90 RVUs a day

[Womb Raider]

Current DR resident. Group I’m interested in after training averages 90 RVUs a day. Sounds like a ton… How doable is this? Can any veterans give any insight to how a practice like this usually works? Burnout likely?

Will be talking with a few of the partners in the practice soon (casually over lunch, not an interview) - what questions are pertinent to ask?

Some things I’m thinking about:
- workflow (how frequent are phone calls, disruptions, etc…)
- procedure expectations
- expected to read mammo? (I don’t think this group does)
- will workload or expectations change after making partner? If so, how?
- what is call like? Do we work nights?
- more specifics of partner buy in (how much $$ / how long)
- benefits (retirement accounts, insurance, etc)
- are expectations more relaxed during my first year as an “attending” as far as speed is concerned?
- is there anyone I can turn to with complicated questions (not sure if a mentor is a thing for newcomers?)
- What’s your practice adjusted collection percentage and how does the group score on MACRA (although these questions may be better for a real interview)

Thanks for the answers!

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[2brads]

Is this RVU or wRVU? My group does similar numbers in RVU, but wRVU it is more like 70 per day. You’ll need to know the mix of studies. Mammo is relatively weighted high for time spent so if you’re not doing mammo, I hope you have a lot of negative head cts. Doing these numbers in plain films only would be nearly impossible. Not sure what “conversation over lunch” is other than an interview. Even if you don’t wear a suit, treat this like an interview. Figure out number of shifts required. This is the only way to compare jobs/offers. Nights/weekends should come at a premium (pay or time off).

Generally, if you are right out of training there is a several month grace period to get up to speed. If they expect you to crank immediately on day 1 that is a red flag. Most groups do not have formal mentorship programs, but generally as long as you aren’t alone, you can just call a coworker to discuss a case. If they say “never call any of us about cases” that is a red flag. MIPS/MACRA is kind of in the weeds. As long as they know what it is and they are doing it, I’m not sure what else I’d want to know in this regard.

Buy in is a touchy subject. I would not even look at groups with buy ins at this point in my career. There’s just too many ways to get screwed.

This is a job seekers market right now. The ball is in your court. Don’t be afraid to let them know you will walk and don’t forget to negotiate if you want something they haven’t offered.

 

[guytakingboards]

90 RVU's a day is a very high weekday number for any non-mammo speciality. That's gotta be greater than 90th percentile daily productivity and depending on how much leave you get, probably gonna be >90-95th %tile annual productivity. I think i've gone over 90 RVU's on a regular day shift less than handful of times in 3 years in my PP job, and I read all sub-spec neuro.

I think your question list is pretty reasonable.... those are pretty basic, big picture questions you'll need answers to.... but a lot of them are kinda "residency program director giving an orientation PPT to start the interview day"-ish. If your first interaction with the group is a casual lunch, I'd just focus on getting to know them and seeing if YOU would want to work with them. You'll get most of those questions answered in due time.

Questions I personally might ask in a more informal setting/information i'd want to know:
- Does the workload match the staffing? is the daily 90 RVU because the partners want to make X amount of money or is it 90 RVU because they're 10 FTE short.
- Is the group growing (i.e. acquiring new contracts), stable or shrinking (e.g. losing contracts)? Is there a lot of competition in the marketplace?
- What's the makeup of the group? are there a lot of juniors in the group or is it mid-career/senior heavy.
- Is it assigned worklists or reading down a shared list? Is easy for people to run cases with each other? Are there a bunch of cherry-pickers?
- Has anyone left or been fired in the last few years... and why.
- (for the junior associates and partners) - was the job sold to you the one you stepped into? I.e. were there a lot of surprises and if so were they good or bad.
- stupid question...but do people interact outside of work? is it a friendly environment or just a clock-in/clock-out job.
- what is the case-mix like? Community hospital negative 20y/o headache brain MRI's or County hospital GSWs to the head.
- How subspecialized/general is the group? Mammo/IR considerations are obvious but would a non-MSK person have to read any MSK MRI/CT? Everything? Just large joints? etc?

*Edit big difference between 90RVU and 90wRVU as 2brads mentioned. 90 wRVU's per day is a ton for non-mammo specialties.

