Hematology / Oncology RVU comp

[bobsmith]

there is an RVU pool above 4,464 wRVUs - after you meet that threshold 40% gets sent to the pool and is distributed equally to all those that met the threshold at the end of the year.

So 60% of (your wRVU productivity over 4464) *conversion rate goes to you, and 40% goes to this pool that then gets divided evenly?

I would hope most physicians are generally in the same range of productivity because otherwise, this seems like a great deal for the person who has 4465 wRVUs and not as great for someone who has 10k wRVUs

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[gutonc]

For my first job out of fellowship, I'm looking at a community practice job that is fairly close to academic (they have a small fellowship and everyone in the clinic subspecializes in 2 cancer types).

Got an offer for guarantee of $516,000 for the first two years with $40k - $50k in citizenship bonuses. It sounds amazing but I had some questions related to wRVUs. The conversion factor is $76.82 (which seems low compared to others I've seen on here), and there is an RVU pool above 4,464 wRVUs - after you meet that threshold 40% gets sent to the pool and is distributed equally to all those that met the threshold at the end of the year. Everyone met the RVU threshold pool last year (which I guess makes sense because 4,464 x $76.82 = $342k.

If I'm doing this math right (and I have no idea that I am), when I no longer have a protected salary it will take 6,717 wRVUs to get what my guarantee is. Does that sound right?

You're definitely going to have to ask them some of the details. $76.82 is a little on the low side for the conversion factor, but not ridiculous. My prior job had a high CF for the base but then when you got to productivity, the CF dropped...which is kind of bass-ackwards IMO. I would ask for median production and compensation in the group to get a better idea of what things will look like in 2 years.

So 60% of (your wRVU productivity over 4464) *conversion rate goes to you, and 40% goes to this pool that then gets divided evenly?

I would hope most physicians are generally in the same range of productivity because otherwise, this seems like a great deal for the person who has 4465 wRVUs and not as great for someone who has 10k wRVUs

I was wondering about this as well. Seems a little sus to me. I'm perfectly fine with community based citizenship bonuses as I think they encourage good teamwork, but if I'm out there doubling the productivity of my partners and they're getting to reap the rewards of my hard work while they sit on their butts, I'm not going to be very pleased about that.

 

[HemeOncHopeful19]

The more complicated the pay structure is the more likely they are trying to get away with lowballing you (and possibly everyone else) without you realizing it IMO

That sounds like the people who have been around the longest with protected time or maybe easing up toward the end of their careers wants a slice of your revenue

 

[bobsmith]

My prior job had a high CF for the base but then when you got to productivity, the CF dropped...which is kind of bass-ackwards IMO. .

Sounds like an instance where they would invoke concerns about "Fair Market Value" (which I have always interpreted as "well, this seems like a convenient excuse for us to not pay you as much")

 

[gutonc]

Sounds like an instance where they would invoke concerns about "Fair Market Value" (which I have always interpreted as "well, this seems like a convenient excuse for us to not pay you as much")

It was barely at 50th%ile of FMV which is one of the things that made it so laughable. Apparently this year they've turned it around, but no longer my problem.

I will say that if you as an institution are routinely paying above the 90th %ile you are setting yourself up for some Stark law scrutiny. When I was a medical director, we had a PSA with a small group of oncologists who were just super busy, and not at all upset about it. Their production based comp put all of them >90th %ile for 2 years in a row. The 2nd year, CMS came knocking. No Stark violations were found, but it was still a pretty big PITA to deal with.

 

[HemeOncHopeful19]

It was barely at 50th%ile of FMV which is one of the things that made it so laughable. Apparently this year they've turned it around, but no longer my problem.

I will say that if you as an institution are routinely paying above the 90th %ile you are setting yourself up for some Stark law scrutiny. When I was a medical director, we had a PSA with a small group of oncologists who were just super busy, and not at all upset about it. Their production based comp put all of them >90th %ile for 2 years in a row. The 2nd year, CMS came knocking. No Stark violations were found, but it was still a pretty big PITA to deal with.

