Medical Directors in Plastic Surgery: How Do We Quantify Their Efforts?

The complex nature of the United States’ health care system has largely transformed the manner in which health care providers are evaluated and reimbursed for their efforts. In the operating room, the efforts of plastic surgeons are quantified by either the amount charged or by the relative value units earned from a surgical procedure.1 While such metrics are well established for measuring surgeons’ clinical efforts, there is no consensus regarding the quantification of effort exhibited by plastic surgeons serving as medical directors, despite their importance. Medical directors serve in many sectors of health care. Consequently, methods for quantifying their efforts should be tailored toward their role (Table 1). Directors tasked with overseeing clinical activities are responsible for maintaining and improving the treatment infrastructure in which high-quality health care is provided. Metrics such as patient satisfaction, efficiency of clinical workflow, and results of safety audits may be used to reflect directors’ efforts.2 While each of these variables is easily quantifiable, their use should not be the sole method for measuring a director’s efforts, as heterogeneity in directors’ autonomy across institutions may limit their ability to improve certain aspects of clinical practice.3 Table 1. - Proposed Measures of Medical Directors’ Efforts across Varying Sectors of Health Care Role Proposed Measurement(s) Benefits Limitations Clinical Oversight 1. Patient satisfaction; 2. Clinical efficiency; 3. Safety auditing Metrics correlate with a director’s efforts to ensure quality health care is provided safely and efficiently Significant disparities in decision-making autonomy across institutions Research & Innovation 1. Research output; 2. Funding from grants Accurately quantifies an institution’s contributions to academia Poorly correlated with a director’s efforts Industry 1. Company valuation; 2. Revenue and profit margins Quantifies the financial impact of the director Market dynamics out of directors control can influence these metrics; failure to account for long-term strategies The primary responsibility of medical directors practicing in industry is to ensure the profitability of the company they work for by analyzing the market, identifying opportunities, and advising the procurement and liquidation of valued and paltry assets, respectively.4 One manner of evaluating directors’ efforts in this setting is by observing how strategies developed by directors influence the valuation or growth of the company; however, this form of measurement is not without limitations. Company valuation is not directly representative of a director’s efforts, as it is heavily influenced by fluctuations in the dynamic health care industry. In addition, some strategies developed by the director may be focused on long-term success and may take months or years to influence the valuation of the company. Within academia, many medical directors are responsible for cultivating an environment in which research and innovation are conducted by facilitating the procurement of institutional grants through advocacy and networking.5 In contrast to directors serving in clinical settings and industry, quantifying the efforts of directors’ contributions in academia is more challenging. Metrics such as research output and funding acquired from institutional grants are heavily reliant on the surgeons conducting the research; thus, it can be difficult to delineate the director’s impact in the process. Despite this, sustained levels of high research output and funding from grants deserve recognition when evaluating a director. Plastic surgeons who undertake the role of medical director allot a significant amount of time to fulfill their director-related duties in addition to their extensive clinical responsibilities. Moreover, many directors, with the exception of those working in industry, serve without monetary compensation and are driven to serve secondary to their intrinsic desire to influence the field of medicine. The methods for quantifying the efforts of medical directors that were outlined in this article have utility; however, their limitations warrant further investigation to establish how directors should be rewarded for their contributions. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

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