Pray L, Williams NN, Mullen JL, Drebin JA, Morris JB Jon B. Morris, MD Professor of Surgery and Vice Chair, Education April 20, 2010 A Rational and Equitable Process to Financially Support Faculty Teaching Efforts

Introduction  Meaningful teaching requires time and effort which should be financially rewarded.

PENN Medicine PENN Graduate Medical Education # Number of Accredited Training Programs 69 Accredited Trainees 989 PENN Surgery# Number of Accredited Training Programs7 Number of Unaccredited Training Programs7 Accredited Trainees115 Non-accredited Trainees15

PENN Surgery Education  One centralized budget for all training programs managed by the Vice Chair for Education Jeffrey Drebin Surgery Chairman Jon Morris Vice Chair, Education Program Director, General Surgery Lori Pray Director, Surgery Education Administration 6.5 FTE Undergraduate Medical Education Graduate Medical Education Professional Medical Education

Inter Entity Transfer (IET) - Hospital Funds Flow*  Clinical Metrics (82%) – New program start-up/new recruit – Programmatic support – Incentive payment  Teaching Metrics (12%) – Program Director support – Supervision/Faculty teaching – Undergraduate Medical Education  Research Metrics (6%) – Academic development funds – Indirect cost sharing – Salary coverage incentive payments * 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

PENN Surgery Education IET Breakdown  25% of the Education IET covers resident and operational expenses – 6.5 FTE in the Division of Surgery Education – All UME, GME and PME activities  75% is distributed back to the Divisions to support base pay for all teaching Faculty members using the Relative Teaching Value Unit (RTVU) methodology

Distribution of the Education IET Relative Teaching Value Units (RVUs) 1.Faculty evals of educational recipients – Quantitative 2.Evaluation of the Faculty by recipients – Quantitative and Qualitative 3.Didactic Sessions – Lecture, CME, PBL, Div Conf, SIM 4.Educational Leadership Positions – PD, APD, CD, Site Coordinators

Calculation of RTVUs  Evaluation Metrics and Didactic Teaching sessions are calculating by percentile ranking = RTVU score – 90th%=5, 80th%=4.5, 70th%=4, 60th%=3.5, 50th%=3, 40th%=2.5, 30th%=2, 20th%= th%=1, 0th%=0  Educational Leadership RTVUs as determined by VCE

1. Faculty Evals of Educ Recipients  # of documented Faculty electronic evals of: – Medical students – General surgery residents – Specialty residents/fellows

2. Educ Recipient Evals of Faculty  # of documented electronic evals of Faculty from: – Medical students – General surgery residents – Specialty residents/fellows Mean Score X # evals = total score

3. Didactic & Simulation Sessions  # of documented Faculty teaching sessions: – UME lecture/PBL, surgery broadcast, etc. – General surgery residents conference – CME/PME courses – Simulation sessions (3X) – Self reported activities with sign-off from the Division Directors Based on contact hours

4. Educational Leadership Positions  # of designated positions – CME course director (1 RTVU per course) – Program Director (5 RTVUs + # trainees) – UME/GME site director (5 RTVUs) – Med Student course director (15 RTVUs) – Advanced Med Student electives site coord (varies based on the # of students)

What’s It Worth ? 1 RTVU = $2300 in fy11 base salary support – 90th% in Faculty evals = 5 RTVU = $ 11,500 – 90th% in Evals of Faculty = 5 RTVU = $11,500 – 48 or more Faculty didactics = 5 RTVU = $11,500 – PD Leadership positions - $11,500 to $142,600

FACULTY REPORT CARD January - December YEAR END REPORT %tile Rank Faculty: Dr. X RTVU ALL FAC EVAL of FAC ACTUAL RTVU = 5.090th% MED Student EVAL MEAN = 4.52N=21 GEN SURG EVAL MEAN = 4.74N=30 SPEC RES EVAL MEAN = 4.52N=21 FAC EVALs Complete ACTUAL RTVU = 5.090th% MED Student N = 4 GEN SURG N = 47 SPEC PROG N = 48 Didactic Sessions ACTUAL RTVU = 4.580th% Total didactic sessions = 41 FAC Leadership ACTUAL RTV = 6.0actual RTVU TOTAL = 20.5 ACTUAL FY11 SUPPORT = $46,661

RTVU Distribution Normalized Division Average $ Per Faculty # Faculty CAR$31,23411 CRS$18,7784 EOS$37,3676 GIS$45,67515 PLA$33,1946 THO$22,7628 TRA$38,44210 TXP$27,5415 URO$17,35616 VAS$33,7636

PENN Surgery Faculty Compensation Plan Base Pay + Incentive  Faculty incentive = 20% of pay at risk  Metrics = Threshold (0.5), Target (1.0) and High Performance (1.5)  Department budgets to 1.2 average payout

Education Incentives  Education metric = 5% of total incentive  Education metrics are calculated from a blended score of evaluations as teacher from medical students, general surgery residents and fellows. – No payout = <5% – Threshold = 5 – 9.9% – Target = 10 – 69.9% – High Performance = 70+%

Challenges  Base pay vs. incentive  Widely divergent salaries and metrics  Providing an incentive reward to a core group of educators by redistributing incentives from clinical to education metrics (budget neutral)

Conclusion  This process is rational and equitable way to financial support the teaching faculty efforts – RTVU metrics support base pay (i.e. good for the Department) – Incentive metrics reward faculty directly for teaching (i.e. good for the Individual)