Yeah that sounds like a huge PITA for those docs… lol…

I get what you’re saying though I’m sure the suits had a lot of paperwork to do!

Imagine any other industry your boss saying “you should not make more than this much based on this survey we have from last year that is based on data from two years ago or the government might punish us… oh also if you quit we’re gonna need you to leave the state thanks”

 

[Mehena]

The high base starting salary is a honeytrap. The production terms and setup resemble a collective farm during Stalin's Soviet era, not the capitalist USA. It will favor baby boomers at the twilight of their careers, not the young and hungry FOB fellows. Providing more specific information about the region, including metropolitan versus rural areas, may allow others to weigh in on the reasonableness of the RVU.

 

[mjp1720]

So 60% of (your wRVU productivity over 4464) *conversion rate goes to you, and 40% goes to this pool that then gets divided evenly?

I would hope most physicians are generally in the same range of productivity because otherwise, this seems like a great deal for the person who has 4465 wRVUs and not as great for someone who has 10k wRVUs

Thanks for the insight. This is exactly correct - and definitely benefits the person who hits 4465 wRVUs more. Having said that, everyone in the organization hit this pool benchmark last year.

I am asking the director for average wRVU totals for the group to help get my mind around it. If I assume ~2 wRVUs per patient encounter, then to get the same compensation as my guarantee for the first two years, it's something like seeing 20 patients a day for 4 days per week (with a few news, some level 4s, and a few level 5s per day).

 

[mjp1720]

You're definitely going to have to ask them some of the details. $76.82 is a little on the low side for the conversion factor, but not ridiculous. My prior job had a high CF for the base but then when you got to productivity, the CF dropped...which is kind of bass-ackwards IMO. I would ask for median production and compensation in the group to get a better idea of what things will look like in 2 years.

I was wondering about this as well. Seems a little sus to me. I'm perfectly fine with community based citizenship bonuses as I think they encourage good teamwork, but if I'm out there doubling the productivity of my partners and they're getting to reap the rewards of my hard work while they sit on their butts, I'm not going to be very pleased about that.

I had a contract attorney look it over and according to their data, the conversion factor of $76.82 is in the 10th percentile (median is $112). Which I find particularly interesting because the guarantee of $516k is 90th percentile for new grads in this area.

Hopefully when they get me some ballpark RVU numbers of the established docs in the group, it'll make more sense. These people don't seem like they are killing themselves with how busy they are

 

[HemeOncHopeful19]

I had a contract attorney look it over and according to their data, the conversion factor of $76.82 is in the 10th percentile (median is $112). Which I find particularly interesting because the guarantee of $516k is 90th percentile for new grads in this area.

This makes perfect sense to me.

Offer a new grad a super exciting base salary for 2 years for recruiting purposes and then afterward pay them peanuts but by the time they realize it their wife/kids have made friends and they’ve bought a house.

 

[MD46]

This makes perfect sense to me.

Offer a new grad a super exciting base salary for 2 years for recruiting purposes and then afterward pay them peanuts but by the time they realize it their wife/kids have made friends and they’ve bought a house.

Typical Bait and switch strategy.................................

 

[mjp1720]

So it turns out I was missing a good part of compensation. The organization has an RVU adjustment as well as physicians getting a percentage of the chemotherapy supervision RVUs. Thus, earned productivity compensation is much more than pure wRVUs.

 

[dcc23]

So it turns out I was missing a good part of compensation. The organization has an RVU adjustment as well as physicians getting a percentage of the chemotherapy supervision RVUs. Thus, earned productivity compensation is much more than pure wRVUs.

How does the RVU adjustment work? I have an offer from a job that is considering a switch to a “point based” system that adjusts RVUs as a boost for non-clinical work (admin, clinical research, etc) but not sure what to make of it.

 

[gutonc]

How does the RVU adjustment work? I have an offer from a job that is considering a switch to a “point based” system that adjusts RVUs as a boost for non-clinical work (admin, clinical research, etc) but not sure what to make of it.

