Nayar Suresh K, Sabharwal Samir, Aziz Keith T, Srikumaran Umasuthan, Giladi Aviram M, LaPorte Dawn M
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Curtis National Hand Center, Union Memorial Hospital, Baltimore, MD, USA.
Arch Bone Jt Surg. 2020 Mar;8(2):173-183. doi: 10.22038/abjs.2019.39965.2072.
There is a high demand for shoulder/elbow experience among hand-fellowship trainees due to the perception that this exposure will improve their professional "marketability" in a subspecialty they perceive as having higher compensation.
Using Medicare data, we investigated the most common surgeries from these fields and determined which have the highest compensation [work relative value unit (wRVU), payment, charge, and reimbursement (payment-to-charge percentage] rates per operative time. We then determined whether the overall non-weighted and weighted (by surgical frequency/volume) compensation rates of shoulder/elbow surgery are greater than that of hand surgery.
Among 30 shoulder/elbow procedures, arthroplasty and arthroscopic rotator cuff repair had the highest payment and wRVU assignments. Among 83 hand procedures, upper-extremity flaps, carpal stabilization, distal radius open reduction internal fixation (ORIF), both-bone ORIF, and interposition arthroplasty had the greatest wRVU assignments with correspondingly high payments. A non-weighted comparison of the two subspecialties showed that hand surgery has a higher mean payment/min ($10.46±3.22 vs. $7.52±2.89), charge/min ($51.02±17.11 vs. $41.96±11.32), and reimbursement (21±4.7% vs. 18±5.1%) compared with shoulder/elbow surgery (all, ). Non-weighted mean wRVUs/min were similar (0.12±0.03 vs. 0.13±0.03, ). When weighted by procedure frequency, hand surgery had greater wRVUs/min (0.15±0.036 vs. 0.13±0.032), payments/min ($14.17±4.50 vs. $6.97±2.26), charges/min ($75.68±30.47 vs. $42.61±7.83), and reimbursement (20±5.0% vs. 17±6.0%) (all, ).
According to Medicare compensation, and when weighted by procedure frequency, hand procedures are associated with greater overall mean wRVUs/min, payments/min, charges/min, and reimbursement compared with shoulder and elbow procedures. Hand-surgery fellowship applicants should be aware that subspecialty compensation is complex in nature but should seek shoulder/elbow elective experience to acquire an additional surgical skill-set as opposed to primarily monetary reason.
手部专科培训学员对肩部/肘部手术经验有很高需求，因为他们认为这种经历会提高他们在一个他们认为薪酬更高的亚专业中的职业“市场竞争力”。
利用医疗保险数据，我们调查了这些领域最常见的手术，并确定了每种手术每手术时间的最高薪酬[工作相对价值单位（wRVU）、支付金额、收费和报销（支付金额与收费的百分比）]率。然后我们确定肩部/肘部手术的总体非加权和加权（按手术频率/数量）薪酬率是否高于手部手术。
在30种肩部/肘部手术中，关节成形术和关节镜下肩袖修复术的支付金额和wRVU分配最高。在83种手部手术中，上肢皮瓣移植、腕关节稳定术、桡骨远端切开复位内固定术（ORIF）、双骨ORIF和间置关节成形术的wRVU分配最大，相应支付金额也很高。两个亚专业的非加权比较显示，与肩部/肘部手术相比，手部手术的平均每分钟支付金额更高（分别为10.46±3.22美元对7.52±2.89美元）、每分钟收费更高（分别为51.02±17.11美元对41.96±11.32美元）以及报销比例更高（分别为21±4.7%对18±5.1%）（所有比较，均为P<0.05）。非加权平均每分钟wRVU相似（分别为0.12±0.03对0.13±0.03，P>0.05）。按手术频率加权后，手部手术的每分钟wRVU更高（分别为0.15±0.036对0.13±0.032）、每分钟支付金额更高（分别为14.17±4.50美元对6.97±2.26美元）、每分钟收费更高（分别为75.68±30.47美元对42.61±7.83美元）以及报销比例更高（分别为20±5.0%对17±6.0%）（所有比较，均为P<0.05）。
根据医疗保险补偿情况，且按手术频率加权后，与肩部和肘部手术相比，手部手术的总体平均每分钟wRVU、每分钟支付金额、每分钟收费和报销比例更高。手部手术专科申请人员应意识到亚专业补偿本质上很复杂，但应寻求肩部/肘部选择性手术经验以获得额外的手术技能组合，而不仅仅是出于金钱方面的原因。
