Introduction: There are limited data on which physician and practice factors are associated with increased productivity. Work-relative value units (wRVUs), the basis for the Center for Medicare & Medicaid Services (CMS) and private payers’ reimbursements, are commonly used to estimate physician productivity. We aimed to determine what factors are associated with urologic wRVUs productivity. Methods: The CMS database from 2017 to 2018 was retrospectively queried for urologic Medicare provider demographics and procedural/service details. Urologists’ medical school graduation year was used to estimate years in practice and urologist’s generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict Medicare specific wRVU production. Results: A total of 6,773 practicing urologists (8.8% female) across the US were included: 10.1% Millennials, 44.6% Gen X, 39.8% Baby Boomers, and 5.6% Post War urologists. Additionally, 57% were general, 18% were oncologic, 17% were endo/MIS, 4.4% were men’s health, 3.2% were FPMRS, and 0.4% were reconstructive urologists. Millennial, Gen X, Baby Boomer, and Post-War urologists produced 1115, 1997, 2104, and 1287 Medicare wRVUs per year, respectively. In adjusted analyses, predictors of wRVU productivity included Gen X and Baby Boomer generations, FPMRS, men’s health, and oncologic sub-specialization, male gender, generating more wRVUs from inpatient procedures and less from office (especially new-patient office) visits, and seeing fewer educated and impoverished patients. Conclusions: The most significant predictor of urologists’ productivity is practice experience, which follows a bell curve over time that peaks 20 to 35 years after graduation; the average Gen X or Baby Boomer urologist produced nearly double the annual Medicare wRVUs of Millennial or Post-War urologists. Further work is needed to incorporate quality metrics into wRVUs or reimbursements, and to ensure that patient demographics do not affect or predict reimbursement. SOURCE OF Funding: None
