Compensation Models

[Ty Row]

It would be great to discuss people's recommendations about productivity based salary. What is a fair metric (or even a very generous one!) that could be negotiated outside of the standard fixed salary + anemic bonus model of many academic departments? I am about to negotiate with an academic center that is in an 'undesirable' location. The RadOnc department recently had a faculty exodus and is now eager to reshuffle and bring new people aboard. The cancer center just recruited a new director with a fantastic national reputation, and they are clearly rebuilding from prior faltered leadership. As a new faculty, I fortunately have the opportunity to select from several treatment sites to take over, including CNS/gamma knife and thoracic which I really enjoy. (Not sure if treatment site/modality is relevant to the compensation model, but this could imply a case load weighted towards brain SRS and lung SBRT.) I always get along very well with colleagues/referrals/patients and anticipate a solid patient base. Though not a business person, my gut feeling is that a productivity model would be advantageous in what is now a very small department. I probably would be unhappy with a largely fixed salary in this non-cush environment where a large percentage of the extra load falls on my shoulders. The downside is that my salary could be low to start, but at least that would correspond to a lower workload in the beginning. Also, because of the current small size of the RadOnc group, do you think any administrative roles within the department or greater cancer center would be to my advantage or could leverage my salary? Just trying to think outside the box...

Would love to hear some words of wisdom! Your advice is greatly appreciated.

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[medgator]

Why not just get into a professional services agreement where you bill professionally and the center bills the technical? Or work out some percentage of the global? This is more akin to what happens in the private world, but if the center is really hurting for productive faculty that will make the program busy, that might be the way to really incentivize them.

 

[Gfunk6]

The challenge in academic satellites is that you are beholden to the policies of the mothership and that starts with the Chair. Some departments are enlightened and recognize the distinction betweeen academic faculty and community faculty. IMO, straight salary is not a viable model for a community center - it will absolutely not incentivize hard work.

I’ve seen several methods to supplement base salary:

1. Medical Director stipend
2. Productivity based on RVUs or ADTs
3. If you globally generate greater than a certain amount, you can keep a percentage over that amount

 

[seper]

IMO, productivity-based incentives for employed RadOnc's increase overutilization at the expense of patients' well being. It is prudent to include some other forms of incentivization (patient satisfaction by surveys, lack of reportable events, etc).

 

[domestique]

Ty Row, I sent you a direct message.

 

[Ty Row]

Why not just get into a professional services agreement where you bill professionally and the center bills the technical? Or work out some percentage of the global? This is more akin to what happens in the private world, but if the center is really hurting for productive faculty that will make the program busy, that might be the way to really incentivize them.

Thanks for the reply - these are solid models. Can you comment more on what would be a good deal within a productivity model? For example, if I try to negotiate for globals, what percentage do you think I should ask for?

 

[Ty Row]

The challenge in academic satellites is that you are beholden to the policies of the mothership and that starts with the Chair. Some departments are enlightened and recognize the distinction betweeen academic faculty and community faculty. IMO, straight salary is not a viable model for a community center - it will absolutely not incentivize hard work.

I’ve seen several methods to supplement base salary:

1. Medical Director stipend
2. Productivity based on RVUs or ADTs
3. If you globally generate greater than a certain amount, you can keep a percentage over that amount

Thank you. If you were taking an RVU based approach, what kind of agreement would be favorable? At this time, they currently have a medical director, but I will keep that in mind.

 

[medgator]

IMO, productivity-based incentives for employed RadOnc's increase overutilization at the expense of patients' well being. It is prudent to include some other forms of incentivization (patient satisfaction by surveys, lack of reportable events, etc).

I think physician ethics play a much larger role there, and I don't see how using a criteria like lack of reportable events will

1. Decrease a desire to overutilize

Or

2. Reflect physician, rather than team, responsibility

 

[seper]

I'm yet to work with a group where ethics was a sufficient barrier, unfortunately. And agree, in most misdministrations physicians are not at fault.

