Table 2:

Design of studies evaluating the effects of the productivity assessment strategies

Study (setting)	Design	Population	Intervention	Risk of bias
Garson et al. (3) (Baylor College of Medicine, Houston, Texas)	Retrospective before–after comparison	17 clinical science departments and 8 basic science departments; n (faculty) not reported	”Metrics process”; goals were set for each department for each area assessed (e.g., 10% increase in NIH grant dollars). Individual and departmental performance data collected, analyzed and fed back yearly Department-based compensation plans were in place (according to author; no further details provided)	Collected data retrospectively Did not use validated outcome measures
Cramer et al. (6) (Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York)	Retrospective before–after comparison	n (faculty) = 38–49	Relative-value–based incentive plan Points totalled quarterly, used as the divisor for that quarter’s available cash Cash value per point multiplied by provider’s point total	Collected data retrospectively Did not use validated outcome measures
Sussman et al. (7) (Division of General Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts)	Retrospective before–after comparison	Employed academic primary care physicians; n (faculty) = 64	Productivity-based salary and bonus measures Annual salary adjustments based on the prior year’s clinical productivity Bonus measures paid quarterly based on medical management, quality of care, teaching and seniority Magnitude of total bonus payments is based on percentage of the wRVU productivity-derived salary, to a maximum bonus of 10%	Collected data retrospectively Did not use validated outcome measures Reported imbalanced co-interventions (training in billing) and another confounding factor (better payer contract)
Andreae et al. (8) (Division of General Pediatrics, University of Michigan Health, Ann Arbor, Michigan)	Before–after comparison (data collection probably prospective)	n (faculty) = 35	Productivity-based faculty compensation program that included a base salary and incentive payment Once minimum wRVUs were generated to cover the base salary, excess wRVUs were converted to cash value as an incentive payment Agreements for protected time or extramural salary support unaltered Base salary independent of academic rank or years of service Wages exclusive of benefits used for compensation	Collected data prospectively Did not use validated outcome measures Reported imbalanced co-interventions (training in billing)
Tarquinio et al. (9) (Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee)	Prospective before–after comparison	12 clinical divisions; n (faculty) = 338	Performance-based compensation plan that included a base salary and productivity adjustments Productivity adjustments were paid when productivity exceeded amount to generate base salary Clinician-educators and physician-scientists given up front 20% and 80%, respectively, of clinical RVU benchmark Base salary based on that of the year before the intervention was implemented Benchmark salary based on survey of peer institutions Cash value per RVU was specialty-specific but unrelated to academic rank or track	Collected data prospectively Did not use validated outcome measures Reported imbalanced co-interventions (introduction of new rank system) and another confounding factor (concurrent increase in federal grant funding)
Miller et al. (10) (Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, California)	Retrospective before–after comparison	Faculty with surgical and obstetric anesthesia responsibilities at three hospitals; n (faculty) = 58	Productivity-based compensation including a base salary and productivity adjustments Expected hours arbitrarily predetermined as 7.5 h/d of assignment No information provided on conversion of credit to cash value	Collected data retrospectively Did not use validated outcome measures Reported imbalanced co-interventions (training in billing)
Reich et al. (11) (Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York)	Retrospective before–after comparison	n (faculty) not reported	Mission-based productivity compensation model with a base salary (based on rank and experience) and a supplemental pay (based on points earned) Cash value of points based on finances of the department and total number of points generated by faculty in the preceding quarter Compensation model placed 70% of total compensation at risk	Collected data retrospectively Did not use validated outcome measures
Schweitzer et al. (12), (13) (Health Sciences Center schools of dentistry, nursing and medicine, University of Louisville, Louisville, Kentucky)	Retrospective before–after comparison	n (faculty) not reported	Recruitment of endowed chairs and their teams New promotion and tenure standards Salary incentives linked to research productivity Post-tenure review: faculty given an unsatisfactory review were reviewed again 2 years later; failed reviews triggered the creation of a faculty development plan Improvements to the research infrastructure The chair’s salary comprised a base salary and a salary supplement based on performance measures	Collected data retrospectively Did not use validated outcome measures Reported imbalanced co-interventions (improvement in research infrastructure)

Note: NIH = National Institutes of Health, RVU = relative-value unit, wRVU = work component of the RVU (14) (see Table 1 footnote for description of RVU and wRVU).