How many RVUs/year do you usually hit?

[DrMDAware]

curious to see what everyone is getting on $/rvu basis?

Non partner: Mid $50s per wRVU up to 5k yearly RVU then around low $40s afterwards (!)
Partner: About low $60s per wRVU as a floor (can go up pending on how many people are on payroll to around mid 60s), does not include ASC and ancillaries income

Realistic wRVU per year: Around 10-12k (8am until 4pm with a 30 min lunch break)

Pros: fed patients, level 4 for a MBB follow up, quick visits for work comp, never on call, no inpatient, ASC treats patients well, scribe, transcriptionist, can profit from using midlevelers, where I want to live, ASC moves relatively fast, little opioids, patients have means to pay cash for PRP, mostly pleasant patients, no special partners with a capital P, same rate no matter the insurance (allows us to treat a lot of Medicare when others are fighting over commercial), Cash Benefit Plan

Cons: low wRVU rate, very low bonus RVU for non partner, ASC facility fee not that high as partner, big overhead, limited time off as a non partner, buy in is high

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[bedrock]

Sure. Paid wrvu like you. At 74$/wrvu flat rate. Anywhere from 9-12k wrvu/year. So income has been all over the place last 5 years, but no where near 5.

15k wrvu is INSANE for our speciality. That’s like 2x median. Your income needs to be commensurate with that. Even big market/city pain docs get 65 or so /wrvu. 500k is nowhere close to what’s appropriate.

I would disagree that the majority of big city pain docs get 65wRVU. 60 still happens frequently in desirable urban areas.

 

[Forwho]

I would disagree that the majority of big city pain docs get 65wRVU. 60 still happens frequently in desirable urban areas.

agree $60 seems to be about average, +/- $5 depending on desirability of location. at least from what i've personally seen

 

[TeslaCoil]

Sure. Paid wrvu like you. At 74$/wrvu flat rate. Anywhere from 9-12k wrvu/year. So income has been all over the place last 5 years, but no where near 5.

15k wrvu is INSANE for our speciality. That’s like 2x median. Your income needs to be commensurate with that. Even big market/city pain docs get 65 or so /wrvu. 500k is nowhere close to what’s appropriate.

Im not paid based on wRVU’s. Im salaried. $520k plus benefits. Its a large private practice with several locations.

 

[TeslaCoil]

Sure. Paid wrvu like you. At 74$/wrvu flat rate. Anywhere from 9-12k wrvu/year. So income has been all over the place last 5 years, but no where near 5.

15k wrvu is INSANE for our speciality. That’s like 2x median. Your income needs to be commensurate with that. Even big market/city pain docs get 65 or so /wrvu. 500k is nowhere close to what’s appropriate.

How did you manage to get 74/rvu. Thats pretty insane. Even when I was interviewing with some podunk underserved hospitals they werent offering that….

 

[mid|ine]

I did about 14.1k wrvu in 2021. It will probably be about 1k less in 22 since I have offloaded a lot more work onto midlevels and we had some PA department issues (everyone had covid) in Jan 2022.

 

[bedrock]

Im not paid based on wRVU’s. Im salaried. $520k plus benefits. Its a large private practice with several locations.

If you are salaried, they need to get another physician. You are doing the work of two average pain physicians.

Or they need to give you a very significant production bonus on top of your 520K salary.

 

[TeslaCoil]

If you are salaried, they need to get another physician. You are doing the work of two average pain physicians.

Or they need to give you a very significant production bonus on top of your 520K salary.

Thats why I have 2 PA’s who work directly under my supervision though…

 

[Forwho]

Thats why I have 2 PA’s who work directly under my supervision though…

are you getting anything in return for overseeing them? if not, then i'd try to negotiate something to get return for that. overseeing PAs is work.

 

[buddababa]

Im not paid based on wRVU’s. Im salaried. $520k plus benefits. Its a large private practice with several locations.

You are so underpaid.