I think physician ethics play a much larger role there, and I don't see how using a criteria like lack of reportable events will

1. Decrease a desire to overutilize

Or

2. Reflect physician, rather than team, responsibility

 

[Gfunk6]

Thank you. If you were taking an RVU based approach, what kind of agreement would be favorable? At this time, they currently have a medical director, but I will keep that in mind.

You would probably need data on what constitutes baseline or median RVUs for a busy Rad Onc where you practice. Generally it is around 8,000 - 9,000 or so. Then you need to to create a tier of RVUs beyond that with fiscal rewards as you hit them.

 

[Neuronix]

How many $ per RVU are you guys finding out there?

Asking for a friend who is in the 8000-9000 professional wRVUs range in "academics".

 

[Doctorer]

You would probably need data on what constitutes baseline or median RVUs for a busy Rad Onc where you practice. Generally it is around 8,000 - 9,000 or so. Then you need to to create a tier of RVUs beyond that with fiscal rewards as you hit them.

8-9k is average for...PP?

Oh man.

 

[kristofer]

How many $ per RVU are you guys finding out there?

Asking for a friend who is in the 8000-9000 professional wRVUs range in "academics".

In reference to "$ per RVU", do you mean work RVU or total RVU? When practices advertise a strictly production-based compensation model of dollars/RVU, do they typically mean wRVU or tRVU?

8000-9000 wRVU with a 4-day week or 5-day week?

 

[Mandelin Rain]

How many $ per RVU are you guys finding out there?

Asking for a friend who is in the 8000-9000 professional wRVUs range in "academics".

Several years ago now, but lowest I saw was $45 and highest was $63. Heard of people getting above that and if I were interested in these jobs, I'm sure I could have negotiated higher as they were initial offers only.

 

[Mandelin Rain]

In reference to "$ per RVU", do you mean work RVU or total RVU? When practices advertise a strictly production-based compensation model of dollars/RVU, do they typically mean wRVU or tRVU?

This is something to clarify and have explicitly laid out in writing with each offer.

 

[Gfunk6]

We get $38.82 in the Bay Area. This is strictly wRVUs. The range in our practice is from part-time (6.5k) to busy full time (12.5k).

We own all machines so we bill and collect globally.

 

[medgator]

We get $38.82 in the Bay Area. This is strictly wRVUs. The range in our practice is from part-time (6.5k) to busy full time (12.5k).

We own all machines so we bill and collect globally.

Interesting...so ownership of the machines is by the entire multi-specialty group and RO is paid on an RVU model?

 

[Gfunk6]

Interesting...so ownership of the machines is by the entire multi-specialty group and RO is paid on an RVU model?

We have a complex compensation model which includes base salary + appropriate surrogates to assess productivity, profitability and “citizenship.”

wRVUs is one part of this calculus.

 

[LostResident1]

Can someone help me evaluate an offer? Hospital employee
~$550K guarantee for 2 years (I think I could ask for more) + some signing bonus + some sort of RVU incentive built in if I exceed a threshold (not sure what the # is yet)
RVU based after year 2. They cite MGMA median $62/RVU and 75th is $79/RVU but they want to be in the mid $50s/RVU because the MGMA data is skewed according to them as it incorporates other compensation/benefits.

 

[deleted18755]

Can someone help me evaluate an offer? Hospital employee
~$550K guarantee for 2 years (I think I could ask for more) + some signing bonus + some sort of RVU incentive built in if I exceed a threshold (not sure what the # is yet)
RVU based after year 2. They cite MGMA median $62/RVU and 75th is $79/RVU but they want to be in the mid $50s/RVU because the MGMA data is skewed according to them as it incorporates other compensation/benefits.

Is this a starting salary for a new resident? It’s so high it’s making me nervous that something is very fishy.

$55/RVU (I assume wRVU) is very reasonable but you should obviously figure out what the threshold is (but for $550,000 a year salary I couldn’t care less about bonus!!!). Most importantly: what happens after two years!?!

