Even though scholarly and educational activities represent two of the three primary pillars at academic medical centers, many academic departments find it challenging to comprehensively measure and reward academic productivity among faculty. Compensation-based systems to reward faculty for their academic productivity are sparse. In contrast, professional service, which is the third pillar, typically requires clinical activity and is often directly linked to faculty compensation. Health care systems have measured faculty clinical activity using relative value units (RVUs) for several decades, and active clinicians may see their compensation vary considerably according to the volume of RVUs that they generate.
There remains a paucity of data describing how faculty scholarly and educational activities can be measured and rewarded.1–4 To our knowledge, no previous study has reviewed in specific detail how academic faculty members in a department are financially rewarded using a point-based academic bonus system. The objective of this study was to describe the development and use of our department’s academic bonus system for incenting scholarly and educational productivity by its faculty members over a 10-year period.
This was a cross-sectional study describing the development and growth of a departmental academic bonus system over a 10-year period. The Oregon Health & Science University (OHSU) investigational review board reviewed and approved this study, including a waiver of informed consent.
The Department of Emergency Medicine was established within the OHSU School of Medicine in 1990. As of 2016, the department consists of 30 core faculty members, 35 affiliate faculty members, and 10 fellows. The department sponsors a postgraduate year 1–3 emergency medicine residency program (33 total residents, 11 per year). The residency is guided by the residency program director and other primary physician educators. The OHSU Department of Emergency Medicine research section was designated the Center for Policy and Research in Emergency Medicine in 2003. It features seven full-time faculty members (five physician–scientists and two nonclinical research faculty) with diverse backgrounds in medicine, public health, epidemiology, economics, and statistics. The Department of Emergency Medicine also sponsors fellowships in education, research, medical toxicology, pediatric emergency medicine, emergency ultrasonography, administration, and global heath.
In addition to the voluntary academic bonus program, the Department of Emergency Medicine requires all faculty members to participate in a clinical productivity bonus program. Clinical bonuses are distributed quarterly according to metrics such as total RVUs generated, RVUs per hour, RVUs per patient, patients seen per hour, and patient length of stay in the emergency department.
Any faculty member whose primary appointment was in the Department of Emergency Medicine at the instructor level or higher, including fellows and adjunct clinical faculty members, was eligible to participate in the academic bonus pool. Participation required that all scholarly activity included “OHSU Department of Emergency Medicine” in the byline (recognition of the department).
Design of the academic bonus system
The objective of the academic bonus system (first implemented in 2001) is to incent faculty members to produce scholarly and educational activities. Each activity is awarded points based on a predetermined point scale. These activities were selected for their contribution to three overlapping goals: preparation of the faculty member for OHSU promotion and tenure, support of essential departmental educational offerings, and enhancement of departmental academic recognition. The point system was originally developed by the department chair with extensive dialogue and input from the faculty members and institutional stakeholders (medical school promotion chair and dean).
The academic activities are broadly separated into two categories: education and scholarly productivity. The education category includes lectures (to medical students, residents, paramedics, grand rounds, etc.), participation in formal School of Medicine education activities, preceptorship of medical students, organizing Journal Club, directing School of Medicine courses, and serving on national or regional committees with an educational focus. Scholarly productivity includes abstract presentations (at regional and national meetings), manuscript submission and publication, grant submission and funding, serving on journal editorial boards and federal study sections, editing textbooks, and publishing book chapters. The academic bonus system is designed to broadly capture the majority of academic activities, whether faculty members are primary educators, primary researchers, administrators, or have a mix of these responsibilities. On the basis of consistency in data capture for academic bonuses (per faculty points and bonuses), we focus on the most recent 10 years of experience with the academic bonus system (academic years 2005–2006 through 2014–2015) for this analysis.
