Stamford Hospital’s Compensation Model for Physicians Participating in Research
Stamford Hospital’s Dr Suzanne Rose, Executive Director of Research, created a compensation model to bridge the mismatch between physicians’ ability to do research and the pressure to log a certain number of RVUs. She tells us about the model, and more about how clinical research is being done at the community hospital level.
Tell us about the physician compensation model you created to encourage physicians to take on research in addition to seeing patients.
The goal of the model was to reduce the competition between research and the current RVU model. Physicians have to have a certain number of RVUs per day/month/year/etc, and that’s their base salary. If physicians want to participate in research, you have to find a way to make a research patient look the same way as a standard-of-care patient, RVU-wise, because otherwise, physicians are potentially losing money by doing research.
Our model is twofold. We have not only created a process to add a research RVU to the system that counts the same as a work RVU, but we also ensure that physicians are paid a fair market rate to do research. We build a budget, we have them sign off, and for every study, there is a specific fee for every activity as part of the study.
"The goal of the model was to reduce the competition between research and the current RVU model."
How did you implement such a model, and continue to make research a priority more broadly at Stamford?
It starts with buy-in from the executive team, and that then flows downward. I was brought to Stamford specifically to do this. They had previously been doing oncology research but had physicians who wanted to expand into non-oncology research. We are a teaching hospital as well, and the goal was to support residents and nursing staff and keep Stamford an independent hospital that could offer physicians a way to participate in research outside of an Academic Medical Center.
We’ve had that buy-in since I started, which you need, especially when signing off on budgets every year. We have a nearly $2 million annual budget, and there has to be someone who says, “We will spend that because we know we will bring X amount of money back in.” We have the best financial outlook of any hospital in the state of Connecticut, and even throughout the pandemic, we have been able to stay in the black.
What can you tell us about cost?
We are breaking even. My commitment to the hospital is for any staff doing clinical research that the trial revenue will pay their salaries. I started out at 50%, and for the last two years, have been at 100%. Every year, the goal has been to increase that amount. Our coordinators, data specialists, research pharmacists and physicians are all supported by what we are either paying in salaries or paying to the physicians to do research, by the clinical research budget and the patients we recruit.
How do you make patients aware of clinical research?
For the public, we have a robust website that we update monthly, with the name of the trial, the physician, the coordinator contact and the link to ClinicalTrials.gov.
We have an internal website for physicians with all of the trials we have. They can filter by indication, get the inclusion/exclusion criteria, the link to the protocol, etc. We recruit internally quite often.
We have information about trials that go into every patient exam room as a reminder to physicians and as a resource to patients. We highlight select clinical trials in our monthly physician newsletter.
We are launching Epic March 1, 2025, so we will be able to use MyChart to mine for patients, and physicians can search for research studies. We are excited about that because we have a huge amount of patients who are not exposed to research. This should also aid in the research billing process, which as of now, is entirely manual.
"My commitment to the hospital is for any staff doing clinical research that the trial revenue will pay their salaries."
How have your physicians responded to potentially doing research?
Most physicians go to a community hospital because they do not want to be in an academic medical research center. Therefore, trying to change their mind about doing research can be very daunting. However, we do get new physicians right out of fellowship who have more research experience. We try to meet with them as soon as they enter the system and present the research we are doing. We have been successful with that. We also give them a tour of our Center for Simulation and Learning so they can see the depth of services provided by our Department.
What is the biggest challenge you’re facing in being able to do the number of trials you’d like to do?
Staffing. We can train someone up, and they might be poached by industry or choose to move on. I am happy to teach them and give them the skills that they need to go on to other careers in medicine, but it’s a challenge to remain fully staffed.
It’s hard to find coordinators, and you can’t run a clinical trial without a clinical research coordinator. Other positions are easier to work without, such as a data specialist because a coordinator could do their own data, or a research pharmacist because we could use the pharmacy inside the hospital. This is not unique to us; it’s an industry-wide challenge to find coordinators.
What is a challenge you’re working to address?
One challenge is getting noticed by sponsors, particularly for non-oncology, but we are working to address that by building strong relationships with medical science liaisons. For every MSL we meet for oncology, we ask them to put us in contact with their non-oncology MSLs. We’ve started creating pathways into our neuroscience service line, building out cardiology, and have new pulmonary trials because we created relationships with MSLs and inquired about their connections to our therapeutic areas of interest.
One ideal solution would be to create a consortium of community hospitals, so that our voice could be heard, presented to pharma, and give us more ability to compete with AMCs and larger health care systems.
"You need buy-in from the system or the hospital. You need a physician who wants to do research. You need a coordinator."
You have partnerships with AMCs and other hospitals. How does that contribute to the success of Stamford’s clinical research program?
We're one of the few independent hospitals left in the state of Connecticut, but we have partnerships with Dana Farber, Hospital for Special Surgery, Boston Children’s Hospital, Columbia, etc. When they are looking to establish a partnership, oftentimes the first question is “What does your research program look like?” They not only want to support us clinically, but they want an outlet to help them grow their research programs. Having these partnerships not only strengthens us clinically and allows us to stay independent, but it has also fostered a strong research environment.
If we take Dana Farber as an example, they have a collaboration with 10 community hospitals. They create their own research protocols and will ask us to recruit a certain number of patients. These are cutting-edge trials, so we are happy to participate, even if we lose money, because it’s research we wouldn’t have access to otherwise.
What is your recommendation for other community hospitals who are considering doing research?
Start with very succinct goals, such as “We want to bring in one clinical trial and recruit X amount of patients.” You need buy-in from the system or the hospital. You need a physician who wants to do research. You need a coordinator.
