You can get totally screwed depending on how they figure your overhead. If they arbitrarily set your overhead at a certain % of your collections you can really get rumphumped. Say they set my overhead at 40% of collections and I collect 1.5 million (which is well within the range of probability by the time I would switch to a production based salary) that would mean my overhead for the year was $600,000. Unless that overhead includes a helicopter to and from work they must be smoking crack if they think I will pay that.
The other thing to think about is that your value is not just your RVU based production. Your total value also includes the income you bring to the hospital through operating room fees, hospital room fees etc. Not to mention the value you would bring to the hospital wound care center by having a "plastic surgeon on staff." One hospital has already started marketing itself as the preferred regional wound care center because I'm there. Your value also has to do with how strong your referral base is. If you are in an area that the hospital currently has no market share in, you are bringing new territory to the hospital. It is difficult to calculate the value of all of those things but just realize that you are not powerless when it comes to negotiating salary with a hospital. We'll see how it goes for me. I'm not optimistic that they will want to pay me what the job is worth but we'll see. I meet with the CEO and COO in a couple weeks to set up expectations etc.