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A Critical Analysis of RBRVS

Robert D. Gillette, MD
JAMA. 1992;267(21):2894-2895. doi:10.1001/jama.1992.03480210051026.
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To the Editor.  —Dr Maloney1 compared data on specialty-specific physician incomes2 and working hours3 and concluded on the basis of his calculations that "Hourly reimbursement rates for surgical and nonsurgical specialties are not substantially different" and that "The 42% higher income of surgeons is explained by their longer working hours." He asserted that RBRVS, which is expected to alter income differentials by specialty, "is an inappropriate basis for reform of the physician reimbursement system." Recalling the observation of Spodick4 that "too often, the 'Conclusions' giveth, but the 'Materials and Methods' taketh away," I reviewed Maloney's "Analytic Methods and Assumptions" and found them inappropriate in the following areas:

  1. He calculates from a table of reported working hours for institution-based physicians (reference 3 [Levy et al], Table 3.4) rather than one for all physicians (reference 3 [Levy et al], Table 3.1). If he had used the latter, he


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