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Ducttape said:
actually, when i look closely at the graph, i stand corrected.

this is a structured contract at which he is salaried up until 7300 wRVU. after 7300 wRVU, he is contracted for $60/wRVU.

his base salary is $448K, which is average.

the expectation that he signed was that he would do more then 7300 wRVU.

why should he get paid more if he is doing less work than he agreed to?
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Correct. His contract is NOT bad for HIM. I think it's bad for the hospital TBH. If I was on that contract I'd blow it up for 5 or 6 yrs and do 11k RVU, then back it down to 3d per week.
 
Ducttape said:
actually, when i look closely at the graph, i stand corrected.

this is a structured contract at which he is salaried up until 7300 wRVU. after 7300 wRVU, he is contracted for $60/wRVU.

his base salary is $448K, which is average.

the expectation that he signed was that he would do more then 7300 wRVU.

why should he get paid more if he is doing less work than he agreed to?
Click to expand...
from my understanding of reading the twitter post, his base salary is 390k. his numbers include his metric bonus from last year I'm guessing.

he gets $35/wRVU above 7300 - he's not contracted at $60/wRVU
 
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Ducttape said:
actually, when i look closely at the graph, i stand corrected.

this is a structured contract at which he is salaried up until 7300 wRVU. after 7300 wRVU, he is contracted for $60/wRVU.

his base salary is $448K, which is average.

the expectation that he signed was that he would do more then 7300 wRVU.

why should he get paid more if he is doing less work than he agreed to?
Click to expand...

They will never love you back. Is the hospital CEO paid less for doing more work? The design is intentional, not accidental.
 
er, um...

it depends on his contract. if those are predetermined contract numbers, then yes, he is getting less pay for wRVU past 7300. but... if he may have a base salary with $60/wRVU bonus. that is a common contract. and in that case, the numbers are much closer.


i think most HOPD docs realize that that there is the magic number of diminishing returns where the benefits (extra money) are not commensurate with the extra time and effort spent.

but at that minimum of 7300, i believe that his salary requires he bill in amounts of the upper third of pain docs.
 
Ducttape said:
er, um...

it depends on his contract. if those are predetermined contract numbers, then yes, he is getting less pay for wRVU past 7300. but... if he may have a base salary with $60/wRVU bonus. that is a common contract. and in that case, the numbers are much closer.


i think most HOPD docs realize that that there is the magic number of diminishing returns where the benefits (extra money) are not commensurate with the extra time and effort spent.

but at that minimum of 7300, i believe that his salary requires he bill in amounts of the upper third of pain docs.
Click to expand...

Show me your spreadsheets and I'll show you your values. A compensation scheme that intrinsically misvalues physician labor by rewarding LESS for doing MORE speaks volumes. If you're HOPD-MD cranking on the SOS and facility fees, you should be rewarded by taking home MORE comp not LESS.

1647883519308.png
 
this is deceptive in its presentation.

this graph shows that a business - HOPD or PP employer - wants to guarantee a minimum amount of work. the sweet spot for the business is where they set rvus for salary.

this graph is consistent with all contracts that are salaried with a set bonus/rvu.

and yes, there is a sweet spot where it does not behoove the doc to work over, which im betting all employed physicians figure out.
 
Ducttape said:
this is deceptive in its presentation.

this graph shows that a business - HOPD or PP employer - wants to guarantee a minimum amount of work. the sweet spot for the business is where they set rvus for salary.

this graph is consistent with all contracts that are salaried with a set bonus/rvu.

and yes, there is a sweet spot where it does not behoove the doc to work over, which im betting all employed physicians figure out.
Click to expand...

I doubt the graph accurately reflects the contract. ADDITIONAL wRVUs over a threshold probably are worth less per wRVU, but it would be crazy to decrease the value of ALL wRVUs as the doc does more work.
 
$350K base with production after 6500/yr wRVU threshold - conv. factor $55/wRVU - where does this fall on the MGMA percentile grid for non anesthesia Pain?
 
Analgesia108 said:
$350K base with production after 6500/yr wRVU threshold - conv. factor $55/wRVU - where does this fall on the MGMA percentile grid for non anesthesia Pain?
Click to expand...
Nationwide median from 2021 (2020 data) is $78/wRVU

$55/wRVU is just below 10th percentile ($58)
 
Analgesia108 said:
$350K base with production after 6500/yr wRVU threshold - conv. factor $55/wRVU - where does this fall on the MGMA percentile grid for non anesthesia Pain?
Click to expand...
If you haven't done the math, those first 6500 wRVUs are only paying out at $53.85/wRVU.
 
Ducttape said:
this is deceptive in its presentation.

this graph shows that a business - HOPD or PP employer - wants to guarantee a minimum amount of work. the sweet spot for the business is where they set rvus for salary.

this graph is consistent with all contracts that are salaried with a set bonus/rvu.

and yes, there is a sweet spot where it does not behoove the doc to work over, which im betting all employed physicians figure out.
Click to expand...

Why are you defending paying less and less to doctors who work more and more?
 
i am clearing up presented data that is being misconstrued and weaponized.



