ilovedance1

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I am in a position with RVU expectations written into my contract. These RVU goals are high compared to other similar settings and I am consistently exceeding the RVU goals by about 30% each month. They are wanting to change my clinic schedule in a way where it will have me exceeding my RVU goal by closer to 70% each month (170% of my RVU goal). Is there any way that I can push back against this? Does the RVU expectation written into my contract protect me at all, or is it just so that they can fire me if I am not meeting it?
 

Ollie123

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I am in a position with RVU expectations written into my contract. These RVU goals are high compared to other similar settings and I am consistently exceeding the RVU goals by about 30% each month. They are wanting to change my clinic schedule in a way where it will have me exceeding my RVU goal by closer to 70% each month (170% of my RVU goal). Is there any way that I can push back against this? Does the RVU expectation written into my contract protect me at all, or is it just so that they can fire me if I am not meeting it?
No real way for us to know the nuances of your work setting. You can certainly push back against it, but what level of protection your contract provides is a nuanced state-dependent legal question and not really something we can help with. It probably provides very little protection, but depending on the organization that may not matter (e.g. some settings will be unlikely to let someone go). T4C brings up a great point. Know your setup and worth. No one wants a salaried professional who will nickel and dime them over every little thing, but consistently exceeding your RVU expectations by 30% (assuming your RVUs and salary are set reasonably) may leave room for negotiation. At 70% I'd expect a substantial pay bump unless the pool of payers changed substantially (i.e. went from private pay to mostly medicaid). In the latter case its still arguably "not your problem" but I'd get that the money may not be available and it would just be time to look for a new job.

Sheer logistics may factor in if the expectations are already high. For comparison - if I was a full-time clinician at my institution, my target would be 3167 wRVUs per year (90832 = 1.5, 90834 = 2, 90837 = 3, 90791 =3). That works out to ~7 cases SEEN per day assuming most are 90834s and some vacation/sick leave. That is on the edge of doable in our (fairly typical outpatient) setting - mostly because of steady patient flow and the fact that few people are really truly 100% clinical. It may be more readily achievable in other settings. 70% over that would not be viable barring very unusual circumstances unless you have interns/post-docs whose RVUs get rolled into yours.

All of this seems somewhat silly on behalf of the institution depending on your population. The whole insurance model is changing and RVUs likely will not even exist (at least in their current form in ~5 years. I'm already being told not to stress too much about hitting the targets because they're likely dropping them next year as the value-based population-health-style systems start to roll out.
 
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MamaPhD

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Is there any way that I can push back against this? Does the RVU expectation written into my contract protect me at all, or is it just so that they can fire me if I am not meeting it?
Depends on your status (employee v. contract), the specific terms in your contract, and the relevant laws in your state.

It's worthwhile to try and negotiate, but also a good idea to have a "walk away" plan in your back pocket.
 

PSYDR

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Same advice for if your job decided you needed to work 7 days a week for the same pay:

Time to start looking for another job. Ask what they are offering for the increased work productivity.
 
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ilovedance1

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The expectations are increasing simply because more patients need to be seen in a shorter period of time. Thanks for the advice, I had a feeling that walking away may be the only option. I will try to negotiate after I come up with a plan B.
 

Sanman

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There is a solution to that...they need to hire another person. Unless this is a goal that is easily attainable due to super low RVU expectations, you are going to be miserable regardless if you are not close to attaining that goal now. Agree with PSYDR, time to start looking around for something better.
 
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Ollie123

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Yup. Unless they set unrealistically low expectations for the compensation they are providing and are moving to fix that (which should become obvious pretty quick when job hunting), I would look elsewhere.

Are they asking you to exclusively bill 20-30 minute sessions? If its moving to a primary care model, its clinically appropriate for the population and they are able to fill the slots that isn't completely insane and wouldn't necessarily change your working hours (artifact of our crummy system). I suspect it is just a "We have high demand for services and you are now required to work almost twice as many hours." That is a garbage justification. You are not singlehandedly responsible for overcoming systemic problems.
 
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ilovedance1

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Yup. Unless they set unrealistically low expectations for the compensation they are providing and are moving to fix that (which should become obvious pretty quick when job hunting), I would look elsewhere.

Are they asking you to exclusively bill 20-30 minute sessions? If its moving to a primary care model, its clinically appropriate for the population and they are able to fill the slots that isn't completely insane and wouldn't necessarily change your working hours (artifact of our crummy system). I suspect it is just a "We have high demand for services and you are now required to work almost twice as many hours." That is a garbage justification. You are not singlehandedly responsible for overcoming systemic problems.
I don't do therapy. I do neuropsychological evaluations. So they are just expecting me to do more evaluations each week. I think your guess about systemic problems is accurate. I already know that I am in the high average end of RVU goals for my type of institution. The problem is the RVU goals don't seem to matter because I am expected to see whoever they schedule for me anyway.
 