 

[DrMDAware]

How did you manage to get 74/rvu. Thats pretty insane. Even when I was interviewing with some podunk underserved hospitals they werent offering that….

I

I would disagree that the majority of big city pain docs get 65wRVU. 60 still happens frequently in desirable urban areas.

agree $60 seems to be about average, +/- $5 depending on desirability of location. at least from what i've personally seen

Are these wRVU before or after overhead?

 

[DOctorJay]

Thats why I have 2 PA’s who work directly under my supervision though…

Are you including their wrvus in your total?

 

[clubdeac]

most pain docs I know who are doing 15000 wRVUs are in the 1 million range for income

 

[bedrock]

Overhead

most pain docs I know who are doing 15000 wRVUs are in the 1 million range for income

True, but aren’t most of those HOPD docs with a juicy SOS?

Much harder to achieve a million of annual income if doing 15000 wRVUs in private practice, considering how little we are paid by federal insurance (and even commercial insurance in many areas)

 

[callmeanesthesia]

Overhead


True, but aren’t most of those HOPD docs with a juicy SOS?

Much harder to achieve a million of annual income if doing 15000 wRVUs in private practice, considering how little we are paid by federal insurance (and even commercial insurance in many areas)

I had about 12,000 wRVUs last year and almost got to $1m. You’re right about the garbage commercial and private insurer reimbursements though.

 

[Ronin1]

Many HOPDs have an income cap no matter the wrvu number.

 

[bedrock]

I had about 12,000 wRVUs last year and almost got to $1m. You’re right about the garbage commercial and private insurer reimbursements though.

You're in california right?

1-private practice or HOPD?
If private practice do you get a slice of ancillary/ASC revenue or is your almost 1million all from pro fees?

2-Socal or Norcal?
I also don't know how you would get close to a million in income from 12K wRVU from private practice in socal, given the worse reimbursement in Socal.....unless you're HOPD.

 

[callmeanesthesia]

You're in california right?

1-private practice or HOPD?
If private practice do you get a slice of ancillary/ASC revenue or is your almost 1million all from pro fees?

2-Socal or Norcal?
I also don't know how you would get close to a million in income from 12K wRVU from private practice in socal, given the worse reimbursement in Socal.....unless you're HOPD.

Private. Almost all procedures in office. 1/2 day every other week at ASC and I don’t own shares. I’ve been asking for over 6 months to buy in and I just keep getting a “yeah, we’re working on it” type of answer. Northern CA, rural. Our payor rates are garbage though - everything pays Medicare rates.

 

[bedrock]

Private. Almost all procedures in office. 1/2 day every other week at ASC and I don’t own shares. I’ve been asking for over 6 months to buy in and I just keep getting a “yeah, we’re working on it” type of answer. Northern CA, rural. Our payor rates are garbage though - everything pays Medicare rates.

sounds like socal rates. Apparently just terrible CA rates anywhere in the state, period.

Still kudos to you for banging out 12k wRVU in the office and making close to a million with those rates.

What percent overhead do you have? I enjoy the ancillary ASC facility fees in our ortho practice, but our total overhead is ridiculous.

 

[callmeanesthesia]

sounds like socal rates. Apparently just terrible CA rates anywhere in the state, period.

Still kudos to you for banging out 12k wRVU in the office and making close to a million with those rates.

What percent overhead do you have? I enjoy the ancillary ASC facility fees in our ortho practice, but our total overhead is ridiculous.

I think our overhead comes out about 50%. Maybe a little more. It’s hard to give a specific figure though because my own salary and benefits are included in my expenses on our financials. I’m in an Ortho group too but the ASC is separate with separate buy-in. We have PT and MRI but the amount they generate is minimal - I think less than 10k per year per partner net on either one.

 

[bedrock]

Private. Almost all procedures in office. 1/2 day every other week at ASC and I don’t own shares. I’ve been asking for over 6 months to buy in and I just keep getting a “yeah, we’re working on it” type of answer. Northern CA, rural. Our payor rates are garbage though - everything pays Medicare rates.