I can't speak for the OP here, but there are a number of ways that I know this sort of system has worked. One is that you get X wRVUs for every Y thing or Z amount of time you spend on non-clinical work. In my prior job it was generally done as a %FTE buy-down for admin and clinical research work with significant (at least 1/2 day a week) time burden, but as I was leaving they were also implementing a system where they were going to reward a certain number of wRVUs for hours spent doing admin/committee work that was still needed and valued but wasn't enough to support an actual FTE buy-down (IRB/Scientific Review Committee type stuff which is 3-4 hours a month). I don't know what actual number they were going for but they were supposedly going to use the median hourly wRVU production for the group which would have been 6-7. That would get added to the "productivity" for the year and used to calculate bonuses.

 

[solidonc2020]

I can't speak for the OP here, but there are a number of ways that I know this sort of system has worked. One is that you get X wRVUs for every Y thing or Z amount of time you spend on non-clinical work. In my prior job it was generally done as a %FTE buy-down for admin and clinical research work with significant (at least 1/2 day a week) time burden, but as I was leaving they were also implementing a system where they were going to reward a certain number of wRVUs for hours spent doing admin/committee work that was still needed and valued but wasn't enough to support an actual FTE buy-down (IRB/Scientific Review Committee type stuff which is 3-4 hours a month). I don't know what actual number they were going for but they were supposedly going to use the median hourly wRVU production for the group which would have been 6-7. That would get added to the "productivity" for the year and used to calculate bonuses.

Here's how it was described to me:
The new model would continue to be productivity based although would offer an incentive point system that could increase the $ per wRVU earned.

Physicians would be paid at the base compensation rate throughout the year, and at the end of the year all points earned are tallied and physicians are placed into tiers based on points (which are accumulated for research, quality, community outreach, stewardship, and hospital metrics). There is then an additional payout based on which tier each physician falls into. Assume similar ratios of Base = $1.00, Tier 1 = $1.50, Tier 2 = $2.00, and Tier 3 = $2.25.

It sounds good in theory for rewarding non-clinical time/work, but this is all theoretical right now and hard for me to wrap my head around how it would actually play out in practice.

 

[gutonc]

Here's how it was described to me:
The new model would continue to be productivity based although would offer an incentive point system that could increase the $ per wRVU earned.

Physicians would be paid at the base compensation rate throughout the year, and at the end of the year all points earned are tallied and physicians are placed into tiers based on points (which are accumulated for research, quality, community outreach, stewardship, and hospital metrics). There is then an additional payout based on which tier each physician falls into. Assume similar ratios of Base = $1.00, Tier 1 = $1.50, Tier 2 = $2.00, and Tier 3 = $2.25.

It sounds good in theory for rewarding non-clinical time/work, but this is all theoretical right now and hard for me to wrap my head around how it would actually play out in practice.

I like that model. I might try to steal that.

 

[HemeOncHopeful19]

Here's how it was described to me:
The new model would continue to be productivity based although would offer an incentive point system that could increase the $ per wRVU earned.

Physicians would be paid at the base compensation rate throughout the year, and at the end of the year all points earned are tallied and physicians are placed into tiers based on points (which are accumulated for research, quality, community outreach, stewardship, and hospital metrics). There is then an additional payout based on which tier each physician falls into. Assume similar ratios of Base = $1.00, Tier 1 = $1.50, Tier 2 = $2.00, and Tier 3 = $2.25.

It sounds good in theory for rewarding non-clinical time/work, but this is all theoretical right now and hard for me to wrap my head around how it would actually play out in practice.

Meh I still stand by the more complicated and ambiguous they make it the worse it will end up for the average doc

 

[gutonc]

Meh I still stand by the more complicated and ambiguous they make it the worse it will end up for the average doc

Not an unreasonable assessment.

I will counter with the fact that there is an expectation in most jobs that you will do non-clinical work and if there's a clear path to getting paid for it, that's better than doing it for free.

 

[solidonc2020]

Not an unreasonable assessment.

I will counter with the fact that there is an expectation in most jobs that you will do non-clinical work and if there's a clear path to getting paid for it, that's better than doing it for free.

