Pray L, Williams NN, Mullen JL, Drebin JA, Pray L, Williams NN, Mullen JL, Drebin JA, Morris JBMorris JB

Jon B. Morris, MDJon B. Morris, MDProfessor of Surgery and Vice Chair, Professor of Surgery and Vice Chair, EducationEducationApril 20, 2010April 20, 2010

A Rational and EquitableA Rational and EquitableProcess to Financially Support Process to Financially Support Faculty Teaching Efforts Faculty Teaching Efforts

IntroductionIntroduction

Meaningful teaching requires timeMeaningful teaching requires timeand effort which should be financially and effort which should be financially rewarded.rewarded.

PENN MedicinePENN Medicine

PENN Graduate Medical EducationPENN Graduate Medical Education ##

Number of Accredited Training ProgramsNumber of Accredited Training Programs 6969

Accredited TraineesAccredited Trainees 989989

PENN Surgery #

Number of Accredited Training Programs 7

Number of Unaccredited Training Programs 7

Accredited Trainees 115

Non-accredited Trainees 15

PENN Surgery EducationPENN Surgery Education One centralized budget for all training programs One centralized budget for all training programs

managed by the Vice Chair for Educationmanaged by the Vice Chair for Education

Jeffrey DrebinSurgery Chairman

Jon MorrisVice Chair, Education

Program Director, General Surgery

Lori PrayDirector, Surgery

Education Administration

6.5 FTE

Undergraduate Medical Education

GraduateMedical Education

ProfessionalMedical Education

Inter Entity Transfer (IET) - Hospital Funds Inter Entity Transfer (IET) - Hospital Funds Flow*Flow*

Clinical Metrics (82%)Clinical Metrics (82%)– New program start-up/new recruitNew program start-up/new recruit– Programmatic supportProgrammatic support– Incentive paymentIncentive payment

Teaching Metrics (12%)Teaching Metrics (12%)– Program Director supportProgram Director support– Supervision/Faculty teachingSupervision/Faculty teaching– Undergraduate Medical EducationUndergraduate Medical Education

Research Metrics (6%)Research Metrics (6%)– Academic development fundsAcademic development funds– Indirect cost sharingIndirect cost sharing– Salary coverage incentive paymentsSalary coverage incentive payments

* Kennedy, David W. MD; Johnston, Elizabeth MBA; Arnold, Ethan MPH. Aligning Academic and Clinical Missions Through * Kennedy, David W. MD; Johnston, Elizabeth MBA; Arnold, Ethan MPH. Aligning Academic and Clinical Missions Through an Integrated Funds-Flow Allocation Process. Academic Medicine, December 2007, Volume 82, Issue 12, Pages 1172- an Integrated Funds-Flow Allocation Process. Academic Medicine, December 2007, Volume 82, Issue 12, Pages 1172-11771177

PENN Surgery Education IET PENN Surgery Education IET BreakdownBreakdown 25% of the Education IET covers 25% of the Education IET covers

resident and operational expensesresident and operational expenses– 6.5 FTE in the Division of Surgery 6.5 FTE in the Division of Surgery

EducationEducation– All UME, GME and PME activitiesAll UME, GME and PME activities

75% is distributed back to the Divisions 75% is distributed back to the Divisions to to support base pay support base pay for all teaching for all teaching Faculty members using the Relative Faculty members using the Relative Teaching Value Unit (RTVU) Teaching Value Unit (RTVU) methodologymethodology

Distribution of the Education Distribution of the Education IETIETRelative Teaching Value Units (RVUs)Relative Teaching Value Units (RVUs)

1.1.Faculty evals of educational recipientsFaculty evals of educational recipients– QuantitativeQuantitative

2.2.Evaluation of the Faculty by recipientsEvaluation of the Faculty by recipients– Quantitative and QualitativeQuantitative and Qualitative

3.3.Didactic SessionsDidactic Sessions– Lecture, CME, PBL, Div Conf, SIMLecture, CME, PBL, Div Conf, SIM

4.4.Educational Leadership PositionsEducational Leadership Positions– PD, APD, CD, Site CoordinatorsPD, APD, CD, Site Coordinators

Calculation of RTVUsCalculation of RTVUs

Evaluation Metrics and Didactic Evaluation Metrics and Didactic Teaching sessions are calculating by Teaching sessions are calculating by percentile ranking = RTVU scorepercentile ranking = RTVU score– 90th%=5, 80th%=4.5, 70th%=4, 60th90th%=5, 80th%=4.5, 70th%=4, 60th

%=3.5, 50th%=3, 40th%=2.5, 30th%=3.5, 50th%=3, 40th%=2.5, 30th%=2, 20th%=1.5. 10th%=1, 0th%=0%=2, 20th%=1.5. 10th%=1, 0th%=0

Educational Leadership RTVUs as Educational Leadership RTVUs as determined by VCEdetermined by VCE

1. 1. Faculty Evals of Educ Faculty Evals of Educ RecipientsRecipients # of documented Faculty electronic# of documented Faculty electronic

evals of:evals of:

– Medical studentsMedical students

– General surgery residentsGeneral surgery residents

– Specialty residents/fellowsSpecialty residents/fellows

2. 2. Educ Recipient Evals of Educ Recipient Evals of FacultyFaculty # of documented electronic evals of # of documented electronic evals of

Faculty from:Faculty from:

– Medical studentsMedical students

– General surgery residentsGeneral surgery residents

– Specialty residents/fellowsSpecialty residents/fellows

Mean Score X # evals = total scoreMean Score X # evals = total score

3. 3. Didactic & Simulation Didactic & Simulation SessionsSessions # of documented Faculty teaching # of documented Faculty teaching

sessions:sessions:

– UME lecture/PBL, surgery broadcast, etc. UME lecture/PBL, surgery broadcast, etc.