(fyi your statement "paying less and less" is also a misconception. the take home pay continues to go up as physicians work more. what you mean to say is that the $/wRVU - the amount of $ per work - goes down with more work, and there is no argument on that effect).
 
Ducttape said:
i am clearing up presented data that is being misconstrued and weaponized.



(fyi your statement "paying less and less" is also a misconception. the take home pay continues to go up as physicians work more. what you mean to say is that the $/wRVU - the amount of $ per work - goes down with more work, and there is no argument on that effect).
Click to expand...
I don’t really see the problem with that pay structure - it’s the free market at work. The hospital offering that structure has decided that they want slightly above average productivity for slightly below average pay. If a job seeker is willing to accept that pay for that locality, they will be successful. Sure, the whole site of service system may be corrupt, and the incentive to not be too busy seems perverse to those of us in private practice, but the guy posting that wage scale is currently working that job.
 
That contract looks bad if you look at it in the same way most Americans read the news.

It isn't terrible. He can do 3d a week and make almost 500k. Alternatively, he can work really hard and make a lot more than 500k.
 
MitchLevi said:
That contract looks bad if you look at it in the same way most Americans read the news.

It isn't terrible. He can do 3d a week and make almost 500k. Alternatively, he can work really hard and make a lot more than 500k.
Click to expand...
Agree. One has freedom to accept the terms. The doc is only grossly illogical if (s)he chooses to crank out 9000+ RVUs in this model.

There are many great studies regarding how humans are illogical, despite thinking otherwise.

Headlines and infographics usually don't tell the story.
 
cowboydoc said:
Agree. One has freedom to accept the terms. The doc is only grossly illogical if (s)he chooses to crank out 9000+ RVUs in this model.

There are many great studies regarding how humans are illogical, despite thinking otherwise.

Headlines and infographics usually don't tell the story.
Click to expand...
This agreement we have right now is immensely heart warming and sublime. Have a good day friend. Truly...
 
myrandom2003 said:
$100/wrvu flat then drops to $75/wrvu for everything after first 5000. patient service agreement between my private practice and hospital.
I take my cases to the hospital.
I cover all my overhead and expenses.
Click to expand...
So for 5000 RVUs, how much would your overhead/expenses be? How much would you net?
 
MitchLevi said:
That contract looks bad if you look at it in the same way most Americans read the news.

It isn't terrible. He can do 3d a week and make almost 500k. Alternatively, he can work really hard and make a lot more than 500k.
Click to expand...
no hospital allows you to work 3 days a week - they want ACCESS for patients so he has to be there 5 days a week

this doc gets $35/wRVU above 7300 wRVUs. he's not going to be banking much above that 7800 mark no matter how hard he works.
 
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PainDoc2025 said:
So for 5000 RVUs, how much would your overhead/expenses be? How much would you net?
Click to expand...
rent $60k
staff $70kish(i have biller, MA, front desk)
EMR is $10k
- i bill insurance, i collect from insurance. I give the hospital what I collect, and they pay me back in the value for the wrvu. If i collect more than what they were going to pay me, I keep the difference. If I collect less than what they pay me, they eat the difference.
(i have additional overhead but thats just me taking advantage of the "business expense write off")
 
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DOctorJay said:
no hospital allows you to work 3 days a week - they want ACCESS for patients so he has to be there 5 days a week

this doc gets $35/wRVU above 7800 wRVUs. he's not going to be banking much above that 7800 mark no matter how hard he works.
Click to expand...
I work 4-4.5 days/week, take vacation and days off when I want. I say (don't ask) when I work. I bet could work 3 days a week if I wanted to, but I do over 9000 RVU, I am self-motivated and I make them a mint. They seem to want access, but need more staff if they don't have it. If they REALLY wanted access, they wouldn't place such a disincentive on seeing more patients!
 
i would like to see his specific contract, because what is standard is getting $60/wRVU. im guessing the curve flattens out so that he ends up getting that after 7800 wRVU
 
Ducttape said:
i am clearing up presented data that is being misconstrued and weaponized.



(fyi your statement "paying less and less" is also a misconception. the take home pay continues to go up as physicians work more. what you mean to say is that the $/wRVU - the amount of $ per work - goes down with more work, and there is no argument on that effect).
Click to expand...

You can’t make it different than what it is: It’s a comp model that misvalues physician labor by paying less and less money for more and more work. No one worked their ass off getting into medical school to be treated that way. Does the hospital CEO get paid like a depreciating factory worker too?
 
It's a great contract for those looking to do small amounts of work and those who have families.
 
I work 4 days a week. Never been an issue. I have exceeded 10k wrvu/year since 2018.
 
drusso said:
You can’t make it different than what it is: It’s a comp model that misvalues physician labor by paying less and less money for more and more work. No one worked their ass off getting into medical school to be treated that way. Does the hospital CEO get paid like a depreciating factory worker too?
Click to expand...
you know that is not entirely accurate.

the typical contract is RVU bonus with a base salary or straight rvu model

if they were on a pure RVU contract at $60/wRVU, they would make exactly the same amount of money at amounts over base of those other contracts.

now if he doesnt have a standard salary + rvu bonus salary - well, he is screwing himself over and should insist on switching.
 
