how many wRVUs can you generate on a reasonable schedule?

[Gubernac]

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I am new to all this as a resident. I am evaluating jobs and I've heard the average number of wRVUs generates if about 4,000/year. That number seems low to me, but I am sure I'm missing something. Here are my assumptions: for most 60 min intake I'd bill 99204+90833. For most 30 min follow-ups I'd bill 99214+90833. I'm assuming ~34 pt. facing hours a week, ~46 weeks a year, and a no show rate of 15-20%?

calculation: 34 patient facing hours x (.80) no show = 27.2 effective hours/week. Assuming you've been in practice for a while and have full schedule I'm guessing 80% are follow-ups and 20% are intakes.
80% of 27.2 hours x 2 = 43.52 f/u per week
20% of 27.2 hours = 5.44 intakes per week

based off these assumptions it seems to me you should be able to clear 8000 wRVUs, and at minimum be easily clearing 6000. How is this possible if average is only 4000? Where am I erring?

 

[splik]

On the old system the median wRVUs for psychiatry was about 3600. On the new system it's about 4200. However you are correct that the you can do much, much higher if you have a large number of follow ups, keep your panel full, and code reasonably. Many people see fewer patients, or spend more time with patients, or don't know how to bill. I think as a model your numbers are okay, though typically we would take 90792 for news (which is a similar number of wRVUs as 99204+90833 on new system), and for follow ups, not all patients will warrant add on codes, and some will be 99213 or 99215. 20% no-show would be astronomically high for a typical wRVUs based job. Now show rates should be less than 10% is a commercially insured population with the option to convert to video visits. 32 patient hours is considered full time.

There are some thoughts you should keep in your head. If you make it known that you can easily clear 8000 wRVUs you will find your conversion factor will dramatically drop. some jobs do actually reduce the conversion factor as you get more productive, often using FMV as specious justification.

 

[lobstar]

On the old system the median wRVUs for psychiatry was about 3600. On the new system it's about 4200. However you are correct that the you can do much, much higher if you have a large number of follow ups, keep your panel full, and code reasonably. Many people see fewer patients, or spend more time with patients, or don't know how to bill. I think as a model your numbers are okay, though typically we would take 90792 for news (which is a similar number of wRVUs as 99204+90833 on new system), and for follow ups, not all patients will warrant add on codes, and some will be 99213 or 99215. 20% no-show would be astronomically high for a typical wRVUs based job. Now show rates should be less than 10% is a commercially insured population with the option to convert to video visits. 32 patient hours is considered full time.

There are some thoughts you should keep in your head. If you make it known that you can easily clear 8000 wRVUs you will find your conversion factor will dramatically drop. some jobs do actually reduce the conversion factor as you get more productive, often using FMV as specious justification.

Does FMV mean fair market value? As in they say average is $X and therefore we try to keep you around $X regardless of if your RVUs would put you more realistically at $X+Y?

 

[nexus73]

Does FMV mean fair market value? As in they say average is $X and therefore we try to keep you around $X regardless of if your RVUs would put you more realistically at $X+Y?

Yes you are correct. Employers really focus on FMV and some places really try to keep pay close to that by paying you less per rvu if you're being very productive. It's nonsense to me, what other job gets paid less if they work more? By doing this they'll get doctors who will not do extra work. If you optimize pay for work why would you work more for decreasing returns, just aim for the target rvu's then go home.

 

[Gubernac]

Yes you are correct. Employers really focus on FMV and some places really try to keep pay close to that by paying you less per rvu if you're being very productive. It's nonsense to me, what other job gets paid less if they work more? By doing this they'll get doctors who will not do extra work. If you optimize pay for work why would you work more for decreasing returns, just aim for the target rvu's then go home.

Yeah, the job I'm considering is structured exactly like this.. It's on the old RVU model, but they go with 90% of median for first ~1800 rvus, 110% of median for next ~1800 rvus, 120% of median for next ~1500 rvus and back to 100% of median beyond ~5000 rvus. They go above median because it is a rural underserved area that's hard to find physicians, but they justify returning to median because of "fair market value." My goal is to hit the 5000 RVUs and call it good. although scaling up that would in reality be around 6,000 RVUs in the current system and was unsure how realistic it is to hit that working a typical FTE. I do have 1:4 weekend coverage of the inpatient unit which would definitely add to meeting that RVU goal. Supposedly they will be eventually switching to the new RVU rates, and they will decrease $/wRVU as a result. Because inpatient codes do not have increased wRVUs after 2021 they have confirmed it would mean inpatient will pay less.

I will likely take this job, which would mean declining a salaried job at 360k a year with excellent sign-on package in a different rural area. The ceiling for the above job is obviously much higher, but I don't want to be putting in tons of extra work to get it. If I'm correct about my model, I don't think I will need to put in crazy work weeks to clear the 360k, but maybe I'm wrong. I'm a resident and a naive to this process.

 

[Bartelby]

I agree that 4k RVUs is not too hard to hit in an employed position. I clock in over that average while still leaving myself schedule gaps for administrative tasks, long lunches, and time to go for short walks and enjoy life! This also leaves room to do some psychotherapy if you choose to (it produces around half the RVUs, but when you are already clearing the bar easily you can add it if you are interested).

So for me instead of trying to generate some big multiple of the minimum I intentionally design a schedule that is more relaxing. I think this might be a big part of why I love outpatient work in contrast to some who feel like it's an overwhelming grind. In many roles you can decide whether it's an overwhelming grind or not 🙂

 

[clausewitz2]

I agree that 4k RVUs is not too hard to hit in an employed position. I clock in over that average while still leaving myself schedule gaps for administrative tasks, long lunches, and time to go for short walks and enjoy life! This also leaves room to do some psychotherapy if you choose to (it produces around half the RVUs, but when you are already clearing the bar easily you can add it if you are interested).