 

[xrthopeful]

i smell fish

 

[Bequerel]

Can someone help me evaluate an offer? Hospital employee
~$550K guarantee for 2 years (I think I could ask for more) + some signing bonus + some sort of RVU incentive built in if I exceed a threshold (not sure what the # is yet)
RVU based after year 2. They cite MGMA median $62/RVU and 75th is $79/RVU but they want to be in the mid $50s/RVU because the MGMA data is skewed according to them as it incorporates other compensation/benefits.

I saw multiple offers like this out of residency and still see offers like this. The place is likely in an undesireable location and it’s likely a solo practice. This is the going starting rate for a solo hospital based position that is hard to fill in undesireable locations. Administrators don’t differentiate between new grads or old grads..they just use the median mgma or other survey figures. Usually start at the median/mean values and negotiate up to 75th percentile if desperate enough. Your offer is fair as long as you can expect up have 10k rvu per year. 10k rvu’s is pretty easy to obtain in an average busy solo practice. You could probably negotiate starting salary up to 600kish and make sure your production bonus potential is NOT capped. You could also easily negotiate up your rvu rate to $60+. Lastly, and perhaps most importantly, if this is a solo position, find out how you will take vacations and study for boards. Sometimes it’s hard to find locums if you live in the middle of no where. Also, ask yourself if you’re ready for a solo practice straight out of residency. Good luck!

 

[Irradi8or]

Can someone help me evaluate an offer? Hospital employee
~$550K guarantee for 2 years (I think I could ask for more) + some signing bonus + some sort of RVU incentive built in if I exceed a threshold (not sure what the # is yet)
RVU based after year 2. They cite MGMA median $62/RVU and 75th is $79/RVU but they want to be in the mid $50s/RVU because the MGMA data is skewed according to them as it incorporates other compensation/benefits.

I think I've seen these numbers before. The trouble I've seen is doing well in the after 2 year pure RVU model. Jobs with a substantial amount of vacation coverage/internal locums, or a slower satellite site, can be challenging to do well in a solely RVU model. However, you definitely have more information about this one that we do.

 

[LostResident1]

Bequerel is correct it is an undesirable location and also correct in that it is solo provider with 1 linac. Vacation to be provided via locums (atleast they say). I agree with you, my gut tells me I have room to negotiate the salary and $/RVU. Does anyone have any estimates on how # of patients on treatment translates into RVUs?

 

[Bequerel]

Bequerel is correct it is an undesirable location and also correct in that it is solo provider with 1 linac. Vacation to be provided via locums (atleast they say). I agree with you, my gut tells me I have room to negotiate the salary and $/RVU. Does anyone have any estimates on how # of patients on treatment translates into RVUs?

It really depends on type of treatments..3dcrt vs imrt vs sbrt vs srs. To be safe, if you averaged 20 treatments on beam I would say you rvu’s would be at least 9k for the year, potentially more if more imrt, sbrt and srs.

 

[Haybrant]

Bequerel is correct it is an undesirable location and also correct in that it is solo provider with 1 linac. Vacation to be provided via locums (atleast they say). I agree with you, my gut tells me I have room to negotiate the salary and $/RVU. Does anyone have any estimates on how # of patients on treatment translates into RVUs?

Careful, not easy to find locums as they’ll make you think

 

[KHE88]

Is this a starting salary for a new resident? It’s so high it’s making me nervous that something is very fishy.

$55/RVU (I assume wRVU) is very reasonable but you should obviously figure out what the threshold is (but for $550,000 a year salary I couldn’t care less about bonus!!!). Most importantly: what happens after two years!?!

The salary number is normal, and should be expected, for a very rural hospital in the Midwest. Occasionally a bad recruiter will try to throw out a lowball number consistent with what you would get on the coast and hope a naïve or desperate candidate takes it, but will otherwise be expecting to go back and forth a few times. Throwing out that number initially is a good sign that they are serious about retaining you.

Lots of doom and gloom on this forum about job market and salaries, but most don't consider jobs like this. Yeah, they exist, but most of the rad onc labor pool wouldn't consider them for any price.