 

[maxxor]

Current DR resident. Group I’m interested in after training averages 90 RVUs a day. Sounds like a ton… How doable is this? Can any veterans give any insight to how a practice like this usually works? Burnout likely?

Will be talking with a few of the partners in the practice soon (casually over lunch, not an interview) - what questions are pertinent to ask?

Some things I’m thinking about:
- workflow (how frequent are phone calls, disruptions, etc…)
- procedure expectations
- expected to read mammo? (I don’t think this group does)
- will workload or expectations change after making partner? If so, how?
- what is call like? Do we work nights?
- more specifics of partner buy in (how much $$ / how long)
- benefits (retirement accounts, insurance, etc)
- are expectations more relaxed during my first year as an “attending” as far as speed is concerned?
- is there anyone I can turn to with complicated questions (not sure if a mentor is a thing for newcomers?)
- What’s your practice adjusted collection percentage and how does the group score on MACRA (although these questions may be better for a real interview)

Thanks for the answers!

Pass. This will be burnout city.

 

[Womb Raider]

Is this RVU or wRVU? My group does similar numbers in RVU, but wRVU it is more like 70 per day. You’ll need to know the mix of studies. Mammo is relatively weighted high for time spent so if you’re not doing mammo, I hope you have a lot of negative head cts. Doing these numbers in plain films only would be nearly impossible. Not sure what “conversation over lunch” is other than an interview. Even if you don’t wear a suit, treat this like an interview. Figure out number of shifts required. This is the only way to compare jobs/offers. Nights/weekends should come at a premium (pay or time off).

Generally, if you are right out of training there is a several month grace period to get up to speed. If they expect you to crank immediately on day 1 that is a red flag. Most groups do not have formal mentorship programs, but generally as long as you aren’t alone, you can just call a coworker to discuss a case. If they say “never call any of us about cases” that is a red flag. MIPS/MACRA is kind of in the weeds. As long as they know what it is and they are doing it, I’m not sure what else I’d want to know in this regard.

Buy in is a touchy subject. I would not even look at groups with buy ins at this point in my career. There’s just too many ways to get screwed.

This is a job seekers market right now. The ball is in your court. Don’t be afraid to let them know you will walk and don’t forget to negotiate if you want something they haven’t offered.

Not sure about wRVU vs RVU. I’ll figure this out. Really appreciate the insight.

 

[Womb Raider]

90 RVU's a day is a very high weekday number for any non-mammo speciality. That's gotta be greater than 90th percentile daily productivity and depending on how much leave you get, probably gonna be >90-95th %tile annual productivity. I think i've gone over 90 RVU's on a regular day shift less than handful of times in 3 years in my PP job, and I read all sub-spec neuro.

I think your question list is pretty reasonable.... those are pretty basic, big pictures questions you'll need answers to.... but a lot of them are kinda "residency program director giving an orientation PPT to start the interview day"-ish. If your first interaction with the group is a casual lunch, I'd just focus on getting to know them and seeing if YOU would want to work with them. You'll get most of those questions answered in due time.

Questions I personally might ask in a more informal setting/information i'd want to know:
- Does the workload match the staffing? is the daily 90 RVU because the partners want to make X amount of money or is it 90 RVU because they're 10 FTE short.
- Is the group growing (i.e. acquiring new contracts), stable or shrinking (e.g. losing contracts)? Is there a lot of competition in the marketplace?
- What's the makeup of the group? are there a lot of juniors in the group or is it mid-career/senior heavy.
- Is it assigned worklists or reading down a shared list? Is easy for people to run cases with each other? Are there a bunch of cherry-pickers?
- Has anyone left or been fired in the last few years... and why.
- (for the junior associates and partners) - was the job sold to you the one you stepped into? I.e. were there a lot of surprises and if so were they good or bad.
- stupid question...but do people interact outside of work? is it a friendly environment or just a clock-in/clock-out job.
- what is the case-mix like? Community hospital negative 20y/o headache brain MRI's or County hospital GSWs to the head.
- How subspecialized/general is the group? Mammo/IR considerations are obvious but would a non-MSK person have to read any MSK MRI/CT? Everything? Just large joints? etc?

*Edit big difference between 90RVU and 90wRVU as 2brads mentioned. 90 wRVU's per day is a ton for non-mammo specialties.

