Development of a local model for measuring the work of surgeons.

Objectives: The Relative Value Unit (RVU) is the main method of calculating surgeons' reimbursements and a tool for measuring the work of surgeons. Existing evidence shows that the work Relative Value Unit (wRVU) does not accurately represent surgeon's work. Therefore, the current study attempted to develop a local model to measure surgeons' work. Material and Methods: This study was conducted in two main phases of determining the metrics and model development using quantitative and qualitative approaches from December 2019 to April 2021. Literature review, focused group discussions, and interviews were used to collect data. Con- tent analysis and Exploratory Data Analysis techniques were applied to analyze data. Results: The findings demonstrated that patient's conditions (age, severity of disease at referring time, and comorbidities), disease specifications (time, complexity, physical effort, and risk), and provider characteristic (surgeon's willingness, imposed stress, and surgeon's skill) were important by 17, 51, and 32%, respectively, in determining surgeons' work. Conclusion: Determining a fixed value for each procedure does not accurately estimate the amount of required surgeon's work for any procedure. Many factors, such as the patient's condition, surgeon's characteristics, and disease specification affect surgeons' work in the operation room. Proper measurement of the surgeon's work is an important step towards establishing equity in payment in the health system.