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Are you saying that they can just add new people to your schedule without you knowing/approving about it? I have certain days and times taht are available for scheduling and I can't conceive of just logging into medical records one day and seeing 2 additional people on my schedule. Or did some supervisor just tell you that you need to open up more slots for scheduling? Good luck with the job search because I would most certainly be looking - and also I would be coming up with some numbers showing that you're performing at above average and should get compensated as such (and also just, no. That is such an unreasonable ask. Are they asking other people to work at 170% too? Any way you can find out the average RVUs of folks in parallel positions at your place of employment?)
I don't do therapy. I do neuropsychological evaluations. So they are just expecting me to do more evaluations each week. I think your guess about systemic problems is accurate. I already know that I am in the high average end of RVU goals for my type of institution. The problem is the RVU goals don't seem to matter because I am expected to see whoever they schedule for me anyway.
but th
 
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There are several basic concepts in ABA (e.g., matching law; ratio strain) that allow us to predict the ultimate outcome of increasing the work-to-reinforcement ratio, and none of those outcomes are particularly good for any party. Increasing you work requirement beyond the contractual limit is not ok. IMHO, consistently working at 130% of minimum expectations without additional pay-off (e.g., tangibles such money or comp time, or more nebulous stuff like higher chance of promotion) is also not ok.

Let me give an example of how this should be handled. I'm in a similar situation in my current position. I do almost exclusively testing (neuro-developmental- evals). We are down a psychologist, with very high demand (I'm booking in December). I consistently work at 130-140% productivity. I am eligible for quarterly productivity bonuses increasing in amount (up to ~5% of annual salary per quarter) based on quarterly productivity amounts over 105%. I can also earn an annual bonus based on productivity that can range up to 20% of annual salary (amount based on personal productivity and overall agency financial performance). I set my own schedule of when to assess. I have recently increased the number of assessment slots per week to help meet demand, but will be reinforced accordingly. I also have the option to schedule at, say. 150% one week and 50% the next. I Have done full weeks with no testing just to breathe and catch up on stuff. In talking with my department head about the high demand for my assessment services (basically amounts to a public health crisis in my area) we have identified options other than me working harder for the same amount of money. One option is to adjust the testing practice and mission to be able to see more kiddos in the same amount of time (e.g., focus just on diagnosis and referral rather than diagnosis and treatment planning; focus just on younger kiddos who take less time). Other option is to do nothing different personally (ultimately, It's not my job to solve access to care issues by changing my schedule) other than focus on recruitment effort (that said- if any of you are licensed/eligible in MA and want a good gig, PM me). Me working more for the same amount of money never came up because a) my employer recognizes my value as well as the risks of losing one of the biggest producers in the company; and b) my employer recognizes that I'm not a fool and could leave tomorrow and generate revenue for somebody else if they treat me unfairly.
 
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ilovedance1

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There are several basic concepts in ABA (e.g., matching law; ratio strain) that allow us to predict the ultimate outcome of increasing the work-to-reinforcement ratio, and none of those outcomes are particularly good for any party. Increasing you work requirement beyond the contractual limit is not ok. IMHO, consistently working at 130% of minimum expectations without additional pay-off (e.g., tangibles such money or comp time, or more nebulous stuff like higher chance of promotion) is also not ok.

Let me give an example of how this should be handled. I'm in a similar situation in my current position. I do almost exclusively testing (neuro-developmental- evals). We are down a psychologist, with very high demand (I'm booking in December). I consistently work at 130-140% productivity. I am eligible for quarterly productivity bonuses increasing in amount (up to ~5% of annual salary per quarter) based on quarterly productivity amounts over 105%. I can also earn an annual bonus based on productivity that can range up to 20% of annual salary (amount based on personal productivity and overall agency financial performance). I set my own schedule of when to assess. I have recently increased the number of assessment slots per week to help meet demand, but will be reinforced accordingly. I also have the option to schedule at, say. 150% one week and 50% the next. I Have done full weeks with no testing just to breathe and catch up on stuff. In talking with my department head about the high demand for my assessment services (basically amounts to a public health crisis in my area) we have identified options other than me working harder for the same amount of money. One option is to adjust the testing practice and mission to be able to see more kiddos in the same amount of time (e.g., focus just on diagnosis and referral rather than diagnosis and treatment planning; focus just on younger kiddos who take less time). Other option is to do nothing different personally (ultimately, It's not my job to solve access to care issues by changing my schedule) other than focus on recruitment effort (that said- if any of you are licensed/eligible in MA and want a good gig, PM me). Me working more for the same amount of money never came up because a) my employer recognizes my value as well as the risks of losing one of the biggest producers in the company; and b) my employer recognizes that I'm not a fool and could leave tomorrow and generate revenue for somebody else if they treat me unfairly.
Thank you very much for this reply. This has given me a great perspective when we are trying to advocate for ourselves here. I really appreciate it!
 