These are fantastic questions that I didn’t think about. Thanks!

You always hear the recommendation to try and find someone that recently left the practice and contact them to get the “real scoop” - but I can’t imagine groups just offering up contact info to someone that left in bad terms. I’ll have to work on that.

 

[maxxor]

These are fantastic questions that I didn’t think about. Thanks!

You always hear the recommendation to try and find someone that recently left the practice and contact them to get the “real scoop” - but I can’t imagine groups just offering up contact info to someone that left in bad terms. I’ll have to work on that.

Archive.org

Check the practice website and look for who is now gone.

Then find their new place. Learned this trick too late.

 

[Radology]

90 rvu is too much

I’ve hit that number on extremely busy call days, and it is too much to read safely in a weekend day without interruptions, let alone day in and day out combined with regular distractions

Look elsewhere

 

[deleted941485]

90 rvu is too much

I’ve hit that number on extremely busy call days, and it is too much to read safely in a weekend day without interruptions, let alone day in and day out combined with regular distractions

Look elsewhere

region and payor dependent but what would be the conv factor on something like that?

 

[jazzman84]

I read almost entirely MSK and spine, usually 200-250 studies per day (40ish MRI, 3-5 US, rest XR), and average about 75-80 wRVU in a 9 hour weekday shift.

90 is a crapload if you aren’t burning through mammo and negative neuro MRI. If there are procedures, forget about it.

 

[2brads]

I read almost entirely MSK and spine, usually 200-250 studies per day (40ish MRI, 3-5 US, rest XR), and average about 75-80 wRVU in a 9 hour weekday shift.

90 is a crapload if you aren’t burning through mammo and negative neuro MRI. If there are procedures, forget about it.

Yeah. It depends on case mix. If you do mainly xr, 90 RVU is a death sentence. If you have a good mix of US/ct/mammo/mri, it’s definitely doable. We read about 90 RVU per shift and our total case load is about 120-130. It is sometimes busy but also sometimes I can watch YouTube, so it’s not like I go home and sit in a corner with my thumb in my mouth.

Case complexity is also a factor. If you’re a level I trauma center and tertiary cancer center and do high level neurosurgery, your case complexity and time per case is going to be a lot different than a guy in a level III trauma center reading negative head cts and appys (I’m in the latter).

 

[maxxor]

Yeah. It depends on case mix. If you do mainly xr, 90 RVU is a death sentence. If you have a good mix of US/ct/mammo/mri, it’s definitely doable. We read about 90 RVU per shift and our total case load is about 120-130. It is sometimes busy but also sometimes I can watch YouTube, so it’s not like I go home and sit in a corner with my thumb in my mouth.

Case complexity is also a factor. If you’re a level I trauma center and tertiary cancer center and do high level neurosurgery, your case complexity and time per case is going to be a lot different than a guy in a level III trauma center reading negative head cts and appys (I’m in the latter).

I was at a tertiary community referral place with an extremely high CMS case mix index. Doing 80 wRVU was exhausting on call. My MSK days I'd read 55 MRs and do a few arthrograms which was around 80 wRVU. Those were full days too, starting to read at 7 and often finishing later. It wasn't just me either; all the partners had those hours to get the work done. Some of them would "pre-read" the night before anything that was still on the list. Difference between me and them was they worked a lot fewer days so they didn't hate it as much; I had 4 years of substantially different work expectations before I'd get to their level.

 

[Radology]

90 rvu is about 60-65 chest and abdomen/pelvis cts, assuming an approximately 50-50 split

If pure x ray, that’s about 400 x rays

That’s an absurd amount of work to do on an average day (average meaning half the time you’re exceeding these numbers). Hope the malpractice insurance is good

 

[2brads]

You guys realize that 1 mammo plus tomo is worth about 1 CTAP w/ con, right?

 

[Rad2013]

How many hours long are the shifts? 90wRVU in 8 hours is way worse than 90wRVU in 10 hours.

 

[Radology]

How many hours long are the shifts? 90wRVU in 8 hours is way worse than 90wRVU in 10 hours.

I would strongly advise anyone to avoid a job with 10 hour work days regardless of volume, unless we’re talking second shift and night hawk in which case this is a whole different story

 

[maxxor]

You guys realize that 1 mammo plus tomo is worth about 1 CTAP w/ con, right?

