Background: Changes in the health-care industry have led to increasing demand for physician-driven clinical volume. This environment has altered the traditional balance among teaching, research, and service responsibilities for faculty in residency training programs. As economic pressures mount and budgets shrink, academic departments are exploring ways of paying faculty that would help to maintain the global mission of the organization. The purpose of this study was to examine the compensation strategy for faculty in academic orthopaedic surgery departments in the United States with a focus on compensation methods for academic productivity.

Methods: Thirty-one academic orthopaedic surgery residency training programs were recruited for the study. Two methods of data collection were used: (1) a survey was mailed electronically to the program chairpersons or the finance directors, and (2) eight program leaders were interviewed to obtain more in-depth information regarding compensation for academic productivity in their organizations.

Results: All thirty-one programs responded to the survey. To compensate faculty for clinical productivity, twenty-two programs used a salary and bonus system, two used salary alone, and the remainder used combined methods. Nineteen departments had a compensation system that included academic productivity, and twelve did not. Of those that compensated for academic work, seven used the chair's decision, six used a point system, one used academic rank alone, and the remainder used a combination of methods. The point systems varied in breadth, focus, and amount of detail.

Conclusions: Most, but not all, departments accounted for academic productivity in their compensation system. Most programs used the chair's discretion to determine academic bonuses, but several departments had developed point systems. There are common themes with regard to this issue, including the importance of the academic mission, the need for clinical revenues, the value of flexibility and transparency, and the importance of culture and leadership.