Objective:

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.

Sources:

• JAMA Surgery
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