Can someone help me evaluate an offer? Hospital employee
~$550K guarantee for 2 years (I think I could ask for more) + some signing bonus + some sort of RVU incentive built in if I exceed a threshold (not sure what the # is yet)
RVU based after year 2. They cite MGMA median $62/RVU and 75th is $79/RVU but they want to be in the mid $50s/RVU because the MGMA data is skewed according to them as it incorporates other compensation/benefits.

Unless they are expecting you to be treating 40 patients at a time alone (which is nuts right out of residency), they're probably near their max they can pay you legally due to Stark law (i.e., if they paid you a 1 million dollar salary for treating 20 patients at a time and you only billed 500k, that other 500k is assumed to made up from all the ancillary stuff you order within the system - imaging, procedures, studies, labs, rehab, etc - which is illegal - even though you only made them 500k, all the other stuff you order probably made the hospital a lot more to justify a 1 million dollar salary, but they can't pay you for it). Bottom line is you probably aren't going to get them to budge much on salary. That's a solid number. What's not, and what they tend to skimp on is the RVU bonus structure. They are giving you a line about how MGMA RVU data are biased against them - they all say that. If you are actually treating so many patients that you are earning above your base salary (around 75%-tile MGMA), then your RVU bonus structure needs to start at the 75-tile for RVUs, not median (or even less in this case). Once you hit the 90% benchmark, then your RVU bonus needs to be bumped up to $70-80 range. Other things to look at are time off and locums coverage. And I would see if I could get that salary guarantee extended to 3-4 years if the volume is low currently.

For a very rural position like that, I would also be expecting a signing bonus of $75k+

 

[deleted18755]

The salary number is normal, and should be expected, for a very rural hospital in the Midwest. Occasionally a bad recruiter will try to throw out a lowball number consistent with what you would get on the coast and hope a naïve or desperate candidate takes it, but will otherwise be expecting to go back and forth a few times. Throwing out that number initially is a good sign that they are serious about retaining you.

Lots of doom and gloom on this forum about job market and salaries, but most don't consider jobs like this. Yeah, they exist, but most of the rad onc labor pool wouldn't consider them for any price.



Unless they are expecting you to be treating 40 patients at a time alone (which is nuts right out of residency), they're probably near their max they can pay you legally due to Stark law (i.e., if they paid you a 1 million dollar salary for treating 20 patients at a time and you only billed 500k, that other 500k is assumed to made up from all the ancillary stuff you order within the system - imaging, procedures, studies, labs, rehab, etc - which is illegal - even though you only made them 500k, all the other stuff you order probably made the hospital a lot more to justify a 1 million dollar salary, but they can't pay you for it). Bottom line is you probably aren't going to get them to budge much on salary. That's a solid number. What's not, and what they tend to skimp on is the RVU bonus structure. They are giving you a line about how MGMA RVU data are biased against them - they all say that. If you are actually treating so many patients that you are earning above your base salary (around 75%-tile MGMA), then your RVU bonus structure needs to start at the 75-tile for RVUs, not median (or even less in this case). Once you hit the 90% benchmark, then your RVU bonus needs to be bumped up to $70-80 range. Other things to look at are time off and locums coverage. And I would see if I could get that salary guarantee extended to 3-4 years if the volume is low currently.

For a very rural position like that, I would also be expecting a signing bonus of $75k+

I totally agree with everything posted above.

I was being a little sarcastic in my initial post so just to be clear the salary is obviously phenomenal but I agree there is wiggle room with RVU bonus.

Here is my main question and one you should think about long and hard: do you plan on staying here for at least 5+ years? If not, it's obviously your personal choice, but rather than thinking of it as a "starter job" where you just show up and make/save a ton of money and gain experience, please do the best job you can and try to improve the department and overall patient experience as much as you can before handing it off to the next guy, who will hopefully do the same. I have known people who took difficult jobs like this and worked like crazy (with no vacation since it's tough to finds locums as others have noted) but just kind of thought of it like another 2-3 years of residency where they additionally provided a service to a community that needed their help while working and spending like a resident while making crazy amounts of money (I can't imagine how easily one could pay off student loans and have a huge chunk of change to invest so early in one's life after making that kind of salary even for just a few years while living off of $50,000/year).