– General surgery residents conferenceGeneral surgery residents conference

– CME/PME coursesCME/PME courses

– Simulation sessions (3X)Simulation sessions (3X)

– Self reported activities with sign-off from Self reported activities with sign-off from the Division Directorsthe Division Directors

Based on contact hoursBased on contact hours

4. 4. Educational Leadership Educational Leadership PositionsPositions # of designated positions# of designated positions

– CME course director (1 RTVU per course)CME course director (1 RTVU per course)

– Program Director (5 RTVUs + # trainees)Program Director (5 RTVUs + # trainees)

– UME/GME site director (5 RTVUs)UME/GME site director (5 RTVUs)

– Med Student course director (15 RTVUs)Med Student course director (15 RTVUs)

– Advanced Med Student electives site Advanced Med Student electives site coord (varies based on the # of students)coord (varies based on the # of students)

What’s It Worth ?What’s It Worth ?

1 RTVU = $2300 in fy11 base salary 1 RTVU = $2300 in fy11 base salary supportsupport

– 90th% in Faculty evals = 5 RTVU = $ 11,50090th% in Faculty evals = 5 RTVU = $ 11,500

– 90th% in Evals of Faculty = 5 RTVU = 90th% in Evals of Faculty = 5 RTVU = $11,500$11,500

– 48 or more Faculty didactics = 5 RTVU = 48 or more Faculty didactics = 5 RTVU = $11,500$11,500

– PD Leadership positions - $11,500 to PD Leadership positions - $11,500 to $142,600$142,600

FACULTY REPORT CARDFACULTY REPORT CARD January - December 2009January - December 20092009 YEAR END REPORT2009 YEAR END REPORT

%tile Rank%tile RankFaculty:Faculty: Dr. XDr. X RTVURTVU ALL FACALL FAC

EVAL of FAC ACTUAL RTVU =EVAL of FAC ACTUAL RTVU = 5.05.0 90th%90th%MED Student EVALMED Student EVAL MEAN =MEAN = 4.524.52 N=21N=21GEN SURG EVALGEN SURG EVAL MEAN =MEAN = 4.744.74 N=30N=30SPEC RES EVALSPEC RES EVAL MEAN =MEAN = 4.524.52 N=21N=21

FAC EVALs Complete ACTUAL RTVU =FAC EVALs Complete ACTUAL RTVU = 5.05.0 90th%90th%MED StudentMED Student N = 4N = 4GEN SURGGEN SURG N = 47N = 47SPEC PROGSPEC PROG N = 48N = 48

Didactic Sessions ACTUAL RTVU =Didactic Sessions ACTUAL RTVU = 4.54.5 80th%80th%Total didactic sessions =Total didactic sessions = 4141

FAC Leadership ACTUAL RTV =FAC Leadership ACTUAL RTV = 6.06.0 actualactual

RTVU TOTAL =RTVU TOTAL = 20.520.5

ACTUAL FY11 SUPPORT =ACTUAL FY11 SUPPORT = $46,661$46,661

RTVU Distribution RTVU Distribution NormalizedNormalized

Division Division Average $ Per FacultyAverage $ Per Faculty # Faculty# Faculty

CARCAR $31,234$31,234 1111

CRSCRS $18,778$18,778 44

EOSEOS $37,367$37,367 66

GISGIS $45,675$45,675 1515

PLAPLA $33,194$33,194 66

THOTHO $22,762$22,762 88

TRATRA $38,442$38,442 1010

TXPTXP $27,541$27,541 55

UROURO $17,356$17,356 1616

VASVAS $33,763$33,763 66

PENN Surgery Faculty Compensation PENN Surgery Faculty Compensation PlanPlan

Base Pay + IncentiveBase Pay + Incentive

Faculty incentive = 20% of pay at Faculty incentive = 20% of pay at riskrisk

Metrics = Threshold (0.5), Target Metrics = Threshold (0.5), Target (1.0)(1.0)and High Performance (1.5)and High Performance (1.5)

Department budgets to 1.2 average Department budgets to 1.2 average payoutpayout

Education IncentivesEducation Incentives Education metric = 5% of total Education metric = 5% of total

incentiveincentive

Education metrics are calculated from Education metrics are calculated from a blended score of evaluations as a blended score of evaluations as teacher from medical students, teacher from medical students, general surgery residents and fellows.general surgery residents and fellows.– No payout = <5%No payout = <5%

– Threshold = 5 – 9.9%Threshold = 5 – 9.9%

– Target = 10 – 69.9%Target = 10 – 69.9%

– High Performance = 70+%High Performance = 70+%

ChallengesChallenges

Base pay vs. incentiveBase pay vs. incentive

Widely divergent salaries and metricsWidely divergent salaries and metrics

Providing an incentive reward to a Providing an incentive reward to a core group of educators by core group of educators by redistributing incentives from clinical redistributing incentives from clinical to education metrics (budget neutral)to education metrics (budget neutral)

ConclusionConclusion

This process is rational and equitable This process is rational and equitable way to financial support the teaching way to financial support the teaching faculty effortsfaculty efforts– RTVU metrics support base payRTVU metrics support base pay

(i.e. good for the Department)(i.e. good for the Department)

– Incentive metrics reward faculty directlyIncentive metrics reward faculty directlyfor teaching (i.e. good for the Individual)for teaching (i.e. good for the Individual)