Yeah, I'm somewhere in between your two assessments. The group currently is getting paid (and paid well) fully based on wRVU productivity, and the complexity of the new possible arrangement makes me nervous. But at the same time, if they want non-clinical work to get done, they need a new system for any type of incentive and hopefully this would support that.

 

[onconc]

I am the OP. New contract was signed January this year. The new RVU reimbursement rate is $100. And I am doing about 10k or 11k RVUs per year.

 

[TexasMed22]

I am the OP. New contract was signed earlier this year. The new RVU reimbursement rate is $100. And I am doing about 10k or 11k RVUs per year.

Good lord

 

[onconc]

Good lord

What are your numbers ? and breakdown?
I can provide mine if you can

 

[TexasMed22]

What are your numbers ? and breakdown?
I can provide mine if you can

I'm not an oncologist, just impressed by how large the number is when you multiply those two values together lol

 

[HemeOncHopeful19]

I'm not an oncologist, just impressed by how large the number is when you multiply those two values together lol

For what that’s worth he/she previously said they see up to 35 patients per day which is probably in the top 1% of Oncologist workloads (and to which all of us said “Good Lord”)

 

[gutonc]

For what that’s worth he/she previously said they see up to 35 patients per day which is probably in the top 1% of Oncologist workloads (and to which all of us said “Good Lord”)

Yup...hard f***ing pass on that noise.

 

[onconc]

I am the OP. New contract was signed earlier this year. The new RVU reimbursement rate is $100. And I am doing about 10k or 11k RVUs per year.

And I work about 55 hours per week with approximately 4 weeks off per year.

 

[HemOncCheng]

For my first job out of fellowship, I'm looking at a community practice job that is fairly close to academic (they have a small fellowship and everyone in the clinic subspecializes in 2 cancer types).

Got an offer for guarantee of $516,000 for the first two years with $40k - $50k in citizenship bonuses. It sounds amazing but I had some questions related to wRVUs. The conversion factor is $76.82 (which seems low compared to others I've seen on here), and there is an RVU pool above 4,464 wRVUs - after you meet that threshold 40% gets sent to the pool and is distributed equally to all those that met the threshold at the end of the year. Everyone met the RVU threshold pool last year (which I guess makes sense because 4,464 x $76.82 = $342k.

If I'm doing this math right (and I have no idea that I am), when I no longer have a protected salary it will take 6,717 wRVUs to get what my guarantee is. Does that sound right?

this is a simple math you can ask the recruiter to formulate out for you after the 2 yrs period ends

 

[gutonc]

And I work about 55 hours per week with approximately 4 weeks off per year.

I work about 30 hours a week with approximately 8 weeks off a year. I'm going to guess I make half-ish of what you do.

I can live with that.

 

[onconc]

I work about 30 hours a week with approximately 8 weeks off a year. I'm going to guess I make half-ish of what you do.

I can live with that.

I am sorry, but you seem to be getting very defensive. Nowhere did I cast any aspersions on anyone else's choices. I was just laying out the facts of my situation so that others can make informed choices on what they themselves can negotiate with their employer; based on their own life situation. I was just contributing some information to the common pool of knowledge in this forum. But I get the feeling you are taking it personally as if I consider myself superior or that others who make less than me are somehow making poor choices.

A person can be perfectly happy making 100k if they want. I myself may do that after I FIRE. Nothing wrong or right with anyone's choices

 

[TexasMed22]

I work about 30 hours a week with approximately 8 weeks off a year. I'm going to guess I make half-ish of what you do.

I can live with that.

I work about 70 hours a week with approximately 2 weeks off a year. I'm going to guess I make -45k a year.

I cannot live with that. I am a medical student. SOS

 

[gutonc]

I am sorry, but you seem to be getting very defensive. Nowhere did I cast any aspersions on anyone else's choices. I was just laying out the facts of my situation so that others can make informed choices on what they themselves can negotiate with their employer; based on their own life situation. I was just contributing some information to the common pool of knowledge in this forum. But I get the feeling you are taking it personally as if I consider myself superior or that others who make less than me are somehow making poor choices.