If you think you will stay for 5-10+ years or could even make a career out of this place, you may have hit the absolute jackpot of medicine (all of the doom and gloom on this message board, which I will readily admit that I have at time contributed to, has nothing to do with this incredible field but rather the job prospects now and in the future, which don't apply to positions like this). There is a senior member on here who took what sounds like a similar position in an "undesirable" location with a job that went unfilled for a year or two and is living the dream right now not just because he took the job as is but because, as I understand it, he took ownership of the position. I don't know him personally but do know of many physicians (mainly IMG family and friends) who took jobs nobody else wanted and not only filled the position but took ownership and built lifelong careers with immense satisfaction in bringing modern medicine and providing care to patient populations with limited access (and in the process honestly made an absolute fortune, which you would too making that kind of money straight out of residency in a place where I bet you can buy a really nice home for 6 months salary!!!).

The only other thing I would add is to definitely try to increase the guarantee to 3 years or of course 4 if you could, but if I were the employer you would really have to convince me that you are serious about not just filling this position for 2-3 years but improving and expanding services more long term before I invested that kind of money in you with that kind of guarantee.

Good luck my friend and welcome to the field. No doubt this is the best field in medicine and if you enjoy or at least don't mind living in a rural/underserved area (and can tolerate the stress of solo practice and limited coverage) get ready for the immense joy of providing life changing/saving therapies to a relatively neglected patient population while quite honestly making a fortune!

PS: Everything above assumes that the ultra high salary and everything is because of the difficulty in recruiting a physician to this position and location and the stress of solo practice NOT that this hospital is shady or out to screw you over, which for all I know it could be!

 

[Dare2Dream]

PS: Everything above assumes that the ultra high salary and everything is because of the difficulty in recruiting a physician to this position and location and the stress of solo practice NOT that this hospital is shady or out to screw you over, which for all I know it could be!

If there were a position like this that was in fact "shady", in what way could a hospital screw you? Is it mainly not having any vacation coverage (zero vacation) and not having enough patients to make it feasible after the 2 years?

 

[KHE88]

If there were a position like this that was in fact "shady", in what way could a hospital screw you? Is it mainly not having any vacation coverage (zero vacation) and not having enough patients to make it feasible after the 2 years?

True rural jobs that are desperate should give you a high guaranteed salary ($550k+) indefinitely. If they push you to a production based model then you could end up screwed when your volume isn't there. More likely they will try to keep you around with the salary guarantee and do everything they can to prevent you from re-negotiating every year. In that situation, they know you have them and can play stick-em-up everytime your contract is done, so it's important to make sure you have a contract that expires at 2 years, ideally every year so that you can re-negotiate frequently.

 

[medgator]

True rural jobs that are desperate should give you a high guaranteed salary ($550k+) indefinitely. If they push you to a production based model then you could end up screwed when your volume isn't there. More likely they will try to keep you around with the salary guarantee and do everything they can to prevent you from re-negotiating every year. In that situation, they know you have them and can play stick-em-up everytime your contract is done, so it's important to make sure you have a contract that expires at 2 years, ideally every year so that you can re-negotiate frequently.

I've always wondered whether that kind of arrangement is more lucrative than simply billing professional fees while the hospital collects technical revenue.

My guess is that it is if the patient volume is on the low side

 

[BobbyHeenan]

I've always wondered whether that kind of arrangement is more lucrative than simply billing professional fees while the hospital collects technical revenue.

My guess is that it is if the patient volume is on the low side

Yup - all depends on volume.

Best way IMO to negotiate these rural centers is to have a guaranteed bottom side with bonus for production. You can do it as salary plus RVU bonus or just bill and collect your professional fees then have the center "fill in" quarters where your collections are below your downside guarantee.