PSYDR

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There are several basic concepts in ABA (e.g., matching law; ratio strain) that allow us to predict the ultimate outcome of increasing the work-to-reinforcement ratio, and none of those outcomes are particularly good for any party. Increasing you work requirement beyond the contractual limit is not ok. IMHO, consistently working at 130% of minimum expectations without additional pay-off (e.g., tangibles such money or comp time, or more nebulous stuff like higher chance of promotion) is also not ok.

Let me give an example of how this should be handled. I'm in a similar situation in my current position. I do almost exclusively testing (neuro-developmental- evals). We are down a psychologist, with very high demand (I'm booking in December). I consistently work at 130-140% productivity. I am eligible for quarterly productivity bonuses increasing in amount (up to ~5% of annual salary per quarter) based on quarterly productivity amounts over 105%. I can also earn an annual bonus based on productivity that can range up to 20% of annual salary (amount based on personal productivity and overall agency financial performance). I set my own schedule of when to assess. I have recently increased the number of assessment slots per week to help meet demand, but will be reinforced accordingly. I also have the option to schedule at, say. 150% one week and 50% the next. I Have done full weeks with no testing just to breathe and catch up on stuff. In talking with my department head about the high demand for my assessment services (basically amounts to a public health crisis in my area) we have identified options other than me working harder for the same amount of money. One option is to adjust the testing practice and mission to be able to see more kiddos in the same amount of time (e.g., focus just on diagnosis and referral rather than diagnosis and treatment planning; focus just on younger kiddos who take less time). Other option is to do nothing different personally (ultimately, It's not my job to solve access to care issues by changing my schedule) other than focus on recruitment effort (that said- if any of you are licensed/eligible in MA and want a good gig, PM me). Me working more for the same amount of money never came up because a) my employer recognizes my value as well as the risks of losing one of the biggest producers in the company; and b) my employer recognizes that I'm not a fool and could leave tomorrow and generate revenue for somebody else if they treat me unfairly.
This response is probably my favorite mix of business advice, professional knowledge, and acknowledging that MA (and therefore the Red Sox) is bad.
 
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This response is probably my favorite mix of business advice, professional knowledge, and acknowledging that MA (and therefore the Red Sox) is bad.
Yes, but we’re the non-Boston part of the state! Yankees are my second favorite team, and I’ll root for them when they’re not playing the Sox. We don’t talk funny like our Boston brethren, and our largest group of descendants of a first wave immigrant group are stoic Poles vs. obnoxious Irish. Plus, we have really good asparagus for a few weeks each year. My wife’s a real estate agent- IM me and I’ll send you her number!

ETA- I don’t know if you’ve been paying attention lately, but the Red Sox are, in fact, objectively bad.
 
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PSYDR

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Yes, but we’re the non-Boston part of the state! Yankees are my second favorite team, and I’ll root for them when they’re not playing the Sox. We don’t talk funny like our Boston brethren, and our largest group of descendants of a first wave immigrant group are stoic Poles vs. obnoxious Irish. Plus, we have really good asparagus for a few weeks each year. My wife’s a real estate agent- IM me and I’ll send you her number!

ETA- I don’t know if you’ve been paying attention lately, but the Red Sox are, in fact, objectively bad.
So.... Martha Stewart, MA or Dunkin Donuts, MA?
 
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267033

See the attached map. I live at the border between the Hippie Farmers and Hippie Students, Was raised in the area of the "cultured hill folk," and work in the area of "blight and basketball." Though I stopped at dunkin donuts this morning on the way in, most in my town prefer to get their coffee at the local coffee house/communist book collective that just eliminated tipping, raised prices, and now pays a fair wage (plenty on-street and lot parking for your Prius, Subaru, or bio-diesel Mercedes!)
 
