First Job Graduating Fellow Questions

[jhamaican]

Gastroenterology fellow here looking for advice about first job out of fellowship:
Currently single and free to move anywhere in the country.
If anyone could or would be willing to provide any insight into the following questions I would greatly appreciate:

• In looking at job opportunities, it seems like the primary distinction is between employed by a hospital vs private practice. Gastroenterology from what I understand is one of the main utilizers of ambulatory surgery centers ASC (with also ortho, pain, urology).
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• With this in mind, I feel like I would be missing out on a major opportunity if I took an employed job that did not have the potential for ownership/stake in an ASC. I am very interested and willing to learn the business aspects of medicine. I am single and young and do not mind working long hard hours early on in my career if this means more potential income and control in the long run rather than working for someone else.
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• Is it reasonable to only want jobs that provide potential ownership in an ASC? Is this a major flow of income for those physicians who own an ASC? Is this even a smart move/reasonable line of thinking?
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• How much does payer mix matter? I see this mentioned in job offers but I am uneducated as to why or how much this matters? Going to assume that more private insurance rather than Medicare/Medicaid will reimburse at higher rates? Should this be a major concern of mine? What is a good mix or percentage of private to Medicare I should be looking for?
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• What exactly in an RVU? I assume it is extra money you generate per number of procedures that you are compensated on top of your normal salary. Is there a standard RVU rate? Or is this negotiable? What even is a “good RVU rate”?
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• Is there anything not mentioned above that you wish you had known or been told about before entering your first job out of training? I read that the majority of physicians change jobs within the first 3-6 years out of fellowship because they are dissatisfied with something. What exactly are they unhappy with? What pitfalls should I be looking out for?

I feel like fellowship does not train or give you any information about the practicalities of entering the physician workplace. I am willing to work hard, feel like I picked an in-demand specialty (judging by the 50 recruiter emails daily in my inbox). Given the abundant job offers I feel like gastroenterology is in much demand and wish to make smart decisions. Definitely feel my training has been lacking in this area of more practical medical business education. And when I try to ask these questions in an academic setting you would think I was talking about murdering innocent children it’s so taboo…

Any advice and insight are greatly appreciated. Thank you!

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[mvenus929]

What exactly in an RVU? I assume it is extra money you generate per number of procedures that you are compensated on top of your normal salary. Is there a standard RVU rate? Or is this negotiable? What even is a “good RVU rate”?

Sorta. RVUs are ways of quantifying how much work you do for a single visit/procedure/consult/whatever. Some positions will pay strictly based on how many RVUs you generate based on a set $ per RVU (I don't know these going rates, because while my attendings care about RVUs, they aren't reimbursed based on them). Other places use them to determine bonuses (i.e. you get a base salary of X, but for every RVU over y you do in a year, you get an extra $z, or if you exceed 'a' RVUs, then you get a bonus of $10K). Other places use them to determine full time vs part time status, or for promotion, or just as an expectation of how productive you are in a week, month, year.

For instance, an uncomplicated office follow-up visit might be worth 0.8 RVU, while a colonoscopy might be closer to 3.5 RVU, depending on what exactly you do as part of the colonoscopy (biopsy, etc).