In rural places your volume can plummet on a whim - there may be only one surgeon, ENT, or med onc in town....if any of them leave or whatever that can take a hit quickly. Unless the center has a very long history of good stable volume and solid referral base I would be very reluctant to take a rural job/single linac on a production only model.

 

[deleted18755]

Yup - all depends on volume.

Best way IMO to negotiate these rural centers is to have a guaranteed bottom side with bonus for production. You can do it as salary plus RVU bonus or just bill and collect your professional fees then have the center "fill in" quarters where your collections are below your downside guarantee.

In rural places your volume can plummet on a whim - there may be only one surgeon, ENT, or med onc in town....if any of them leave or whatever that can take a hit quickly. Unless the center has a very long history of good stable volume and solid referral base I would be very reluctant to take a rural job/single linac on a production only model.

In addition, a lot of smaller and especially rural hospitals are perpetually on the verge of bankruptcy, consolidation, ruthless acquisition from neighboring academic centers (there are some "affiliations" or "satellite" centers literally hundreds of miles from the mothership), etc and even those that are doing ok can quickly go downhill from a relatively simple change in any number of variables. Nobody can tell the future so it's possible that in good faith they recruit you down there and then the hospital gets bought out or whatever and you suddenly have a new employer and new compensation model or of course worst case the hospital closes. However, I've heard non-first hand stories of physicians relocating their entire family and taking a job like this and literally within 2-3 months something like this happens and it makes me suspicious that the administration must have known this was going to happen and withheld the information from the new hire.

 

[KHE88]

Can anyone give some advice Re: "eat-what-you-kill" partnerships vs. true partnerships (equal splitting of profits, either single speciality or multispecialty)? Pitfalls? Red flags? Things to look at up front in the pre-partnership associate period?

 

[Mandelin Rain]

Can anyone give some advice Re: "eat-what-you-kill" partnerships vs. true partnerships (equal splitting of profits, either single speciality or multispecialty)? Pitfalls? Red flags? Things to look at up front in the pre-partnership associate period?

What you are are describing as a "true partnership" is an ideal set up as long as the group keeps metrics to ensure work is split evenly.

Equal work, equal pay, equal vote on group business. This is how you run a stable, happy, collegial group. It's a common sense approach to the way professionals can conduct themselves, but it is not a very common arrangement.

No faster way to fall apart than let outside forces sense discord within the group.

 

[medgator]

What you are are describing as a "true partnership" is an ideal set up as long as the group keeps metrics to ensure work is split evenly.

Equal work, equal pay, equal vote on group business. This is how you run a stable, happy, collegial group. It's a common sense approach to the way professionals can conduct themselves, but it is not a very common arrangement.

I've seen situations where it is a "partnership" in the sense that you become partner after X number of years and collect your professional billings, but because there isn't a way to keep the work equally divided (referral patterns, some partners want to work less etc), it is an eat-what you-kill model.

As you said, the true partnership model requires a lot of parity in the group and its members in many aspects. And if that parity cannot be maintained, it will create a lot of anamosity and resentment in the group. So honestly IMO, eat-what-you-kill is not a bad way to go if there are significant differences between individuals within the group

 

[Mandelin Rain]

I've seen situations where it is a "partnership" in the sense that you become partner after X number of years and collect your professional billings, but because there isn't a way to keep the work equally divided (referral patterns, some partners want to work less etc), it is an eat-what you-kill model.

As you said, the true partnership model requires a lot of parity in the group and its members in many aspects. And if that parity cannot be maintained, it will create a lot of anamosity and resentment in the group. So honestly IMO, eat-what-you-kill is not a bad way to go if there are significant differences between individuals within the group

Definitely not easy. Have to have a mechanism to ensure roughly equal work i.e. within about ~10% of each other's billings (not collections). This obviously become a bit of a floating target that needs regular evaluation. But it ensures that the guy working his butt off in an under-/un-insured area is not getting way less than the guy treating breast/prostate in the affluent suburb. Or that the guy who happens to have 2 surgeons and a med onc skip town on him doesn't go destitute during the 6-12 months it takes to replace them. It also allows to the group to specialize based on interest/skill set. One person can do HDR, another prostate brachy, another Cyber/Gamma/Linac SBRT etc.... without issue.

