Canadian Academic Health Science Centres: Developing a Framework to Address Compensation, Academic Productivity, Performance and Quality

Academic leaders and policymakers are faced with a series of difficult and complex decisions around methods of assessing and compensating academic physicians with regards to their performance. Despite the introduction of Alternative Funding Plans by many provincial governments, concerns around the reliance on clinical revenues to fund components of the medical school’s academic mission, increased competition for research grants, physician compensation costs coupled with the rising costs of education and health care delivery, the prevalence of institutional ranking systems and pressures to demonstrate accountability, have all endured. While anecdotal evidence on the types of compensation and academic productivity frameworks exists, studies or literature on the prevalence of these models and their effectiveness within Canadian Academic Health Science Centres (AHSCs) are limited. This dissertation uses an emergent, multi-phase, mixed methods research methodology to explore the methods used to compensate and assess Canadian academic physicians. This dissertation provides methodological, empirical and theoretical contributions to knowledge. Empirically, the phase 1 national survey of academic leaders achieved a 61% response rate (39 respondents), and confirmed that AHSCs use various systems to compensate, assess and incentivize academic physicians. Phase 2 consisted of three mixed methods case studies (three institutions, three provinces, four clinical academic departments and five different compensation models) to analyze the academic productivity of 150 academic physicians over a five-year period between 2006 and 2011. Qualitative data were gleaned from the interviews of academic leaders. Methodologically, a new quantitative and bibliometric assessment model – the K-MAAP© – was developed to analyze the research outputs and impact of those included in the sample, calculate research return-on-investment and efficiency. Theoretically, elements of contract theory, incentives, and behavioural economics were utilized. Behavioural economics is an emergent, hybrid field that seeks to reconcile the gap between standard economic theories and cognitive theories by showing how people actually do behave, and not just how they are expected to behave. A new type of incentive which emerged during the case study research – called a “placebo incentive” – was also described. Several policy implications are presented including methods to fund AHSCs; methods to fund academic physicians; the use of incentives in academic medicine; accountability, metrics and productivity assessments; and systems-level issues related to the alignment of incentives and compensation programs. This information is important for policy makers, AHSCs, hospitals, physician associations, practice plans and academic leaders as they seek research addressed at understanding the efficacy of the models used to compensate, assess, motivate and reward academic physicians for scholarly tasks.

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