendectomy</topic><topic>Cholecystectomy</topic><topic>Emergency procedures</topic><topic>Faculty</topic><topic>Generalized linear models</topic><topic>Health care policy</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Physician compensation</topic><topic>Postoperative Complications</topic><topic>Productivity</topic><topic>Statistical models</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical training</topic><topic>Teaching cases</topic><topic>United States</topic><topic>Variables</topic><topic>wRVU</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nwokedi, Ugoeze</creatorcontrib><creatorcontrib>Graviss, Edward A.</creatorcontrib><creatorcontrib>Nguyen, Duc T.</creatorcontrib><creatorcontrib>Pei, Kevin Y.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nwokedi, Ugoeze</au><au>Graviss, Edward A.</au><au>Nguyen, Duc T.</au><au>Pei, Kevin Y.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2024-01</date><risdate>2024</risdate><volume>227</volume><spage>117</spage><epage>122</epage><pages>117-122</pages><issn>0002-9610</issn><issn>1879-1883</issn><eissn>1879-1883</eissn><abstract>Work-relative-value-units (wRVUs) are a core metric of faculty effort but do not account for the additional work associated with intraoperative teaching. This study introduces and assesses an indexed effort, wRVU per minute (wRVU index). We hypothesize that there is a significant decrease in the calculated wRVU index among teaching cases.
We queried the ACS-NSQIP database for 7 core Emergency General Surgery procedures and records were stratified into teaching vs non-teaching, and emergent vs non-emergent procedures. We utilized multivariable generalized linear models to determine factors associated with increased operative time and decreased wRVU index.
Data were available for 953,967 cases from 2005 to 2010. For all cases, teaching vs non-teaching, the median wRVU index was 0.16 vs 0.21 (p < 0.001). There was a positive association between teaching cases and decreased wRVU index for all cases.
The wRVU index was 24% lower for teaching cases when compared to non-teaching cases despite controlling for patient-specific factors. This finding highlights the need for further evaluation of the current wRVU framework.
•Intraoperative teaching increases OR time.•Surgeon productivity is measured in wRVUs.•wRVU index accounts for length of procedure.•In this ACS-NSQIP analysis, wRVU index was 24% lower for teaching cases.•Current wRVU framework undervalues teaching efforts.•wRVU index provides additional evidence for “educational RVU”.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37806890</pmid><doi>10.1016/j.amjsurg.2023.09.051</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American journal of surgery, 2024-01, Vol.227, p.117-122 |
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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; MEDLINE; ProQuest Central UK/Ireland |
| subjects | Academic Medical Centers Acute Care Surgery Appendectomy Cholecystectomy Emergency procedures Faculty Generalized linear models Health care policy Humans Laparoscopy Physician compensation Postoperative Complications Productivity Statistical models Surgeons Surgery Surgical training Teaching cases United States Variables wRVU |
| title | Work relative value units undervalue the clinical effort associated with teaching cases: An ACS-NSQIP analysis |
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