 

[BobbyHeenan]

Definitely not easy. Have to have a mechanism to ensure roughly equal work i.e. within about ~10% of each other's billings (not collections). This obviously become a bit of a floating target that needs regular evaluation. But it ensures that the guy working his butt off in an under-/un-insured area is not getting way less than the guy treating breast/prostate in the affluent suburb. Or that the guy who happens to have 2 surgeons and a med onc skip town on him doesn't go destitute during the 6-12 months it takes to replace them. It also allows to the group to specialize based on interest/skill set. One person can do HDR, another prostate brachy, another Cyber/Gamma/Linac SBRT etc.... without issue.

It can be really hard to do. Sometimes you get one big referring doc who really prefers one rad onc in the group, or fluctuations outside of one's control (ie your rural partner having a volume swing due to a med onc leaving...or like medgator says, some partners really don't want to work 5 days/week or hustle much) make the balancing act tough. You can balance it out but that takes training the reception staff to funnel x diagnosis to x doctor and though that sounds simple it's not always that simple.

In the history of my group we have gone with all different models over the years depending upon partner satisfaction ranging from eat what you kill 100% to 50% group shared, 50% eat what you kill (based on billing - not collections) and parts in between. Your accounting firm starts getting a little testy when you start splitting the pot so many different ways too.

It's definitely a moving target and something that takes practice and patience.

Regardless of our payment model we have all always had equal voting rights on things like schedule, call, retirement plans, etc.

 

[Mandelin Rain]

Recruiting is very important in such a scenario. Can't bring in people who don't want to hustle (not always easy to tell). You also have to make sure they're comfortable earning a little more than they deserve sometimes, and a little less than they deserve at other times. Basically, you want a group of like minded people who value their independence over short term monetary considerations. When I type that, it seems easier said than done.

Also, groups, please don't beat up the new docs. See them as future partners or don't hire them. Treat them well. Pay them adequately. Let them have a voice in group business. Be transparent with the numbers. Do this, even if you weren't extended the same courtesy.

 

[radicaloncologist]

Anyone have any good resources for assessing compensation models? I've been in academic practice for a few years and am joining a Northeast (my ideal location) hospital based practice as medical director and am having difficulty finding good resources. Everyone I know is in academics so it has been almost impossible to get a good assessment of their offer.

Base: $490,000 (if I don't achieve at least 8,212 WRVU by second year of contract, they can reduce my salary by 20K)
Productivity Incentive (calculated every 6 months):
65% of MGMA for WRVUs for radiation oncology of at least 4,568 WRVUs but less than 5,126 WRVUs: $6,666.66
75% of MGMA for WRVUs for radiation oncology of at least 5,126 WRVUs but less than 6,362 WRVUs: $13,333.33
90% of MGMA for WRVUs for radiation oncology of at least 6,362 WRVUs: $20,000.00.

Sorry for stealing this thread but curious to see other peoples thoughts who are in the private practice realm.

 

[lhl]

Anyone have any good resources for assessing compensation models? I've been in academic practice for a few years and am joining a Northeast (my ideal location) hospital based practice as medical director and am having difficulty finding good resources. Everyone I know is in academics so it has been almost impossible to get a good assessment of their offer.

Base: $490,000 (if I don't achieve at least 8,212 WRVU by second year of contract, they can reduce my salary by 20K)
Productivity Incentive (calculated every 6 months):
65% of MGMA for WRVUs for radiation oncology of at least 4,568 WRVUs but less than 5,126 WRVUs: $6,666.66
75% of MGMA for WRVUs for radiation oncology of at least 5,126 WRVUs but less than 6,362 WRVUs: $13,333.33
90% of MGMA for WRVUs for radiation oncology of at least 6,362 WRVUs: $20,000.00.