DOctorJay said:
Nationwide median from 2021 (2020 data) is $78/wRVU

$55/wRVU is just below 10th percentile ($58)
Click to expand...

I saw this same stat and speaking with friends interviewing around the country i haven’t heard of any place offering >$70/wrvu.

I wonder where these $78 or higher jobs are.
 
My contract is based off of mgma and set at the median. Average rvus went down and average salary and 90% salaries are both up. So was a decent year after several crappy ones.
 
Laryngospasm said:
My contract is based off of mgma and set at the median. Average rvus went down and average salary and 90% salaries are both up. So was a decent year after several crappy ones.
Click to expand...
Is it common for most contracts to be based off MGMA? Is your base salary set at the median or your total compensation after RVUs/bonuses etc?
 
yes common. Base at median. Bonuses above median rvus at rate of median mgma per rvu.
 
Ducttape said:
actually, when i look closely at the graph, i stand corrected.

this is a structured contract at which he is salaried up until 7300 wRVU. after 7300 wRVU, he is contracted for $60/wRVU.

his base salary is $448K, which is average.

the expectation that he signed was that he would do more then 7300 wRVU.

why should he get paid more if he is doing less work than he agreed to?
Click to expand...

so I am clear, when people are discussing this. would benefits be on top of this money? when we are discussing salary, are people saying this is W2 work?

I always get confused. I was under assumption mgma is total compensation. thanks
 
oreosandsake said:
still confused.

total cash, excludes benefits?
Click to expand...
i looked it up

Total Compensation: The amount reported as direct compensation on a W2, 1099, or K1 (for partnerships) plus all voluntary salary reductions such as 401(k), 403(b), Section 125 Tax Savings Plan, and Medical Savings Plan.
 
oreosandsake said:
i looked it up

Total Compensation: The amount reported as direct compensation on a W2, 1099, or K1 (for partnerships) plus all voluntary salary reductions such as 401(k), 403(b), Section 125 Tax Savings Plan, and Medical Savings Plan.
Click to expand...
Yes. The new data is published in late summer/early fall per my source.
 
Laryngospasm said:
yes common. Base at median. Bonuses above median rvus at rate of median mgma per rvu.
Click to expand...
If you don’t mind me asking what is the median wRVU value for pain these days?

My hospital hasn’t honored the increase payment in E/M codes by CMS last year. Rumor has it they will starting next year but will also cut our $/wRVU to compensate for it. Pretty dirty
 
Many hospitals froze wrvu values from 2020.
This is because since 2021 Medicare increased cpt/wrvu values but decreased the $/wrvu value. They did not like paying more for less. I don’t think they will change anything unless there is an appropriate cut elsewhere.
 
myrandom2003 said:
Many hospitals froze wrvu values from 2020.
This is because since 2021 Medicare increased cpt/wrvu values but decreased the $/wrvu value. They did not like paying more for less. I don’t think they will change anything unless there is an appropriate cut elsewhere.
Click to expand...
indeed, but will use thresholds from 19. ammo for russo
 
I assume the MGMA RVU is before overhead, right?
 
Another data point for y'all...midwest community hospital based practice.

450k salary
6000 wRVU target
$70/wRVU above target

Another example of regressive pay for increased work. At target you're doing $75/wRVU, but drops to $70 for every wRVU thereafter. Upside is no official "draw" language if you're below target, but I suspect they would implicitly or explicitly encourage you to get up to target at least.
 
le pain quotidien said:
Another data point for y'all...midwest community hospital based practice.

450k salary
6000 wRVU target
$70/wRVU above target

Another example of regressive pay for increased work. At target you're doing $75/wRVU, but drops to $70 for every wRVU thereafter. Upside is no official "draw" language if you're below target, but I suspect they would implicitly or explicitly encourage you to get up to target at least.
Click to expand...
That's a nice 3 day a week gig. (2 days for the real ballas)
 
le pain quotidien said:
Another data point for y'all...midwest community hospital based practice.

450k salary
6000 wRVU target
$70/wRVU above target

Another example of regressive pay for increased work. At target you're doing $75/wRVU, but drops to $70 for every wRVU thereafter. Upside is no official "draw" language if you're below target, but I suspect they would implicitly or explicitly encourage you to get up to target at least.
Click to expand...
In office or asc?
 
cowboydoc said:
That's a nice 3 day a week gig. (2 days for the real ballas)
Click to expand...
le pain quotidien said:
Another data point for y'all...midwest community hospital based practice.

450k salary
6000 wRVU target
$70/wRVU above target

Another example of regressive pay for increased work. At target you're doing $75/wRVU, but drops to $70 for every wRVU thereafter. Upside is no official "draw" language if you're below target, but I suspect they would implicitly or explicitly encourage you to get up to target at least.
Click to expand...
So what happens when you hit your RVU target? take the rest of the year off?
Do you just do 8-2pm M-Th?
Seems stupid to disincentivize your production.
 
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