Each participating emergency medicine faculty member accumulates points based on their activity (numerator), and the cumulative points of all faculty members serve as the denominator. The allocation of points and activities included in the system has been refined over time to incent and reward varying activities in the department and faculty maturation (e.g., competing for research grants and national educational initiatives) based on review of the point distribution, departmental priorities, and requests from the dean’s office. For example, the points allocated for lectures and resident conference attendance were increased in response to a reduction in the number of faculty volunteering for lectures and engaged in resident conferences. Another example is the differentiation of grant submissions to detail the source of funding (federal vs. foundation), indirect cost payments, amount of salary support for faculty and staff, total amount, and duration of the award. For manuscripts and grants, points are awarded separately for submission and acceptance to ensure that faculty members are incented to submit research papers and grants, even with acceptance/award not guaranteed. This accomplishes two things: It reenforces desirable behavior by shortening the interval between the primary effort and a fiscal reward (thus encouraging initial submission of papers and grants) and separately rewards the paper/grant acceptance (thus encouraging revision and resubmission to achieve full value from the initial effort). Points are assigned both for lead and collaborative participation on papers and grants, to encourage team scholarship.
Each faculty member enters her or his respective activities at the end of the academic year (June 30) into an online data collection system developed by the department. After completion, these data are then exported to an Excel database, which is reviewed by the chair for completeness and accuracy before being translated into bonuses. Entries were made using the honor system. No attempt was made to verify all data points, although assigned departmental staff and the chair had access to (and compared submitted information with) considerable data related to specific faculty involvement on grants submitted/awarded, publications, and mission-critical lectures. Whenever a discrepancy was noted, the conflicting information was discussed with the faculty member and (if needed) with her/his peers such that accuracy of the data used was verified.
The dollar value of a “point” has varied over time according to the total funding allocated to the academic bonus pool, the number of participating faculty, total number of faculty academic activities, and changes to the academic bonus point system. However, within a given academic year, the value of a point is constant among all faculty members, allowing financial compensation based on standardized academic productivity for each faculty member. Bonuses are then distributed to faculty members in mid-August. The academic bonus system for the most recent year (academic year 2014–2015) is included in Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/A422.
Each year, the department chair will budget a set amount of funds derived from clinical revenue to support the academic bonus system. In the initial year of implementing the bonus system (academic year 2003–2004), $180,000 was budgeted ($225,850 in 2015 dollars). The amount of funds allocated to the academic bonus system has steadily increased over time, with growth in the number of faculty and clinical revenue. In the two most recent years of the system (academic years 2013–2014 and 2014–2015), $270,000 was budgeted per year for the academic bonus. Individual faculty members receive a portion of the annually budgeted academic bonus amount based on the percentage of points that they have earned. For academic year 2014–2015, the total pool of available academic bonus money was 8% of the total clinical margin, after accounting for all departmental expenditures.
The academic bonus plan was reviewed annually with an emphasis on alignment of criteria with institutional academic promotion requirements, extent of faculty participation, overall departmental grant success and scholarship productivity, and weighting of criteria in contrast to degree of difficulty (required effort). The model was reviewed periodically with faculty, and suggestions were taken for modifications. In the absence of a strong consensus, the decision to modify the criteria fell to the department chair.
The variables in this study were individual faculty member (deidentified), academic year, bonus system points, bonuses awarded, and measures of academic productivity (lectures given, manuscripts submitted and published, grants submitted and awarded, etc.). We adjusted all dollar values to 2015 dollars for consistency in interpreting financial metrics over time.
We analyzed data using descriptive statistics (medians, proportions), including measures of variance where appropriate. Data were collected in Excel and then translated into SAS statistical software for analysis. We conducted all database management and analyses in SAS statistical software, version 9.3 (SAS Institute Inc., Cary, North Carolina).