This is easily verifiable. Values from my MAC's CPT lookup form for 2022.

Mammo screening CPT 77067 RVU 1.08 (wRVU 0.76)
Screening Tomo CPT 77063 RVU 0.86 (wRVU 0.60)

1 screen mammo + tomo RVU 1.94 (wRVU 1.36)

CT Chest W CPT 71260 RVU 1.63 (wRVU 1.16)
CT AbdPel W CPT 74177 RVU 2.57 (wRVU 1.82)

CT CAP W RVU 4.2 (wRVU 2.98)

A rough rule of thumb is that wRVU is about 70% of RVU. I do think it's ridiculous that wRVU even exists; it's not like we don't generate the value for the "overhead" of Practice Expense and Malpractice Expense.

No argument from me that mammo racks up the RVUs in screening. But unless you're doing considerable amounts of mammo, 90 wRVU is a lot.

 

[2brads]

This is easily verifiable. Values from my MAC's CPT lookup form for 2022.

Mammo screening CPT 77067 RVU 1.08 (wRVU 0.76)
Screening Tomo CPT 77063 RVU 0.86 (wRVU 0.60)

1 screen mammo + tomo RVU 1.94 (wRVU 1.36)

CT Chest W CPT 71260 RVU 1.63 (wRVU 1.16)
CT AbdPel W CPT 74177 RVU 2.57 (wRVU 1.82)

CT CAP W RVU 4.2 (wRVU 2.98)

A rough rule of thumb is that wRVU is about 70% of RVU. I do think it's ridiculous that wRVU even exists; it's not like we don't generate the value for the "overhead" of Practice Expense and Malpractice Expense.

No argument from me that mammo racks up the RVUs in screening. But unless you're doing considerable amounts of mammo, 90 wRVU is a lot.

Agreed. Our billing co only generates RVU values so my 90 RVU translates to a little less than 70 wRVU as I stated above. I wouldn’t do 90 wRVU. OP needs to clarify and get an idea of case mix.

 

[qxrt]

I am going to do some math here using some assumptions, since I don't know your whole practice situation. Assuming that the group you are joining really averages 90 RVU/shift (let's assume they are talking true RVU and convert that to 70 wRVU/shift), let's say that you have 10 weeks of vacation/year (most private practices have around 8-10 weeks vacation). That would mean you are working 42 weeks x 5 days/week, or 210 shifts. That's not including weekend call shifts (again assuming that you are not in one of those outpatient-only no-weekend call gigs). Let's say you work q5 weekend shifts, which would mean another 10 weekends x 2 days/weekend, or 20 shifts.

That adds up to around 230 shifts/year, which, assuming an average of 70 wRVU/shift, equals 16,100 wRVUs/year. If I recall correctly, MGMA data put 15,000 RVU or wRVU (I don't remember which) at the 90th percentile of radiologist productivity.

That means that the vast majority of radiologists are not reading anywhere near the number of cases your group is expected to read.

And that is using a whole bunch of assumptions that give you the benefit of the doubt. If you are not getting paid in the 90th percentile of radiologist salary at that volume, then you are getting ripped off.

 

[maxxor]

I am going to do some math here using some assumptions, since I don't know your whole practice situation. Assuming that the group you are joining really averages 90 RVU/shift (let's assume they are talking true RVU and convert that to 70 wRVU/shift), let's say that you have 10 weeks of vacation/year (most private practices have around 8-10 weeks vacation). That would mean you are working 42 weeks x 5 days/week, or 210 shifts. That's not including weekend call shifts (again assuming that you are not in one of those outpatient-only no-weekend call gigs). Let's say you work q5 weekend shifts, which would mean another 10 weekends x 2 days/weekend, or 20 shifts.

That adds up to around 230 shifts/year, which, assuming an average of 70 wRVU/shift, equals 16,100 wRVUs/year. If I recall correctly, MGMA data put 15,000 RVU or wRVU (I don't remember which) at the 90th percentile of radiologist productivity.

That means that the vast majority of radiologists are not reading anywhere near the number of cases your group is expected to read.

And that is using a whole bunch of assumptions that give you the benefit of the doubt. If you are not getting paid in the 90th percentile of radiologist salary at that volume, then you are getting ripped off.