I'm a bit worried they don't value you if you've been asking for 6 months to buy in with no timeframe in site. But then again, that is typical ortho behavior.

The tricky part of your situation is that many ortho groups want you to do everything in the ASC, and then you get screwed on the low pro fees.
That said, there are many HMOs in CA that pay better overall as an office procedure (global) than an ASC procedure. (pro + facility)

So them allowing you do do most of your cases in office, might be nice, or maybe that just pencils out for reimbursement?

What kinds of cases are you taking to the ASC? Maybe you could get away with only 1/2 ASC day/month?

My first job was an ortho practice and I did 99% of cases in office with PO xanax, including RFA at all locations, and Stim trials. I did do an asc half day once every 4-5 weeks for my "weenie" patients or for cases that needed DSA or IV access.

 

[callmeanesthesia]

I'm a bit worried they don't value you if you've been asking for 6 months to buy in with no timeframe in site. But then again, that is typical ortho behavior.

The tricky part of your situation is that many ortho groups want you to do everything in the ASC, and then you get screwed on the low pro fees.
That said, there are many HMOs in CA that pay better overall as an office procedure (global) than an ASC procedure. (pro + facility)

So them allowing you do do most of your cases in office, might be nice, or maybe that just pencils out for reimbursement?

What kinds of cases are you taking to the ASC? Maybe you could get away with only 1/2 ASC day/month?

My first job was an ortho practice and I did 99% of cases in office with PO xanax, including RFA at all locations, and Stim trials. I did do an asc half day once every 4-5 weeks for my "weenie" patients or for cases that needed DSA or IV access.

I’ve been with the group for almost 5 years, bought in after 1 1/2. The group’s ASC is controlled by a national ASC company and they said I couldn’t buy in at all due to Safe Harbor rules because I didn’t do at least 30% of my cases there. They also had trouble getting me anesthesia time for implants. So I switched to the other ASC in town. They’re also controlled by a national chain. They told me I should be able to buy in, but keep telling me the valuation is pending but it’s been delayed to get it.

I only do stim implants and the occasional RFA (usually local anesthetic resistant patients), and occasional stim trial at the ASC.

 

[bedrock]

I’ve been with the group for almost 5 years, bought in after 1 1/2. The group’s ASC is controlled by a national ASC company and they said I couldn’t buy in at all due to Safe Harbor rules because I didn’t do at least 30% of my cases there. They also had trouble getting me anesthesia time for implants. So I switched to the other ASC in town. They’re also controlled by a national chain. They told me I should be able to buy in, but keep telling me the valuation is pending but it’s been delayed to get it.

I only do stim implants and the occasional RFA (usually local anesthetic resistant patients), and occasional stim trial at the ASC.

That part of the story makes sense. Sounds like the original orthos ASC was bought out by this national company, which is partially why they don't care as much about you not doing your procedures there.

You should check with your billers what you are paid for pro fee vs global fee on your commercial insurance and WC contracts. Many of them are the same in office as they are in the ASC. So you could do 30% of your procedures at an "efficient" ASC without you losing money and this would take care of 30% safe harbor rules and you can then get facility fees without much sacrifice.
For example, in my area I get paid the same by most commercial payors, Medicaid, and WC whether I'm doing the procedure in the ASC or office. I only get penalized by medicare and Cigna, for which I would take a 50-60% haircut to do the Cigna/Medicare cases in the ASC instead of the office.

(HOWEVER, I do remember from my time in LA, there are several california HMOs that pay better for office procedure than pro fee in ASC)
So do your research, as your area may be different from mine.

 

[PinchandBurn]

When I was at the hospital it started at 75..when I left 1.5yr ago it was 72 a rvu

 

[callmeanesthesia]

That part of the story makes sense. Sounds like the original orthos ASC was bought out by this national company, which is partially why they don't care as much about you not doing your procedures there.