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Yes, but we’re the non-Boston part of the state! Yankees are my second favorite team, and I’ll root for them when they’re not playing the Sox. We don’t talk funny like our Boston brethren, and our largest group of descendants of a first wave immigrant group are stoic Poles vs. obnoxious Irish. Plus, we have really good asparagus for a few weeks each year. My wife’s a real estate agent- IM me and I’ll send you her number!

ETA- I don’t know if you’ve been paying attention lately, but the Red Sox are, in fact, objectively bad.
...you’re a Red Sox *AND* Yankees fan!? It doesn’t get any worse.

The only time I root for the Red Sox is when they’re playing the Yankees!

Mets 4 Life!

(yes, I realize how embarrassing that is)
 
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Sanman

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It's ok, Tebow is on the cusp of being called up, he'll turn things around..... If turning things around means striking out 2-3 times a game and straddling the Mendoza Line. John 3:16

I've said it once and I'll say it again, the problem with the Mets is the wrong drugs. The 86 Mets weren't on steroids and look how far it got them. Cocaine man...cocaine. I will always remember them for the two worst baseball games I ever has the displeasure of sitting through though.

Oh and the Red Sox suck! Yankees 4 life!

Ok, I'm done now...back to your regularly scheduled programming.
 
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I've said it once and I'll say it again, the problem with the Mets is the wrong drugs. The 86 Mets weren't on steroids and look how far it got them. Cocaine man...cocaine. I will always remember them for the two worst baseball games I ever has the displeasure of sitting through though.
You’re welcome...?

Oh and the Red Sox suck! Yankees 4 life!
I would just like to point out that the Mets are currently kicking the Yankees butts. And they didn’t even have to call up Tebow!

This will likely be the highlight of our season.
 

Therapist4Chnge

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...you’re a Red Sox *AND* Yankees fan!? It doesn’t get any worse.

The only time I root for the Red Sox is when they’re playing the Yankees!

Mets 4 Life!

(yes, I realize how embarrassing that is)
I’m a diehard Mets fan of 30+ years. They have the worst ownership in major sports and they continue to find new ways to disappoint the fanbase, but I come back every year hoping for a different result....
 
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I’m a diehard Mets fan of 30+ years. They have the worst ownership in major sports and they continue to find new ways to disappoint the fanbase, but I come back every year hoping for a different result....
And the training staff needs to be replaced. The constant rotation of injuries is absurd.

I've been a fan for the same amount of time actually. They get our hopes up each year and always break our hearts. Nobody Mets harder than the Mets. But they're my Mets and I love 'em. And 2015 was so magical, it'll probably sustain me for a few more years. Cheers!

267051
 
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Sanman

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Well then, I bet you eat your cauliflower crust pizza with tofurroni with a fork.
Great, not have me looking up what tofurroni is. There is only one way to eat pizza correctly....

How to Eat a Slice, aka 'The Fold Hold'


I’m a diehard Mets fan of 30+ years. They have the worst ownership in major sports and they continue to find new ways to disappoint the fanbase, but I come back every year hoping for a different result....
Excuse me, but James Dolan and the New York Knicks would like a word with you.
 
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Therapist4Chnge

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Excuse me, but James Dolan and the New York Knicks would like a word with you.
:laugh:

At least Dolan isn’t afraid of spending $. I view Dolan like Dan Snyder (WAS Redskins owner), he is meddlesome, but no one can claim he doesn’t spend money....he just does it really really badly. I will admit Dolan makes some horrible decisions....hiring Isiah Thomas as GM, more recently hiring Phil, and that Porzingas trade....franchise crippling. Being all in on Anthony AND Amare....those were brutal moves. You know...the more I think about it....Dolan is *really* bad too. I swore the Knicks off after the Isiah hiring. I was a lifelong fan....until that dumpster fire really picked up in the early ‘00s.
 
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Thank you very much for this reply. This has given me a great perspective when we are trying to advocate for ourselves here. I really appreciate it!
Sorry your thread has been hijacked by those rotten fans of New York sports teams (though I confess to encouraging them). I think you got some good advice regarding your OP, and now we're just trying to demonstrate the benefits of reasonable productivity expectations with some goofing off
 

MAClinician

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View attachment 267033

See the attached map. I live at the border between the Hippie Farmers and Hippie Students, Was raised in the area of the "cultured hill folk," and work in the area of "blight and basketball." Though I stopped at dunkin donuts this morning on the way in, most in my town prefer to get their coffee at the local coffee house/communist book collective that just eliminated tipping, raised prices, and now pays a fair wage (plenty on-street and lot parking for your Prius, Subaru, or bio-diesel Mercedes!)
Sooo accurate!! :laugh:
America runs in Dunkin!