To add some more context:

Median private practice is 10,000 wrvu I believe.

50th percentile for academics is 8000.

I was in a practice that had those expectations and personally did 14000 wrvu in 11 months. The partners were absolutely making > 90th percentile, but it was a constant churn and burn associate machine. 14 people started and left in the 8 years prior and only 2 had made partner. That’s where I figured out that archive.org trick. Of course they lied when I asked about people who had left, and naively I believed them.

 

[CyrusHabs7695]

Question Ive always wondered about negotiating an attending contract. Say youre negotiating a contract for a private practice and they offer you idk, $350k with 10 weeks vacation. Is it possible or a common thing to cut your vacation time for a higher salary? Could you say I'll take 5 weeks vacation for $425k or something like that? Just using random numbers for example sake

 

[2brads]

Question Ive always wondered about negotiating an attending contract. Say youre negotiating a contract for a private practice and they offer you idk, $350k with 10 weeks vacation. Is it possible or a common thing to cut your vacation time for a higher salary? Could you say I'll take 5 weeks vacation for $425k or something like that? Just using random numbers for example sake

It depends on the practice but generally, yes. For our practice it would only work in one direction though (i.e. request to work more, not less).

 

[maxxor]

It depends on the practice but generally, yes. For our practice it would only work in one direction though (i.e. request to work more, not less).

Or you can “sell” the vacation by taking extra shifts.

 

[2brads]

Or you can “sell” the vacation by taking extra shifts.

Yeah. Same thing.

 

[CyrusHabs7695]

It depends on the practice but generally, yes. For our practice it would only work in one direction though (i.e. request to work more, not less).

Im sure its super practice dependent, but in yours for example, how much movement is there? Like trading a couple weeks away gets you how much more? Sorry if stupid question, nowhere else to really find out about this stuff

 

[2brads]

$2000-$2500 per shift.

 

[2brads]

Our shifts are 8am-5pm. But again, highly variable.

 

[maxxor]

Our shifts are 8am-5pm. But again, highly variable.

Previously was in a place that was 7-5:30 daytime. The evening shifts were 4pm-12am or 6-2 am, and overnight was 12-7am.

 

[RadJon]

90 rvus a day would be ridiculous. That's insane.

 

[GadRads]

Agreed. Our billing co only generates RVU values so my 90 RVU translates to a little less than 70 wRVU as I stated above. I wouldn’t do 90 wRVU. OP needs to clarify and get an idea of case mix.

Isn't the true private practice daily wrvu presumably around 70? 90 is definitely a lot but may not be that far off for the practice depending on length of work day. That's an additional 10 CT AP w contrast which can be read in 60-90 mins depending on complexity and reading speed. I have read around 85 wrvu but it was a very busy day. Definitely would cause burn out in the longterm.

 

[Rad2013]

90 wRVU is meaningless without additional details

How long is the day?
Are these ER or outpatient?
What is the modality make up?

90 wRVU could be crushing or not too bad.

 

[Womb Raider]

90 wRVU is meaningless without additional details

How long is the day?
Are these ER or outpatient?
What is the modality make up?

90 wRVU could be crushing or not too bad.

After further talks the neuro guys read 100-110 RVU on average per day (8-5) with 50% general 50% neuro. Combination of ER and outpatient.

 

[Cognovi]

After further talks the neuro guys read 100-110 on average per day (8-5) with 50% general 50% neuro. Combination of ER and outpatient.

That amounts to reading each neuro study in 6-7 minutes, which is doable if the vast majority are normal, simple, or you don't care about the quality of your report. If you're reading posttreatment skull base cancer cases then good f'ing luck.

 

[Tiger100]

Current DR resident. Group I’m interested in after training averages 90 RVUs a day. Sounds like a ton… How doable is this? Can any veterans give any insight to how a practice like this usually works? Burnout likely?

Will be talking with a few of the partners in the practice soon (casually over lunch, not an interview) - what questions are pertinent to ask?

