Background: Academic hospital medicine (HM) faculty typically follow clinician educator tracks with academic hospitalists seeing education as their primary motivation for joining academic programs. According to the 2020 State of Hospital Medicine survey, shifts and clinical work hours for academic HM faculty expectations are similar to community practice (ref). Many academic HM faculty are on a base plus incentive compensation model. Incentive plans typically reward clinical productivity, quality of care and operational alignment. Educational activities such as medical student teaching without residents, development and delivery of didactics, curriculum development, writing letters of reference, mentoring in quality improvement and/or scholarly activities and small group teaching, are often undertaken by HM faculty without incentive compensation for performance beyond expectations. When added to full clinical schedules, educational activities above and beyond expectations have increasingly become a sources of burden and burnout, rather than motivation and renewal.

Purpose: We sought to transform the HM incentive model of an academic hospital medicine practice to incentivize educational activities and to better align division finances to team values.

Description: The hospital medicine practice of a large, urban academic safety-net hospital is at a base (85%) plus incentive (15%) compensation plan. In fiscal year (FY) 2020, incentives were for clinical and operational performance (wRVU, timely discharge orders, night shift participation and patient experience). For FY2021 to better align with our educational mission, we replaced the night shift incentive, worth a potential $4500, with an educational incentive program.We based our educational RVU (eRVU) incentive model on a 2000-hour work year and an expectation of 4000 RVU annually. If working fulltime (2000 hours annually) as an educator, 2 eRVU/hour would generate 4000 eRVU annually. We used a typical compensation of $240,000 annually determine an hourly rate of $120/hour at 2000 hours/year (equivalent to $60/eRVU).In addition to traditional ward teaching, HM faculty are expected to participate in a minimum (base) of 20 hours (40 eRVU) of educational activities throughout the year or 5 hours (1/2 day) quarterly. Additional hours above the base requirement are eligible for the eRVU bonus. To earn the full $4500 eRVU bonus a faculty must provide a base of 20 hours of educational engagement as well as 37.5 hours (at $120/hour = $4500) of incentive educational activities over the course of a year.

Conclusions: In the first year of implementation, 68 of our faculty logged 4,190 eRVU representing 8,380 hours of educational activities. Twenty (29.4%) received the full incentive and nine (13.2%) received no incentive. The mean educational incentive was $2628 (SD $1548) and mean eRVU generated was 61 (SD 45). Top educational activities included medical student teaching without residents, simulation lab teaching, curriculum development, letters of recommendation, and mentoring students and residents in scholarly activities (Table 1). Previously difficult to fill teaching activities are now oversubscribed. Challenges include tracking of individual eRVU’s and determining equitable distribution of previously undesired eRVU opportunities. Quality of education is also not accounted for in this model. Despite the challenges, our HM faculty have embraced the eRVU model which we plan to continue to evolve.

IMAGE 1: Educational RVU Opportunties, Learners, and Values

IMAGE 2: Educational RVUs Activity, Hours and Reimbursements for Fiscal Year 2021