A person can be perfectly happy making 100k if they want. I myself may do that after I FIRE. Nothing wrong or right with anyone's choices

Sorry, not trying to be defensive. Just making sure there's another end of the spectrum (honestly, smack in the middle of it) counterexample.

 

[gutonc]

I work about 70 hours a week with approximately 2 weeks off a year. I'm going to guess I make -45k a year.

I cannot live with that. I am a medical student. SOS

You'll get there.

 

[whoknows2012]

I know this is not the angle most are taking in this thread but am personally curious. For those that spend time inpatient even if mixed inpatient/outpatient in academic or hybrid practice, where do you end up for yearly RVUs and if an incentive is paid what is that number per rvu

 

[DOCVENU]

Pls anyone could comment on RVU generated in private practice model: how is it different than RVU generated by hospital employed oncologist?

Is it true there is an RVU for chemo administration
RVU for procedures that nurses typically do in the infusion center?
What other RVUs could be granted to a private oncologist that a hospital employed one may not see or get?

In the thread the quoted average RVU is around 2 so you see 20 patients you would expect 40 RVU. Is this true in a pure private model where other RVUs may be added such the chemotherapy administrative one that o got to know about it today

Thanks

Did u ever get your answer? I am struggling in a private practice as it’s hard to find these numbers and calculations are complex

 

[DOCVENU]

So I in private practice seeing 20-25 pts with supervision of NP on another 15pts, and generating about total RVU. At the end compensation comes around 65/RVU

 

[checkpointinhibitor]

So I in private practice seeing 20-25 pts with supervision of NP on another 15pts, and generating about total RVU. At the end compensation comes around 65/RVU

do you have other ancillary income?

 

[kgb109]

Thanks for all your posts, this has been helpful.

Does anyone know what the 2023 or even more current MGMA and other big pay databanks for oncology per RVU reimbursement are?

I'm in a historically competitive and hence generally lower paying metro area (also with high taxes ughhh...). Nonetheless, I was able to find a hospital/insurer position that once you met thresholds, you were invited to the more lucrative RVU based system. Essentially you'd receive a draw throughout the year with an expectation on both sides you would surpass by 10% or more by the end of year and we settle then with a bonus/catch up check. The CF given was essentially the RVU average of the MGMA and two other data banks median reimbursement/RVU for your given specialty. At the end of the year up 2021, it equated to about $99 and some change. Prior and up to I was doing like 5500-7500 per year depending up until then. I never followed closely to confirm the accuracy of my production, but you would receive monthly RVU reports to watch and confirm you were producing to pass the draw/base rate to confirm you would get bonus and no surprises to anyone involved. Of note, they used the same CF for other specialties. Oncology was the highest/RVU, but as you all know, our RVU are some of the hardest to get...

Mid 2022, the RVU went up substantially with the numbers they were giving without a considerable change in my practice. Like 18-19% by my calculation. I confirmed with colleagues who saw the same. By the end of the year, they were basically like, CMS increased the RVU for the work you do, we cant just give everyone an 18% pay raise/bonus this year even though the RVU went up that much. This was understood ultimately it was agreed for onc specifically to be $84ish, which considering the random 18% in RVU without extra work, is still like 3-4% raise so everyone agreed. Since then there has been further negotiation between the primary care, hospitalists, specialists, medical officers, c-suite and laywers/advisors on both sides. For 2023, no change so 84ish. Last I heard there may be another 3% or something this year.

Did anyone else have similar changes in RVU? Does anyone know the most recent medians and even other percentiles for MGMA or other data banks. Its too soon for me to throw down a a few hundred to talk to some lawyers that may have it, and I'm deferring to my superiors that the negotiations are honest.


Any thoughts will be greatly appreciated!

 

[HemeOncHopeful19]

Thanks for all your posts, this has been helpful.

Does anyone know what the 2023 or even more current MGMA and other big pay databanks for oncology per RVU reimbursement are?