Some things I’m thinking about:
- workflow (how frequent are phone calls, disruptions, etc…)
- procedure expectations
- expected to read mammo? (I don’t think this group does)
- will workload or expectations change after making partner? If so, how?
- what is call like? Do we work nights?
- more specifics of partner buy in (how much $$ / how long)
- benefits (retirement accounts, insurance, etc)
- are expectations more relaxed during my first year as an “attending” as far as speed is concerned?
- is there anyone I can turn to with complicated questions (not sure if a mentor is a thing for newcomers?)
- What’s your practice adjusted collection percentage and how does the group score on MACRA (although these questions may be better for a real interview)

Thanks for the answers!

Let me give you a perspective.

In a radiology group, some studies are low RVU and some are high. If a group gives you the capability to read 100 RVUs, usually there is someone else who may read 40 RVUs and then there is a redistribution of RVUs.

In other words, there is no way that in a radiology group someone consistently reads Xrays, does fluoro, does IR and reads outpatient cancer follow-ups and even gets close to that number. A 100% outpatient Neuro reader or an ER reader can generate twice as much as the person who does barium work, reads PET scans or portable chest Xrays.

The group needs to provide all services in order to survive. In most groups, all partners get paid equal.

 

[shadowlightfox]

Generally, if you are right out of training there is a several month grace period to get up to speed.

Is it okay to ask this in an interview or is this one of those questions you should ask anyone else but the interviewer? Maybe it's just me, but I feel like asking this question sounds like you're putting them on the spot, especially if they are guilty of making you crank from day 1.

 

[guytakingboards]

Is it okay to ask this in an interview or is this one of those questions you should ask anyone else but the interviewer? Maybe it's just me, but I feel like asking this question sounds like you're putting them on the spot, especially if they are guilty of making you crank from day 1.

Feel like that's generally understood but maybe ask an associate in workup if you don't feel comfortable asking your interviewer.

It's usually neither possible nor desirable from a newbie fresh out of training to come out guns blazing unless they have significant prior moonlighting experience.

It's not good for the newbie rad nor the group if the newbie is rushing through studies, throwing out crap reads and/or missing things. Both groups I've been in made it clear they had reduced and/or no expectations for new hires in the early months. It takes time to get comfortable with the PACS/EMR/clinical sites/etc.

 

[recycledpaper]

What is the purpose of wRVU when you already have RVU as a metric of productivity?

 

[maxxor]

What is the purpose of wRVU when you already have RVU as a metric of productivity?

Pithy: It’s another way for the people with money to cut your pay.

Actual:
All rvus have 3 components: work, practice expense, malpractice.

People who control the money like to say to employed physicians that they are only entitled to the “work component” of the rvu and that the employer gets to keep the rest.

As a rough rule of thumb, wRVU = 0.6 * RVU

 

[recycledpaper]

So for non-employed physicians who work in a traditional private practice model, how does that work out? Are we paid based on RVU and then we chip in accordingly for practice and malpractice expenses? And when does $/RVU factor in for our pay? I see different $ amounts - sounds like another way for people to make money off our work?

 

[GadRads]

Is it okay to ask this in an interview or is this one of those questions you should ask anyone else but the interviewer? Maybe it's just me, but I feel like asking this question sounds like you're putting them on the spot, especially if they are guilty of making you crank from day 1.

I was slower than I was as a resident/fellow my first few 2 months due to being uncomfortable with the PACS. It took me 10 mins to read my first chest X-ray, which I would have read in 1 min. Same with CT and MRI. All the window keys were different from what I was used to as a resident. Even an experienced new attending hire took a while to get comfortable with our PACS and system. Expecting top productivity from day 1 is unrealistic and not safe.

 

[recycledpaper]

As a resident, you can be "fast" since you have someone over-reading you. It's different when you're the final word. I imagine that plays a role in being slow right out of fellowship unless you were final signing studies as a moonlighter. That sounds like a good way to bridge to your first real job.

 

[Tiger100]

So for non-employed physicians who work in a traditional private practice model, how does that work out? Are we paid based on RVU and then we chip in accordingly for practice and malpractice expenses? And when does $/RVU factor in for our pay? I see different $ amounts - sounds like another way for people to make money off our work?

Most rads in a traditional private practice get paid the same. In many practices, the workflow is kind of similar but people make different RVUs. For example, the IR rotation may generate a lot less RVU compared to Neuro but both are get paid the same per day of work.

The whole practice generates revenue by RVU.

