Use, misuse, and underuse of work relative value units in a vascular surgery practice.

Health care reform is forcing "alignment" between hospitals and physicians. The acceleration of employment of physicians by hospitals is bringing into focus contractual terms where compensation is tied to clinical productivity. Physician productivity is being almost entirely defined by work relative value units (WRVUs). However, vascular surgeons may bring value to a health system in ways that are unique and separate from clinical revenue as measured by WRVUs. Incentives for physicians should also be tied to behaviors that are desired, such as quality of care, efficiency, patient outcomes, patient satisfaction scores, teaching, and research, depending on the specific environment. Vascular surgeons must be aware of proper use and misuse of WRVUs and have access to the most appropriate benchmarks in negotiations for employment. With increasing employment of physicians by hospitals and focus on "alignment," a more comprehensive measure of physician productivity is necessary.