The Passion Tax: Valuation Disparity among Academic and Nonacademic Surgery Subspecialty.

Abstract

Academic surgery requires commitment beyond financial incentives. Nevertheless, the monetization of clinical effort measured by work relative value units (wRVUs) is not well characterized. Previous work indicates academic surgery charges a premium of 16% compared with nonacademic counterparts. In this study, we analyzed patterns in the valuation of academic and nonacademic work across general surgery subspecialties. Medical Group Management Association datasets (calendar year 2014, 2018, and 2022) were queried for total cash compensation (TCC) and wRVU among colorectal (CR), general, surgical oncology, plastic and reconstructive, transplant, trauma, and vascular surgery. TCC, wRVU, and TCC per wRVU were compared between academic and nonacademic. ANOVA and t -test were used as appropriate; a p value of <0.05 was deemed statistically significant. Linear regression was used to perform trend analysis to evaluate TCC per wRVU over time by subspecialty. TCC in all academic subspecialties was less than nonacademic at all years. wRVUs in academic subspecialties were greater than nonacademic at all years. TCC per wRVU in all academic subspecialties was less than nonacademic at all years. Differences between academic and nonacademic TCC per wRVU varied from -$36 of -52% (trauma surgery; p = 0.03) to +$4 of +6% (CR; p = ns). Trend analysis shows that the gap between academic and nonacademic TCC per wRVU in multiple GS subspecialties is widening. Academic exacts a passion tax over nonacademic for virtually all GS subspecialties. As measured by TCC per wRVU, academic TR charges the highest tax (-52%; p = 0.03), followed by plastic and reconstructive surgery (-40%; p = 0.01), surgical oncology surgery (-27%; p = 0.02), vascular surgery (-12%; p = 0.02), transplant surgery (-10%; p = ns), and GS (-9%; p = 0.04). Only academic CR yields a positive "return" (+6%; p = ns). Embarking on a career in academic demands a passion for values that transcend financial gain.