 

[guytakingboards]

As a resident, you can be "fast" since you have someone over-reading you. It's different when you're the final word. I imagine that plays a role in being slow right out of fellowship unless you were final signing studies as a moonlighter. That sounds like a good way to bridge to your first real job.

That's certainly part of the transition to practice from trainee to attending. Everyone goes through that at some point.

Something I took for granted when changing jobs was how the group sets you up to be efficient.

My first job out of training had a single PACS, excellent templates (that autopopulated upon opening a study), functional but not great hanging protocols. It had very minimal interruptions and little user input into the report other than the findings/impression.

My current job has multiple different PACS, no default templates, no default hanging protocols and several times you have to manually input the histories. Opening a study loads a blank report in PS360. I'd have to find a template, find a usable hanging protocol and often manually enter the history. On every single study sometimes. Just wildly inefficent. Despite being a seasoned attending it took months to become semi-efficient in my current job and it's no where near what my old job was like.

 

[guytakingboards]

So for non-employed physicians who work in a traditional private practice model, how does that work out? Are we paid based on RVU and then we chip in accordingly for practice and malpractice expenses? And when does $/RVU factor in for our pay? I see different $ amounts - sounds like another way for people to make money off our work?

The group is paid by the RVU as Tiger100 said. Expenses are subtracted from the total revenue and the remainder is split amongst the partners/stakeholders as profit.

Despite the intention of $/RVU to be a one size fits all metric, I've found there to be a lot of grey area in the way it's talked about.

My old PP group talked about $/RVU from the individual/take-home level. This number was the weighted average value of a RVU that each partner saw in their paycheck. So if they reported that the take-home $/RVU number was $42/RVU, their contracts were probably higher in the 50-60/RVU range and then expenses were deducted.

My current group talks about $/RVU on the contract level. XYZ hospital's contract is worth $55/RVU. This is pre-expenses. Post-expenses the $/RVU to the rad is lower. (this was a source of disappointment for me after joining the group).

In either case, that $/RVU is an average across all RVU's and partners in the group. As Tiger100 mentioned, some (e.g. IR) will be lower and some (e.g. DR like mammo/neuro) will be higher. If your group average is 12k RVU per year and you're a mammo rad cranking 20 RVU's per year, your individual $/RVU number will be significantly lower than your group's reported average. Vice versa if you're IR.

Theoretically $/RVU for a pure pay-per-click gig should be the most honest number.

 

[Neopolymath]

That's certainly part of the transition to practice from trainee to attending. Everyone goes through that at some point.

Something I took for granted when changing jobs was how the group sets you up to be efficient.

My first job out of training had a single PACS, excellent templates (that autopopulated upon opening a study), functional but not great hanging protocols. It had very minimal interruptions and little user input into the report other than the findings/impression.

My current job has multiple different PACS, no default templates, no default hanging protocols and several times you have to manually input the histories. Opening a study loads a blank report in PS360. I'd have to find a template, find a usable hanging protocol and often manually enter the history. On every single study sometimes. Just wildly inefficent. Despite being a seasoned attending it took months to become semi-efficient in my current job and it's no where near what my old job was like.

This hurt me to read. What an inefficient mess. I don't expect many things to improve post residency but I certainly don't expecy many things to be worse.

 

[maxxor]

That's certainly part of the transition to practice from trainee to attending. Everyone goes through that at some point.

Something I took for granted when changing jobs was how the group sets you up to be efficient.

My first job out of training had a single PACS, excellent templates (that autopopulated upon opening a study), functional but not great hanging protocols. It had very minimal interruptions and little user input into the report other than the findings/impression.

My current job has multiple different PACS, no default templates, no default hanging protocols and several times you have to manually input the histories. Opening a study loads a blank report in PS360. I'd have to find a template, find a usable hanging protocol and often manually enter the history. On every single study sometimes. Just wildly inefficent. Despite being a seasoned attending it took months to become semi-efficient in my current job and it's no where near what my old job was like.

I left a practice (for many reasons), but one insane one was they used the last digit of the accession number as a way to assign work.

Eg. MSK reads body accessions ending in 0, 1, or 2

It was insanely inefficient.

The PACS had serviceable worklist functionality. They refused to create them because “this is how we always have done it”