You should check with your billers what you are paid for pro fee vs global fee on your commercial insurance and WC contracts. Many of them are the same in office as they are in the ASC. So you could do 30% of your procedures at an "efficient" ASC without you losing money and this would take care of 30% safe harbor rules and you can then get facility fees without much sacrifice.
For example, in my area I get paid the same by most commercial payors and WC whether I'm doing the procedure in the ASC or office. I only get penalized by medicare and Cigna, for which I would take a 50-60% haircut to do the Cigna/Medicare cases in the ASC instead of the office.

(HOWEVER, I do remember from my time in LA, there are several california HMOs that pay better for office procedure than pro fee in ASC)
So do your research, as your area may be different from mine.

I wasn’t aware of that - I’ll look into it, thanks. That said, I see about 50% Medicare and 30% the local MediCal carrier. About 10% Work Comp.

 

[bedrock]

I wasn’t aware of that - I’ll look into it, thanks. That said, I see about 50% Medicare and 30% the local MediCal carrier. About 10% Work Comp.

That is great that you’re making close to 7 figures with mostly Medicare and Medicaid, (and CA WC which doesn’t pay well).

Well done

BTW, in my state Medicaid pays the same in office or ASC.

 

[clubdeac]

Overhead


True, but aren’t most of those HOPD docs with a juicy SOS?

Much harder to achieve a million of annual income if doing 15000 wRVUs in private practice, considering how little we are paid by federal insurance (and even commercial insurance in many areas)

yes all HOPD docs. I didn't know private practice docs' productivity was calculated in wRVUs? I thought that was only a HOPD thing

 

[bedrock]

yes all HOPD docs. I didn't know private practice docs' productivity was calculated in wRVUs? I thought that was only a HOPD thing

Ah. Makes sense.

BTW, some private practices calculate wRVU as a way of measuring productivity.

I asked for mine before becoming partner to demonstrate how productive I am…and because I was curious.

 

[paindoc007]

Thats why I have 2 PA’s who work directly under my supervision though…

Negotiate bruh.

“Our total practice productivity is over 2x median for pain management, and yet my salary is not commensurate with that volume, frankly not even close. This is significant work and time for me, so going forward I want 150k yearly per each mid level I am supervising in addition to my income of 520k”

You’re welcome.

 

[DrMDAware]

Negotiate bruh.

“Our total practice productivity is over 2x median for pain management, and yet my salary is not commensurate with that volume, frankly not even close. This is significant work and time for me, so going forward I want 150k yearly per each mid level I am supervising in addition to my income of 520k”

You’re welcome.

ChatGPT couldn’t have said it better!

 

[Ducttape]

are your PAs working on an wRVU basis too? if so, you probably wont be able to generate much $$$ for what the PA does if they are billing independently.

requiring payment for monitoring their work may affect their income, as i would guess the practice would consider reducing their salaries if they are not essentially billing independently.



wRVU should be irrespective of overhead. they should not be giving you a wRVU amount then expecting to pay staff through that amount.

 

[TeslaCoil]

Are you including their wrvus in your total?

yes

 

[DOctorJay]

yes

ok that's a little different. I supervise a PA as well but only count the wRVUs for the patients I see as the PA sees patients somewhat independently and I review the notes/plans.

if you're actually seeing each patient then you should be getting those wRVUs not the NP/PA.

 

[TeslaCoil]

ok that's a little different. I supervise a PA as well but only count the wRVUs for the patients I see as the PA sees patients somewhat independently and I review the notes/plans.

if you're actually seeing each patient then you should be getting those wRVUs not the NP/PA.

In my practice they dont see many of the patients entirely independently. If we're talking just my RVU's alone Im still in the 10-12k Range, and still underpaid.

 

[SpineandWine]

Niiiiice. Any tips for the internet on how to replicate this?

I do q15 minute slots for everything (returns, New, Procedure). Rarely see any returns as my NP does that.
As far as procedures, all of them can be q15 except advanced procedures (kyphoplasty, scs trials, scs implants, perc SI fusion, etc.) - those I do on the first Friday of each month.
Try my hardest to not take anything to ASC given payment model is for wRVU and turn around time is not worth billing for 15 minute sedation.