Sorry for stealing this thread but curious to see other peoples thoughts who are in the private practice realm.

I would ask for a per RVU bonus after a certain threshold and negotiate the rate per RVU. What you have described is a "capped" bonus where despite significantly more effort on your part the returns for you are quite limited and the profit for the institution increases rapidly.

 

[radicaloncologist]

Thank you! I'll see if I can convince them of that. Any standard per RVU amount?

 

[BobbyHeenan]

I would ask for a per RVU bonus after a certain threshold and negotiate the rate per RVU. What you have described is a "capped" bonus where despite significantly more effort on your part the returns for you are quite limited and the profit for the institution increases rapidly.

Agree strongly with this. Capping bonus pay like that is not helping at all. If you're bringing in 90% of MGMA rvu but making ~550K, then not only are they making plenty of technical revenue money but I suspect you'd be making potentially high 5 to 6 figures less than what you would be making if billing your own professional fees too.

Depending on payer mix and a number of factors, with that salary structure if you're really at 90% RVU one year and they're paying you ~550K they're making 6 figures in extra profit by funneling off your professional fees. Obviously, in a competitive market where there is an over supply of rad oncs they may tell you take it or leave it, but in the good ole days - and arguably what is "fair," is that you should not be forgoing some of your professional fee revenue to the hospital.

I'm out of the loop on the job hunt and more contemporary negotiations, but capped RVU bonuses weren't really viewed as favorable previously. I had three prior hospital employed offers (one academic), and none of them capped bonuses. All were base pay of $X salary with an expectation after so many years my RVU would be Y per year... if you go over Y RVU then everything on top of that pays $Z/RVU which seemed fair and standard at that time.

 

[McConaughey]

For those who have a professional fee agreement, what do you get per RVU?

I’m also curious how much groups are paying per physician for billing services. Ballpark #s?


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[Neuronix]

What I was told is that $43/wRVU is 25th percentile MGMA and $50/wRVU is 50th percentile MGMA.

 

[medgator]

For those who have a professional fee agreement, what do you get per RVU?

I’m also curious how much groups are paying per physician for billing services. Ballpark #s?


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A professional services agreement? No RVUs involved, you bill professional codes like CPT OTV and plan charges

 

[BobbyHeenan]

A professional services agreement? No RVUs involved, you bill professional codes like CPT OTV and plan charges

This is how a lot of people do it.

Some places (read: rural) that have a hard time recruiting may throw in other administrative or management fees paid by the hospital to supplement your billing on top of the professional fees as well.

 

[McConaughey]

A professional services agreement? No RVUs involved, you bill professional codes like CPT OTV and plan charges

Sorry...to clarify, for what is collected in a professional fee agreement, how does that compare to an RVU model? The wRVU are known in a professional fee situation, so what’s the approximate $/wRVU?


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[Mandelin Rain]

Sorry...to clarify, for what is collected in a professional fee agreement, how does that compare to an RVU model? The wRVU are known in a professional fee situation, so what’s the approximate $/wRVU?


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In a professional fee agreement, you get all the money you earn directly through the reimbursement of the CPT codes you bill. There is no RVU system through the hospital. You do a sim? You bill it. You get the reimbursement. See an OTV? Bill it. Get the reimbursement. It's not, do a whole bunch of work billed by the hospital system, money collected by hospital system, have the hospital system tell you how many RVUs you generated, multiply out by your negotiated $/RVU conversion = salary.

 

[medgator]

In a professional fee agreement, you get all the money you earn directly through the reimbursement of the CPT codes you bill. There is no RVU system through the hospital. You do a sim? You bill it. You get the reimbursement. See an OTV? Bill it. Get the reimbursement. It's not, do a whole bunch of work billed by the hospital system, money collected by hospital system, have the hospital system tell you how many RVUs you generated, multiply out by your negotiated $/RVU conversion = salary.

I imagine the RVU system is probably less financially renumerative in most situations, unless they really need you and increase your RVU amount as a result