So for me instead of trying to generate some big multiple of the minimum I intentionally design a schedule that is more relaxing. I think this might be a big part of why I love outpatient work in contrast to some who feel like it's an overwhelming grind. In many roles you can decide whether it's an overwhelming grind or not 🙂

This is absolutely the way. I love doing outpatient work. I also give myself 90 minute lunch breaks and try to make sure I never see more than five patients in a row without a 30 minute break right after. A break after every four or so would be ideal. Definitely leaving money on the table but the point is I can stay at the table indefinitely.

 

[dl2dp2]

You are not wrong. This is why solo PP can gross a *lot* even with insurance. In facility based practice they often stuff you but haircut you on a low ceiling. 5 one hour intakes a week is a *lot*.

Still you cannot possibly expect to get this many RVUs in year 1.

 

[Gubernac]

You are not wrong. This is why solo PP can gross a *lot* even with insurance. In facility based practice they often stuff you but haircut you on a low ceiling. 5 one hour intakes a week is a *lot*.

Still you cannot possibly expect to get this many RVUs in year 1.

For sure, luckily they do have a minimum guaranteed salary at median for first 2 years. I've heard that term "haircut" on here a few times, is that referring to reducing pay after a certain point?

edit: okay understood now, per google:

Haircut
a reduction in an amount of money:
The museum director took a haircut of about 8% from his salary.

 

[annoyedpsychiatrist]

This is absolutely the way. I love doing outpatient work. I also give myself 90 minute lunch breaks and try to make sure I never see more than five patients in a row without a 30 minute break right after. A break after every four or so would be ideal. Definitely leaving money on the table but the point is I can stay at the table indefinitely.

How many patients do you average a day?

 

[J ROD]

I purposely look for jobs that do not "limit" my monies on my effort. I focus on medication management with supportive therapy. Have about 24-25 slots per day. New evals are 40 min and follow up are 20 min. Get about a hour lunch break. Easily clear 8000/year working 4 days per week. Job and work is not stressful to me. Was doing another job. about 11500/year and very stressful. Always pushed to see more patients. Did clear 600K. Did some as inpatient and then outpatient. That did burn me down. Clear about 400-450K/year currently. Much easier life and spend more time with outside endeavors and children.

 

[clausewitz2]

How many patients do you average a day?

11-13 is typical

 

[Attending1985]

This is absolutely the way. I love doing outpatient work. I also give myself 90 minute lunch breaks and try to make sure I never see more than five patients in a row without a 30 minute break right after. A break after every four or so would be ideal. Definitely leaving money on the table but the point is I can stay at the table indefinitely.

Are you employed or pp?

 

[clausewitz2]

Are you employed or pp?

I do private practice 2.5 days per week and a specialized CMHC gig 1.5 days per week. I'm describing my PP schedule. My CMHC schedule is sometimes a bit more busy than that but is often less so. The setting also means that I am required to see people quite frequently and never see anyone for less than 30 minutes so it replicates the scheduling dynamics of PP in some ways. I'm the only psychiatrist in that particular program so I also have PP level freedom for the most part to do the job how I want to. There's a theme.

 

[Attending1985]

I do private practice 2.5 days per week and a specialized CMHC gig 1.5 days per week. I'm describing my PP schedule. My CMHC schedule is sometimes a bit more busy than that but is often less so. The setting also means that I am required to see people quite frequently and never see anyone for less than 30 minutes so it replicates the scheduling dynamics of PP in some ways. I'm the only psychiatrist in that particular program so I also have PP level freedom for the most part to do the job how I want to. There's a theme.

Sounds ideal that’s a cool setup

 

[J ROD]

Yeah, I agree. I got more freedom in my new position. I can refuse referrals and get rid of patients if I want to. Enough to where I will probably not consider PP. That was once a goal. I still take on more challenging patients than other psychiatrists in my practice. I do so to help those complex patients with medical issues. Mostly geriatric with PD and dementia or both. I also treat ASD and ID and help with behavioral issues.

I am content with work and pay. Get to do my side jobs too and have time for children and family responsibilities.

 

[clausewitz2]

Yeah, I agree. I got more freedom in my new position. I can refuse referrals and get rid of patients if I want to. Enough to where I will probably not consider PP. That was once a goal. I still take on more challenging patients than other psychiatrists in my practice. I do so to help those complex patients with medical issues. Mostly geriatric with PD and dementia or both. I also treat ASD and ID and help with behavioral issues.

I am content with work and pay. Get to do my side jobs too and have time for children and family responsibilities.

That is a big advantage clinically as well to a schedule with more slack. Not being super booked all the time means you can handle complex cases a lot better since you don't have to make everyone's problems fit into 30 minutes every X weeks. You can also take the time to call relevant collateral without sacrificing time outside of office hours as well

 

[FlowRate]

Maybe my math is wrong but 99214+90833 is almost 6 RVU (depends on your location). 1500 clinical hours * 2 appointments/hour = 3000 * 6 = 18000 RVU. Obviously there's a bunch of nuance but even billing straight 99213 should get you to around 8100 (assuming no no-shows/full template utilization.)

Edit: realized we're talking purely wRVU, not total RVU, will update in a bit.

ETA2: 99214+90833 is around 3.4 wRVU and 99213 is around 1.3. So that would put you in a broad range of 3900-10000 wRVU depending on your billing mix.