The total number of Department of Emergency Medicine faculty members participating in the academic bonus system was 42 in academic year 2005–2006 and 42 in the most recent academic year (2014–2015). The median number of participating faculty members over the 10-year period was 43 (range 37–47). For the 2014–2015 academic year, 31 faculty members were practicing faculty clinicians, 3 were nonclinical research faculty, and 8 were fellows. The distribution of rank among the 42 faculty members for the 2014–2015 academic year was 8 (19%) clinical instructors, 17 (41%) assistant professors, 8 (19%) associate professors, and 9 (21%) full professors. During the 10-year interval, 8 faculty members were promoted to associate professor, 4 were promoted to professor, and 1 was promoted to professor with tenure. Nineteen (45%) faculty members participating in the academic bonus plan were women.
During the 10-year period of the study, the percentage of total annual compensation made up by both the academic productivity incentive and clinical productivity incentive ranged between 33% and 61% for faculty members. The academic bonus component accounted for approximately 8% of the total annual bonus distribution during the 10-year span.
Figure 1 illustrates growth of the total financial bonus pool and changes in faculty-level academic bonuses (median, interquartile range, maximum) over the 10-year period, beginning with academic year 2005–2006. The academic bonus pool was $211,622 for 42 faculty members in year 1 (adjusted to 2015 dollars), and it was increased to $270,000 for 42 faculty members in year 10. The median faculty academic bonus remained fairly constant over time, while the largest distributed bonus increased from $16,920 in year 1 to $39,207 in year 10.
Figure 2 illustrates the distribution of academic bonuses among participating faculty members over the 10-year period, from lowest to highest. The distribution of bonuses over time (slope) was fairly constant up to approximately the 75th percentile of faculty, with notable increases among the top 25th percentile of faculty over the 10-year time period.
In Figure 3, we demonstrate the distribution of academic points, categories for academic points (education vs. scholarly productivity), and corresponding academic bonuses for individual faculty members in the most recent academic year (2014–2015). Academic bonus payments directly mirror academic points, and the relative contribution of education versus scholarly points varied among faculty across the distribution. As in Figure 2, academic bonuses and points in the most recent academic year generally followed a linear slope up to the 75th percentile of faculty, then increased exponentially among the top 25th percentile of academic faculty.
For academic year 2014–2015, Figure 4 illustrates a count-based (rather than points or dollars) depiction of academic productivity and the type of productivity for individual faculty members at the 25th, 50th, 75th, and 100th percentiles of the academic point distribution. In Supplemental Digital Appendix 2 (https://links.lww.com/ACADMED/A422), we detail the 2014–2015 academic productivity for each of these faculty members to further illustrate the amount and type of productivity rewarded across the spectrum of the academic bonus program.
Between 2010 and 2015, 18 faculty members participated in the academic bonus program. Table 1 demonstrates how these faculty members have shifted between quartiles during those five academic years. These data demonstrated that 7 of 18 (39%) faculty members remained in the same quartile over five years while the remaining changed quartiles, both up and down. Supplemental Digital Appendix 3 (https://links.lww.com/ACADMED/A422) illustrates the annual academic bonus amounts (adjusted to 2015 dollars) for each of the 18 faculty members plotted over the five years.
This is the first study, to our knowledge, to detail and describe a department’s academic bonus system for incenting scholarly and educational activities by its faculty members. Our findings demonstrate that our faculty members were rewarded for their productivity over a broad range of educational and scholarly activities, as measured through an “academic RVU” (the bonus system “academic point”). The distribution of bonuses over time was fairly constant up to the 75th percentile of faculty members, with notable increases among the top 25th percentile of faculty members. As the amount of dollars earmarked for the academic bonus pool increased, the range and size of the bonus distributions to individual faculty members also grew, although this growth was most notable among the top 25% of academic faculty members. Given the significant weighting for grant submission, acquisition, and retention, plus the concurrent papers that would be anticipated with such grants, the significant growth in points and remuneration for the top 25% of academic faculty members is to be anticipated as a measure of academic success in the department. The median reward was maintained at a fairly consistent level, thus reinforcing to the faculty as a whole that the overall goal of a balanced portfolio of academic support is still being met.
