Letters to the Editor: Letters & Announcements
As stated in the last sentence of our article, “having a variety of methods for comparison will allow new chairs, and those interested in implementing an incentive system, to have a variety of alternatives to consider and be able to evaluate the impact of implementation on their own departments.” (1) In that regard, we are delighted to learn that Mets and Eckerd have shared their incentive plan with us. After careful consultation with multiple experts on incentive systems many years ago, we came to the conclusion that incentives should be based on actual productivity, rather than availability or a nonspecific bonus. In that regard, Mets and Eckerd should be congratulated on providing another, and somewhat different, method of rewarding and incentivizing productivity.
An unintended outcome of our plan was that educational and research activities continued to grow, even though our financial productivity plan was only clinically based. This outcome is contrary to predictions of Abouleish et al. (2) and Mets and Eckerd. One inevitable conclusion is the presence of incentives other than money. In our department at UCSF, for example, educators and researchers have more non-clinical time available to pursue their academic interests. Furthermore, the clinical incentive program markedly decreased the demands by our clinicians of more clinical time from researchers. That is obviously a non-financial type of benefit. Mets and Eckerd have stated that they “agree with Abouleish” that focusing on clinical productivity alone may undermine a department's academic mission. Although they may believe that, they have not proven it. Furthermore, is only 15% of the total compensation enough to influence behavior? At least in one department, we have proven that a clinical productivity incentive plan directly facilitates clinical care but unexpectedly did not harm and may have facilitated our nonfinancially incentivized educational and research activities.
Clearly, the decision as to whether all of the clinical, educational, and research responsibilities should be financially incentivized is debatable. Of prime importance is that modern-day economics demand that academic anesthesia departments develop not only incentive and bonus plans but those that are based on actual productivity. Hopefully, numerous academic anesthesia programs will eventually implement productivity-driven incentive programs. Then, a proper scholarly analysis can be performed to determine which types of incentive plans best facilitate academic anesthesia.
Ronald D. Miller, MD
Neal H. Cohen, MD
Department of Anesthesia and Perioperative Care
University of California San Francisco
San Francisco, CA
1. Miller RD, Cohen NH. The impact of productivity-based incentives on faculty salary-based compensation. Anesth Analg 2005;101:195–9.
2. Abouleish A, Apfelbaum J, Prough D, et al. The prevalence and characteristics of incentive plans for clinical productivity among academic anesthesia departments. Anesth Analg 2005;100:493–501.