To systematically review and analyze various surgeon compensation models in the US and their impacts on productivity, quality, and nonclinical contributions, emphasizing the systematic nature of the review.
Approach:
Key Findings:
Five primary compensation models identified: salary, wRVU-based, hybrid, fee-for-service, and value-based.
Productivity-based models linked to increased surgical volume, e.g., wRVU-based compensation led to a 45% increase in elective hip and knee arthroplasties.
Salary models provided financial stability and promoted team-based care but had lower clinical productivity.
Hybrid models offered flexibility but were complex and often favored procedural volume.
Value-based models showed limited adoption and infrequent reporting, with specific data points included.
Interpretation:
Understanding the trade-offs of each compensation model is crucial for developing payment structures that align the interests of surgeons and institutions, with implications for future research.
Limitations:
Heterogeneity in study design and outcomes limited quantitative synthesis and causal inference.
Most studies were observational, potentially affecting the reliability of compensation data.
Compensation data may not reflect institutional nuances or market influences, impacting the findings.
Conclusion:
The review highlights the complexity and variability of surgeon compensation models, emphasizing the need for better alignment of incentives in surgical practice.
