The perils of paying academic physicians according to the clinical revenue they generate.

Proponents of paying academic physicians according to the clinical revenue they generate cite the dangers of failing to reward high-performing faculty members, the unfairness of equally compensating physicians who generate very different amounts of revenue, and the positive role variable compensation can play in promoting the financial health of the organization. Yet there are caveats in revenue-based compensation (RBC). Amount of clinical effort and the revenue it generates are not necessarily tightly linked. Such approaches emphasize revenue-producing activities such as patient care at the expense of other academic missions such as education. By focusing attention on pay, RBC may distract our best faculty members from the intrinsic rewards of academic medicine. And by fostering financial competition within the academic health center, RBC jeopardizes mutual dedication to the larger missions of the organization as a whole. Debates over how to compensate medical school faculty members represent nothing less than a battle for the heart and soul of academic medicine.