Sara Forootan1, Sakineh Hajebrahimi2, Ali Janati1, Behzad Najafi3, Mohammad Asghari-Jafarabadi4

1Department of Health Policy and Management, Tabriz University of Medical Sciences School of Management and Medical Informatics, Tabriz, Iran
2Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences Faculty of Medicine, Tabriz, Iran
3Department of Health Economics, Tabriz University of Medical Sciences School of Management and Medical Informatics, Tabriz, Iran
4Center for the Development of Interdisciplinary Research in Islamic Sciences and Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran


Objective: 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.

Keywords: Relative value unit, work relative value unit, surgeon’s work, measurement


Ethics Committee Approval

This study approval was obtained from Tabriz University of Medicine Sciences (Decision no: IR.TBZMED.REC.1397.960).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - A.J., S.H.; Design - A.J., S.H., B.N., M.A.J.; Supervision - A.J.; Data Collection and/or Processing - S.F., A.J., S.H.; Analysis and/or Interpretation - S.F., B.N., M.A.J.; Literature Search - S.F.; Writing Manuscript - S.F., A.J.; Critical Reviews - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.