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"For the Love of the Game"?: Calculating the Premium Associated with Academic Surgical Practice
*Emily A. Grimsley1, *David O. Anderson2, *Tyler l. Zander1, *Melissa Kendall1, *Rajavi Parikh1, Ronald Weigel3, Paul C. Kuo1
1Surgery, USF, Tampa, FL; 2Sullivan Cotter, Tampa, FL; 3University of Iowa, Iowa City, IA

Objectives: An academic surgical career, embodying passion, dedication, innovation, mentorship and transformative potential, offers intrinsic rewards. These benefits notwithstanding, the monetary valuation of clinical effort as normalized to the wRVU between academic (Ac) and nonacademic (NonAc) paths is not well characterized. We analyzed trends in the valuation of Ac and NonAc surgery work from 2010 to 2022.
Methods: Surgical specialties (General, CV, Colorectal, Neuro, Onc, Plastic, Thoracic, Transplant, Trauma, Vascular, Uro, Gyn, Ortho, ENT; total=24023, Ac=4117, NonAc=19906) were globally considered. Total cash compensation (TCC), wRVUs, and total collections (TotColl) were derived from MGMA for 2010, 2014, 2018 and 2022 and limited to cFTE>0.67. Values varied less than 5-10% when comparing MGMA with Vizient and AAMC. Inflation/CPI adjusted and raw TCC, wRVU, TCC/wRVU and TotColl/wRVU were examined as measures of compensation, clinical activity, compensation normalized for clinical activity, and organization professional revenue capture efficiency. TCC includes salary, bonus and incentive, stipends, honoraria, and profit distribution listed as direct compensation (W2, 1099, or K1) and voluntary salary reductions (401(k), 403(b), Section 125 TSP, and MSP). Practices in which the majority owner is a university, organization type is medical school or university hospital, or are medical school faculty practices were defined to be Ac. Linear modeling and trend analysis was performed using Python sklearn. Data are presented as mean +/- SD; analysis was performed using ANOVA or Students t-test.
Results: From 2010 to 2022, wRVUs for Ac decreased 7% (9794 ± 823 to 9109 ± 474) and NonAc decreased 2% (8249 ± 389 to 8062 ± 252). Raw TCC for Ac increased 52% (372k ± 17k to 564k ± 24k) and NonAc increased 34% (470k ± 17k to 628k ± 15k). CPI adjusted TCC for Ac increased 13% and NonAc decreased 0.4% (p=NS). Raw TCC/wRVU for Ac increased 29% (59± 6.6 to 76 ± 3.8) and NonAc increased 37% (66± 3.8 to 90 ± 3.8). CPI adjusted TCC/wRVU for Ac decreased 3.8% and for NonAc increased 2.2%. Raw TotColl/wRVU for Ac increased 75% (44± 12 to 77 ± 8.1) and NonAc increased 16% (62± 5.5 to 72 ± 6.1). CPI adjusted TotColl/wRVU for Ac increased 30% and NonAc decreased 13%. Unless otherwise noted, TCC, wRVU, TCC/wRVU, and TotColl/wRVU within and between Ac and NonAc and over time were statistically significant at p<0.001. Trend analysis indicates Ac and NonAc are converging: wRVUs =8305 in 2027 (Rsq= 0.88, 0.98), TCC/wRVUs=82.5 in 2027 (Rsq=0.94, 0.98), and TCC = $600k in 2025 (Rsq=0.98, 0.98).
Conclusions: In 2022, compared to NonAc, Ac was associated with more clinical activity, less total and normalized clinical compensation, but superior organizational professional revenue capture. Based on TCC/wRVUs, surgeons pay an 18% surcharge to work in Ac as of 2022. However, trends in Ac and NonAc suggest that TCC, wRVUs and TCC/wRVUs will converge within the next decade.
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