Most prior studies have focused on faculty compensation models revolving around clinical productivity. One previous study assessed how academic departments of internal medicine in the United States measure overall faculty productivity for the purpose of compensation. The survey of department chairs found that almost all departments measured clinical productivity, but recognition of teaching and research productivity was more variable. Respondents to the survey reported using research grant funding, faculty career awards, full-length peer-reviewed publications, and varying teaching activities as metrics for bonus compensation. The study did not specifically detail the manner or compensation amounts that department chairs rewarded their faculty for the teaching and research productivity.5
Similarly, a survey study of orthopedic surgery department chairs found that the majority of departments used a base salary and bonus system to reward clinical productivity. Most departments had an academic bonus system in place that relied on any combination of chair’s judgment, academic rank, or a point system. The point systems varied in focus, breadth, and detail. The study cited one case study department of orthopedic surgery that allocated their bonus compensation based on clinical, academic, and administrative activities. Academic activities that were rewarded included resident lectures, student advising, fellow education, research grants, publications, journal editorial service, and scientific presentations. However, specific points and compensation data for each activity, and the bonus template used, were not described in the study.6
While promotion and tenure decisions in academic medicine rely heavily on academic activities, faculty financial compensation for these activities remains relatively unknown. With the belief that academic productivity also justifies and can be incented by financial compensation, we present our department’s academic bonus system and data from this system over the past 10 years. Although this system was developed within a department of emergency medicine, the premise for the bonus system and details of point allocation are generalizable to academic faculty from a broad array of disciplines (i.e., this system is not specific to emergency medicine). The point system is modifiable for individual departments to incent certain academic behaviors. For example, if a given department wanted to further incent grant submissions or research manuscript submissions, these activities could be weighted with a greater number of points. Alternatively, if educational activities in the School of Medicine were prioritized, these activities could be further weighted. As a result, we believe these findings are generalizable to many other academic departments at medical centers across the United States. Furthermore, in departments with clinical and nonclinical faculty, the integration of an academic bonus system may allow additional financial compensation (based on academic productivity) for faculty who are not eligible for clinically based bonuses.
There were limitations in this study. First, the data from this academic bonus system are unique to the Department of Emergency Medicine at a single academic medical center. While it could easily be translated to external institutions and non-emergency-medicine departments/divisions, the distribution of points and bonuses is likely to vary according to the total academic bonus pool (dollars), number of participating faculty members, and distribution and type of academic productivity. Second, the structure of the academic bonus system, point values, and activities awarded has changed over time, commensurate with annual examination of the point distribution and departmental priorities. Thus, the system itself morphed over the 10-year period, creating some variation in year-to-year comparisons beyond that of faculty growth and academic productivity. Also, several faculty members participating in the academic bonus system have turned over during the 10-year span of the study, so it was not possible to track the growth of all individual faculty over time using these data.
Finally, we are unable to test a causal relationship with these data. The data do not allow us to assess whether implementation and use of the academic bonus system incented greater academic productivity and engagement than would have occurred without the system. The amount of behavior change resulting from an academic bonus system likely varies by individual faculty, with some faculty being unaffected by the bonus system (i.e., same productivity whether or not the system was used) and others having a notable increase in academic productivity due to financial incentives. While being unable to establish a causal relationship, we believe that the academic bonus system has been integral in establishing an academic culture in the department and demonstrating the “value” of academic contributions. As an example during the 10-year period, the annualized departmental extramural research grant funding rose from $950,844 (2015 dollars) in academic year 2005–2006 to $2,735,233 in FY15, with the department being ranked third nationally in National Institutes of Health funding within its specialty.7
Academic faculty can be incented and rewarded for their educational and scholarly activities using an academic bonus system that is based on a point system tailored to an individual department’s goals. Our findings demonstrate a system for objectively measuring such academic productivity through a point system akin to “academic RVUs.”