 

[DrMDAware]

I do q15 minute slots for everything (returns, New, Procedure). Rarely see any returns as my NP does that.
As far as procedures, all of them can be q15 except advanced procedures (kyphoplasty, scs trials, scs implants, perc SI fusion, etc.) - those I do on the first Friday of each month.
Try my hardest to not take anything to ASC given payment model is for wRVU and turn around time is not worth billing for 15 minute sedation.

RFAs for 15 mins, too? Burn once? Not judging.

 

[TeslaCoil]

RFAs for 15 mins, too? Burn once? Not judging.

I have excellent results with just one burn 🤷🏻‍♂️

 

[SSdoc33]

RFAs for 15 mins, too? Burn once? Not judging.

I burn once

and you make up for a little longer on RFs with joints/SIJ, etc

honestly, i could do 25 shots a in a half day fairly easily if I had the infrastructure to do it (obviously not several RFs)

 

[SpineandWine]

RFAs for 15 mins, too? Burn once? Not judging.

Burn once
My partners do q15 unilateral only (R L4, L5 and also followed by left at another visit still). They double book their slots and do about 40 procedures a day

I try to pair up my bilateral RFAs with SIJ as next procedure to make up time difference. I don’t double book my slots.

 

[TeslaCoil]

Burn once
My partners do q15 unilateral only (R L4, L5 and also followed by left at another visit still). They double book their slots and do about 40 procedures a day

I try to pair up my bilateral RFAs with SIJ as next procedure to make up time difference. I don’t double book my slots.

Where are you located?

 

[SpineandWine]

Novant Health NC though I’m leaving for ohio for another practice in a month

 

[SC Tian]

I had about 12,000 wRVUs last year and almost got to $1m. You’re right about the garbage commercial and private insurer reimbursements though.

Just finished reviewing the productivity of 2022, 15k wrvu with one NP, do not feel busy though, good luck 2023

 

[DrMDAware]

Just finished reviewing the productivity of 2022, 15k wrvu with one NP, do not feel busy though, good luck 2023

Nice! Any tips how to efficiently use the NP? Have them see follow ups, established, new patients without any imaging, etc.

 

[SC Tian]

Nice! Any tips how to efficiently use the NP? Have them see follow ups, established, new patients without any imaging, etc.

Thanks, the NP is a proactive person, seeing patients, doing joint injections in office, I do relatively extensive annual review with the practicing data and incentivize her every year, sent her for conference every two years.

 

[DOctorJay]

Just finished reviewing the productivity of 2022, 15k wrvu with one NP, do not feel busy though, good luck 2023

please clarify, is that 15k wRVUs for you alone or you and the NP combined?

 

[SC Tian]

Combined

 

[drusso]

Just finished reviewing the productivity of 2022, 15k wrvu with one NP, do not feel busy though, good luck 2023

For those of us who work in a collection/cash world, what does that look like? How many patients per day, new and FU, procedures, etc?

 

[SC Tian]

We are working in a collection and cash model, wrvu is for record only, it may not very accurate, would say md see 25, Np 15 per day, 5-10 nps per day, i did quite a few procedures, a few of kyphos and quite a few of stim, they contribute more wrvus imo, 40% wrvus from procedures, 25 regular injection a day. My payor mixture is fairly good, 60% commercials.

 

[SC Tian]

We are working in a collection and cash model, wrvu is for record only, it may not very accurate, would say md see 25, Np 15 per day, 5-10 nps per day, i did quite a few procedures, a few of kyphos and quite a few of stim, they contribute more wrvus imo, 40% wrvus from procedures, 25 regular injection a day. My payor mixture is fairly good, 60% commercials.

my pay is not wrvu based, whenever my injection day falls on holiday or vacation, I will try my best to make up those days, imo this helps a lot for private practice.

 

[mja75]

8800 wRVUs, 4 day workweek. Heaven.