Relative value units do not adequately assess clinician worth

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The topic of measuring productivity among providers came up for discussion at a recent practice meeting. It was a heated discourse as we have a diverse practice consisting of many physicians and midwives, all with their own ideas of what constitutes productivity. 

Many practitioners are aware of the term relative value unit, or RVU. RVUs are used to measure a provider's value to a practice by assigning the clinician a numeric value based on the number of patients seen and services provided. 

Many practices use strict guidelines for salary, raises and bonuses using RVUs. But do these numbers accurately measure a practitioner's skill level, patient rapport and true value?

As a midwife I enjoy spending time getting to know my patients and talking to them about their lives and overall health in addition to any obstetric or gynecological concerns they have. I generally spend more time with each patient than my physician colleagues — I believe that this is why many women choose to see a midwife in the first place. 

If I spend more time with each patient, I cannot see as many people in any given day. This means I may fall behind on my RVUs compared with the physicians in the practice. However, my patient satisfaction may be higher and my care just as good, if not more holistic and comprehensive. But pure numbers expressed as an RVU do not demonstrate this. 

Recently an older post-menopausal client told me that her friends asked why she still saw a midwife after her childbearing days. Her reply: “My midwife listens to my complaints about my adult kids and my stagnant sex life. She remembers my big life events and the names of my grandkids. She doesn't just examine my breasts, do my pap and hand me a referral for a mammogram. She really cares.” 

Can this patient's comments ever be quantified by RVUs or do we need to find a new way to measure performance among mid-level practitioners, or possibly all health care providers?

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