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Clinical Research Compensation Model?

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  • Clinical Research Compensation Model?

    Our hospital is looking to find a better model to incentivize physician's participation in clinical trials and Im just curious if anyone has any thoughts?   The academic model is not going to work here for several reasons.   Most of us don't have the time nor the desire to write grants or conduct investigator-initiated trials.  Although we have students, residents, and fellows.. our programs are mainly clinical.  Most of us are relatively young and prefer a work-life balance.  Those who do a lot more clinical research do it for the patients, to advance of the care, and for me, to be involved in the latest novel therapies.

    Just some background on our hospital system, our practice is a very large non-profit, private, multi-speciality practice.  We have 8 large hospitals throughout the region, most of which are concentrated in the downtown area with probably greater than 2000 beds in aggregate.  We're all employed and work under a wRVU model.  Im one of 18+ medical oncologist that sub specializes.  Salary is based on a specific target and then bonus X amount per wRVU above target.  There's an additional bonus structure for extracurricular work (ie leadership, clinical trials, committee participation, publications, presentations at national meetings, etc).   Although there is some incentive for doing clinical trials.. this models does not necessarily motivate nor incentivize the physician properly as it relates to the amount of research work that's involved in conducting trials as a principal investigator.  Most of us work 3-4 days in clinic and then have 1-2 days for admin, education, research activities.  Most of us participate in clinical trials but only a few of us do it a lot more than the rest.  I have about more or less 6-8 actively enrolling trials at a given time.

    The problem again is that we're not properly incentivized enough to participate in clinical trials that's commensurate to the work involved.. ie regulatory review, resource/financial review, weekly research meetings with the research team which consist of a regulatory coordinator, data manager, clinical research coordinators, clinical trial leadership, ensuring proper patient enrollment and strict protocol adherence, response assessments etc.  Each severe adverse effects or major deviations add more work to write up which happens sporadically.  Although the hospital and the clinical trials office are paid directly by the sponsors, I as a PI don't see any of these funds.  Im just curious to see how other folks who are in a similar hybrid program incentivize the physician to participate in clinical trials?

    If you have protected time.. is your base salary similar to those who are pure clinical practice but with expectations for a certain of trials/pt enrollment?  How much time is protected?  None of us want to take a pay cut and really want the work to be incentivized on top of our clinical work.  What's a fair and equitable model amongst clinician and clinical investigator?   Are you paid per trial as a PI.. per enrolled pt?  How much?   A percentage of sponsored payments?

  • #2
    Few options I think.

    -can set goals for the group and get bonus payment for meeting them. Ie. 10k bonus per doc if you enroll 50, 20k if 100, etc

    -could do flat dollar amount per patient

    -another option is to set up a research director and a few assistant research director positions (all paid) and just rotate those positions amongst doctors in the group. Contingent on enrolling ? patients in trials


    • #3
      From what I know from working on similar non-clinical comp with the corporate attorneys is that the pay for your clinical research time would need to be based on a formula that is defensible from a fair market value standpoint.  Our attorneys would probably say that this is not the same work as seeing patients, so could not be compensated at the same rate they pay you as an oncologist.  They would probably argue that you need to use the standard "medical director" compensation rate, which at our organization is $150/hr.  So that approach would involve calculating an average time a physician would spend for each patient.  One could break it down to enrollment and annual maintenance for time on trial.  This would be the kind of comp proposal that might pass legal muster at our organization.

      I think to do this there needs to be some executive interest in increasing clinical trial accrual.


      • #4
        Very similar situation here as well. Lot of pressure to participate actively in research, all of us are clinicians and are trying to subspecialize. Model for compensation is pure wRVU based.

        The administration is looking in to hiring people with 50% academic 50% clinical role but has not clarified how they are going to pay for the 50% academic role (especially if they don't bring any grants). They are also looking at a fixed salary for all clinicians (which would be a massive cut for a lot of pure clinicians) and then use the saved $ to compensate researchers.

        One thing for sure, no one knows how this would pan out.