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You’re Worthy, Regardless of Your RVUs

Op-Med is a collection of original articles contributed by Doximity members.

When I first heard the concept that “self-worth is not determined by productivity,” I let out an audible laugh and nearly spit out my coffee (my third of the day).

At that point, I had gone through the familiar scenario of being a gifted high achiever in most everything I did, and had been working as an NP in the ED for about five years. My whole life up until that point had been defined by my ability to produce. Whether it was producing academically or seeing two patients per hour in the ED, productivity was how I defined my success and self-worth.

But certainly it’s not just me, and this isn’t unique to health care, either. We live in a society that values productivity and hustle. The American Dream, our national ethos, is a set of ideals and beliefs that anything is possible for anyone, if they work hard enough. But this isn’t necessarily innate to humans in general — there are societies that value rest in a way we in the U.S. rarely embrace. For example, many Western European countries have a long break in the afternoon after lunch. Businesses close, schools send their students home, and it is acceptable and encouraged to take a break to recharge and rest. 

Our preoccupation with productivity is very much due to capitalism and our need to keep our society functioning. But I have to wonder if we’ve gotten to the point that our obsession with productivity has completely devalued things like rest, imperfection, inner peace, personal boundaries, hobbies, and activities that we do just for fun.

I’d like to think there’s a middle ground here, where we can live productive lives and also honor our need for rest and personal fulfillment outside of our work. Our workplaces tend to incentivize productivity, which can make it difficult to dissociate our worthiness from our productivity. 

As a career mentor for NPs, I’ve reviewed many job offers and contracts, and have studied the various types of business models in medicine. I’ve also seen, firsthand, a variety of productivity incentives in my last 10 years of practice. For clinicians, there appear to be three common models of payment and salary structure for employees. 

Straight Salary

The straight salary model is just that — the clinician is paid a fixed salary for an expected amount of hours of work, usually tied to shifts or the practice’s hours. There may or may not be extra pay for overtime, on call, or additional shifts worked. These compensation structures typically include traditional benefits and paid time off. This method has dropped in prevalence among physicians from 20% to 18.9% during 2012–2018.

Straight Productivity

Straight productivity pay is a compensation model in which one’s pay is directly influenced by the number of patients seen and/or RVUs generated. This compensation model often does not typically include paid time off, and the clinician often decides their schedule with consideration of how many patient care sessions they will have during a pay period. This method has also dropped in prevalence among physicians from 21.7% to 17% during 2012–2018.

Hybrid: Base Salary with Productivity Incentives

The hybrid model is typically a combination of salary and productivity pay, and can also include other bonus structures for performance, metrics, or other activities. 

According to the 2018 Physician Practice Benchmark Survey, unlike the straight salary and straight productivity models, the prevalence of hybrid models steadily increased between 2012–2018. In 2018, it was the most common compensation model among physicians.

Even though it appears that our productivity, revenue generation, and income will likely remain entangled, it’s important to recognize that this data doesn’t define our worthiness as people or as medical professionals. In recognizing this, we can bring more awareness to the fact that our self-worth is not tied to how many RVUs we generated, or how much money we made, or how little time off we took. We are in an industry where burnout is rampant, and working to examine our self-worthiness may be a protective factor. 

The truth is, as clinicians, we are innately worthy of love, acceptance, belonging, rest, and play.

Here are five activities to try as you learn to embrace your innate self-worth:

1) Explore a new hobby, ideally one that doesn’t have a highly valued outcome. When trying to explore what I enjoyed doing in my down time, I realized that so many of my hobbies were fun to me because of the outcome I produced. I learned to quilt so that I could admire my finished quilts. I wanted to learn calligraphy so I could admire the pretty finished product. What hobby or activity can you do or learn that is all about the process, rather than the outcome?

2) Set firmer boundaries. Are you obligated to have your work email on your phone? If not, remove it, or at least turn off notifications when you are not working. 

3) Take your earned time off. You might be incentivized financially to rollover or give back your time off, but if you have it, take it, and, ideally, use it to truly rest and recharge. One of my ED positions a few years ago gave generous time off, but if you didn’t take it, you would get paid out at the overtime rate at the end of the year. That was an enticing offer, and I would take a week off but still schedule myself for the same number of shifts per month. I soon realized that I’d rather take the actual hours off than be overworked for the rest of the month.

4) Practice mindfulness. This can look different for everyone and can include traditional meditation practice, grounding techniques and exercises, journaling, or reciting affirmations. Mindfulness techniques help bring awareness to the present moment and remove expectations of our future selves or criticism of our past selves. This is a work in progress for me, but I’ve found that anchoring this to another habit I already have is helpful. For example, I like to practice some breathing exercises while I wait for my coffee to brew in the morning.

5) Stop glorifying productivity. Busyness is not a badge of honor — you can start congratulating yourself and others for taking time off and engaging in self-care activities. I used to resent coworkers for taking time off, but now I realize that they had more courage than I did to prioritize their rest. 

Before we become good at something, most of us start out resisting that thing, especially if it goes against what we’ve known for many years. That’s how I’ve felt about the mindset practice surrounding the recognition of my self-worth. Maybe this is the first time you’ve considered this concept, or perhaps you just need a gentle reminder that you are innately worthy of acceptance and rest. As Brené Brown wisely said, “When you get to a place where you understand that love and belonging, your worthiness, is a birthright and not something you have to earn, anything is possible.” 

How did you find your self-worth? Share in the comments to help those who are still looking.

Amanda Guarniere is a dual-certified adult and women's health NP with a focused clinical background in emergency medicine. She holds a BA in Italian Literature and Violin. She believes strongly in the healing and educational power of storytelling. She is also an entrepreneur and works with other NPs as a career mentor so that they may find personal and professional fulfillment. She is a 2020–2021 Doximity Op-Med Fellow.

Illustration by April Brust

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