Growing the pie

Ten years ago, the ambulatory clinics at Iowa River Landing in Coralville opened their doors. We established a major footprint off-campus, increasing patient convenience and volume, and expanded the services we could offer. Now that we are bumping our heads against the ceiling of IRL, we have turned our sights toward North Liberty and an ambitious expansion of our main healthcare campus over the next decade. What other opportunities to grow will we have seized over the next ten years? We want to remain the major force in providing healthcare for the people in eastern Iowa and beyond and remain at the forefront of academic medicine. Take, for example, the expectation that many private practice internists in the area will retire soon. How can we grow into that void and provide the same world-class care the state associates with our name, while also keeping our focus on our other core missions, education and research?

There are challenges and limitations to growing such a system, some in our control, others that are not, like our payor mix, our reimbursement rate, and state funding support. To accommodate these more intractable factors, we have worked with collegiate leadership and others for months to develop a compensation model that will allow us to achieve our goals. The compensation model will also be aligned with other successful departments within University of Iowa Health Care. We have made a lot of progress and are still working on some details, but we are ready to discuss broad elements of the plan with you. Transparency and benchmarking are guiding principles of this new model, and it is important that we are transparent about the new model sooner rather than later.

Let’s address the top-line change first. For the first time, you will be invited to evaluate and adapt your practice against national benchmarks throughout the year with the understanding that you can influence your compensation accordingly. A faculty member’s salary can go up based on what they achieve throughout the year. In terms of clinical productivity, RVU targets are among those goals, as are quality measures. But productivity will also be measured by the quantity and quality of the teaching you do or how many grants you submit or manuscripts you publish. Equitable—and achievable—benchmarks for all this work will be established across all three of our missions. Over the next few months, the details of these benchmarks will be shared with you, offering you ample chance to review and respond. And then, throughout Fiscal Year 2023, we will evaluate the strengths and weaknesses of this model. We will rely on each division to find optimal charge capture and identify new opportunities tailored to their specific practice. You will be able to track your own effort with regular reports to see how you are performing. It is important to reiterate that FY23 will be a test. No one’s salary will be affected by the compensation model in this first, trial-run year.

We do understand that despite the opportunity that change can represent, it can also bring worry and anxiety. Again, the model will not affect your salary in FY23, but you can affect the model. Department leadership will fan out in a variety of settings in the coming months to explain, listen, answer, discuss, and adapt. We will provide you detailed information about the plan and your projections. Published FAQs and worksheets are planned, and Q&A-style town halls may be offered. Your Division Director and Division Administrator will also be important channels, bundling your questions and concerns either for the department to address or for us to communicate to collegiate leadership. You will not lack any opportunity to weigh in, both before the test run begins and throughout the coming year.

And, of course, the department’s new feedback tool is open to your anonymous or signed input or questions. Thank you to those who have already begun to use it. We will post more of the kudos you sent soon, but I offer here an example of what we hope to inspire more of. Immunology Division Director Dr. Scott Vogelgesang wrote in to say:

Amy Dowden has developed an incredible portfolio of leadership within the American Academy of Allergy, Asthma and Immunology. She is currently the Chair of the In-training Examination Committee; Chair of the Core Curriculum, Education and Residency Review Subcommittee; Executive Board member of the Program Directors Assembly; and Vice Chair of the Adverse Reactions to Drugs, Biologicals and Latex Committee meeting. She continues to make our Division very proud and represents UIHC at its best!

We also received an anonymous submission about our Chief Residents:

It’s hard to think of someone who is a bigger supporter of other people than Desmond Barber. He made sure to spread the word that two of his fellow Chief Residents (and future pulmonary fellowship colleagues), Sydney Bowmaster and Yana Zemkova, were featured in UI Health Care’s new PSAs about pandemic safety. Dr. Barber deserves as much praise for HIS hard work and enthusiasm as he shows for everyone else.

Excellent! Please continue to support one another like this, and thank you for everything you do even as we adapt to ever-present change.