Student Debt in American Medicine

Clinical Academic Rheumatology: A Boon for Health Systems

BACKGROUND/PURPOSE

Finding a balance between clinical and scholarly productivity is a challenge for many academic clinician-educator (CE) rheumatologists. An examination of workload and downstream revenue determines if the financial value generated by services rendered by rheumatologists are proportionate to the financial value created for a health system. A 2005 study found that academic rheumatologists generate $10.02 for every $1.00 they receive for an office visit.² METHODS: A retrospective analysis of ordering practices of five full-time CE rheumatologists from August 2017 - February 2019 was done. Individual workload is defined as averaged full-time equivalents based on time spent on clinical and academic duties. Academic productivity was reviewed. Revenue generating activities that benefited the division directly and downstream revenue were collected. Revenue was extrapolated based on volumes of referrals, publicly available drug costs and estimated Medicare reimbursement values (average sales price) of representative drugs.

RESULTS

The total revenue by physician which benefited the division directly is $597,203 with evaluation and management codes accounting for $174,456. Downstream revenue by physician totaled $2,119,437. The largest contributor was from referrals to the hospital-based infusion center at $1,287,496. The downstream revenue generated by rheumatologist per dollar of evaluation and management services was found to be $12.14 ($9.37 in 2005 dollars).

CONCLUSIONS

For every $1 generated though office visits by five practicing academic rheumatologists at our institution $12.14 were generated through downstream revenue, which when adjusted for inflation shows stability in the value generated by academic rheumatologists ($10.02 vs. $9.37).