I'm in a historically competitive and hence generally lower paying metro area (also with high taxes ughhh...). Nonetheless, I was able to find a hospital/insurer position that once you met thresholds, you were invited to the more lucrative RVU based system. Essentially you'd receive a draw throughout the year with an expectation on both sides you would surpass by 10% or more by the end of year and we settle then with a bonus/catch up check. The CF given was essentially the RVU average of the MGMA and two other data banks median reimbursement/RVU for your given specialty. At the end of the year up 2021, it equated to about $99 and some change. Prior and up to I was doing like 5500-7500 per year depending up until then. I never followed closely to confirm the accuracy of my production, but you would receive monthly RVU reports to watch and confirm you were producing to pass the draw/base rate to confirm you would get bonus and no surprises to anyone involved. Of note, they used the same CF for other specialties. Oncology was the highest/RVU, but as you all know, our RVU are some of the hardest to get...

Mid 2022, the RVU went up substantially with the numbers they were giving without a considerable change in my practice. Like 18-19% by my calculation. I confirmed with colleagues who saw the same. By the end of the year, they were basically like, CMS increased the RVU for the work you do, we cant just give everyone an 18% pay raise/bonus this year even though the RVU went up that much. This was understood ultimately it was agreed for onc specifically to be $84ish, which considering the random 18% in RVU without extra work, is still like 3-4% raise so everyone agreed. Since then there has been further negotiation between the primary care, hospitalists, specialists, medical officers, c-suite and laywers/advisors on both sides. For 2023, no change so 84ish. Last I heard there may be another 3% or something this year.

Did anyone else have similar changes in RVU? Does anyone know the most recent medians and even other percentiles for MGMA or other data banks. Its too soon for me to throw down a a few hundred to talk to some lawyers that may have it, and I'm deferring to my superiors that the negotiations are honest.


Any thoughts will be greatly appreciated!

I’ve interviewed at multiple places in the past few months and I’ve heard 90, 98, 100 per RVU. These were small/med cities with metro pops of around 500k-1m.

One of the docs at the place that paid $98 told me it was around 40th percentile and they planned to negotiate higher.

84 is low.

 

[MD46]

Since the new CMS guidelines on RVUs, while clinic visits are paying more for level 4 and 5 with RVU numbers going up, most hospitals are bringing down the RVU value itself to counter that.

So need to see if these places with higher RVU values are following current or older CMS values.

for example: level 4 follow-up: old: 1.5 RVUs, new 1.92 RVUs

 

[kgb109]

I’ve interviewed at multiple places in the past few months and I’ve heard 90, 98, 100 per RVU. These were small/med cities with metro pops of around 500k-1m.

One of the docs at the place that paid $98 told me it was around 40th percentile and they planned to negotiate higher.

84 is low.

Since the new CMS guidelines on RVUs, while clinic visits are paying more for level 4 and 5 with RVU numbers going up, most hospitals are bringing down the RVU value itself to counter that.

So need to see if these places with higher RVU values are following current or older CMS values.

for example: level 4 follow-up: old: 1.5 RVUs, new 1.92 RVUs

Thank you both for your thoughts.

@HemeOncHopeful19 - I think MD46 is correct. Like my group, I doubt they gave everyone an 18% raise from 2022-2023 and are in negotiation status on how to use the new CMS values, or staying with the older CMS values.

If any future readers come across legit MGMA or other databanks for oncology compensation/RVU for 2023 and on, please let me know! They might not even be out yet...

 

[osprey099]

Thank you both for your thoughts.

@HemeOncHopeful19 - I think MD46 is correct. Like my group, I doubt they gave everyone an 18% raise from 2022-2023 and are in negotiation status on how to use the new CMS values, or staying with the older CMS values.

If any future readers come across legit MGMA or other databanks for oncology compensation/RVU for 2023 and on, please let me know! They might not even be out yet...

Join private practice! IMO, hospitals will keep short-changing $/wRVU until we're getting paid at primary care rates.

 

[kgb109]

Join private practice! IMO, hospitals will keep short-changing $/wRVU until we're getting paid at primary care rates.

When? Where? Patients/day? Hours per wek? $/RVU? Did I miss any questions @gutonc