Need some RVU job advice

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

rbsc

Full Member
7+ Year Member
Joined
Jan 26, 2016
Messages
19
Reaction score
0
Hi everyone. Will be finishing pain fellowship this June and need some quick job advice. Won't bore you with the details, it boils down to one thing I'm a bit clueless on. One has a higher base but bonus starts at higher RVU, specifically 8,892 (weird number, I know. don't know where it comes from). The other, lower base by about $25,000, but bonus starts at 7,000 RVU. Currently negotiating per RVU payment on both, but they'll probably end up pretty similar.

Here's what gets me. MGMA data says 6,484 is average RVU (2013 data). So based on the that the second job, bonus starting at 7,000, sounds like the way to go. But several people at the first job tell me they're at 12,000 plus RVU while working 8 to 4 for four days per week. Does that sound realistic? If 6,484 is the average I have trouble seeing that being true but two of them are somewhat friends and I'm hoping they wouldn't be straight up lying to me.

Thanks in advance, I appreciate any help you guys might be able to offer.

Members don't see this ad.
 
12,000 RVU might be possible but probably not joining a already existing group. They have that much unmet need with multiple existing doctors in the group?. They certainly would need to work more than that unless they are only doing injections or they have the worlds best scribes.
 
Last edited:
Members don't see this ad :)
12,000 RVU might be possible but probably not joining a already existing group. They have that much unmet need with multiple existing doctors in the group?. They certainly would need to work more than that unless they are only doing injections or they have the worlds best scribes.


Great point. I tried to spare you guys all the details but should have clarified that part.

The one with higher RVU base is a group that doesn't have a presence in the town I'm interested in. They have several clinics around the state but this would be new territory. So I would be solo essentially.

Other option is joining someone who does med management but doesn't do injections. She is very established in the area. My clinic would be about 30 miles from her base clinic but still well within her referral range.
 
stay clear of the med management office because you will be expected to do consults to generate procedures. Likely referral base is PCP dumps of opioids. For your sanity don't go there.
 
  • Like
Reactions: 1 user
stay clear of the med management office because you will be expected to do consults to generate procedures. Likely referral base is PCP dumps of opioids. For your sanity don't go there.

Ok, interesting take. Hadn't thought of it that way. Let me clarify to make sure we're on the same page. This doctor is PM&R so does med management plus in house PT. feels like a lot of his patients need injections and has to refer them out, and has wanted a partner who does injections for some time. So I was looking at it as built in referral base and a doctor they already know and trust referring them to me for injections. He doesn't care whether I do med management or not. Sounded like a good situation to me but I do see your point. Thanks so much.
 
Don't go to work for a non pain trained physiatrist.

Would that just bother you philosophically to work for that person, or is there a practical reason such as the one SpineBound mentioned?

Ok, so I guess if I gave a little detail it might help.

Offer one is the one with the established pain group who would be opening a clinic for me in this area. $400k (no benefits) the first year. Years two and three $400 base and anything over 750 RVU per month is paid at $45 per RVU (yeah, I know that's on the low side). After year three monthly RVU required goes down to 650 per month and paid at $55 per. This is an employed position with no partnership option. Two year non-compete with 25 mile radius.

Offer two is the one with the PM&R guy. Still negotiating base but it started at $375 and I asked for $400, waiting to hear back. Anything over 7,000 is paid at $55 per RVU. He originally offered a partnership arrangement but I was more comfortable with a known salary for the first year or so. I don't know what partnership would look like. And, yes, I know I need to know that before I sign anything but just don't know right now how it would look. I get the concern with the opioid referral dump, but isn't that a lot of our referrals these days? To me, this one makes more sense from that perspective as he would be sending me patients who he's already prescribing for, I'm just there for procedures. But he has also said if I'm having trouble generating the RVU's I want he would be fine with me doing med management also.

And I know neither of these are perfect offers, the other fellows have offers that a re a good deal better. But this is a town we've wanted to live in for a long time (pretty small town) and these are the only games in town. Short of taking out a loan and hanging out a shingle, I see no other option. And I don't have the nerve to do that.

Thanks, everyone.
 
Last edited:
Option C:

Hang your own shingle.

Option D:

Go to work for the local hospital.

My situation wasn't too much different from yours now that you gave more detail and I chose option D and have better deals than either of those.
 
Option C:

Hang your own shingle.

Option D:

Go to work for the local hospital.

My situation wasn't too much different from yours now that you gave more detail and I chose option D and have better deals than either of those.

Yeah, I tried that. They're not particularly motivated to do much pain, apparently. A hospital close by has two injection only guys who aren't well liked. That's why a few of us think this area is ripe for the picking, but these appear to be my options for now.

Terrified to hang out a shingle and don't have any cash flow to support doing that.

Do either of these seem just flat out terrible, or just not great?
 
Or partnership with the pain group.You are their peers and will bring significant revenue because this is new underse

Don't be the employee of a pill mill.

The local hospital will be willing to match or beat pm&r guys offer. With more referrals than just one person.

Look at the map and see exactly how much territory you have. I am over 45 miles from the nearest board certified pain Doctor in one direction and maybe 150 miles in any other direction.
 
Need to see what pmr doctor feels about opioids for sure. Perhaps he doesn't prescribe opioids? In that case, this option would be much more appealing, esp if partnership is open in a year
 
Need to see what pmr doctor feels about opioids for sure. Perhaps he doesn't prescribe opioids? In that case, this option would be much more appealing, esp if partnership is open in a year

He does prescribe so I get the pill mill concern. Don't think that's the case, but I felt better about this as I'm being asked to be the injection. You guys all seem to agree that this sounds less than ideal, so clearly I'm missing something.
 
Last edited:
Members don't see this ad :)
Do either of these seem just flat out terrible, or just not great?

400K/year just starting out is a great offer. take the one with the higher guaranteed base. odds are you wont be at your first job in a year or 2 anyway. make sure you dont have a restrictive covenant, or at least a reasonable one. i dont se ehow a non-interventional PMR guy can make the sort of money you are talking about without a high volume opioid-based practice. this job must be somewhere in BFE with the numbers you are talking about.
 
  • Like
Reactions: 1 user
400k with established group sounds loads better. With the PMR solo guy you will have to build infrastructure, select and buy supplies, RFA/autoclave/fluoroscope, billing, train staff, etc. You need to see what his patients are on; ultram TID is very different than oxy 30 6/day. The latter patients never improve with injections; TRUST ME!!!

A few other factors to consider:
building something with the PMR guy could be awesome because you can buy what you like and do things as you see fit. Joining the established group means you will use what they use and they will likely resist your new ideas. Ask them how many RFA cannulas you will be allowed per case, or how many spinal needles allowed for MBB. Ask them if you burn 4 nerves how many RFA codes will be billed. If established group's setup is different than you prefer than look at the other option.

Also, don't take job advise from this board!!!! I was advised to take the job closer to where I live but am miserable there because of high overhead, mediCal patients with crappy payers and addicted, forcing me to see a high volume of patients who I don't want to see at all.
 
Last edited by a moderator:
If PMR guy really thinks his patients need injections he should still refer to you as the only game in town even if you aren't his employee.
 
  • Like
Reactions: 1 user
This is great advice, and much appreciated. I was taking the other perspective and thinking there would be more pressure to over prescribe or push for procedures for the higher RVU base, but it sounds like you guys think those RVUs aren't unreasonable.

So if those RVU's sound reasonable the second option might be the better choice. The PMR has offered to hire a consultant but you guys are right, there would still be a ton of things to sort out that would be done for me with the other guy. Oh, and by the way, the established group guy doesn't make you pinch pinkies with needles and such. He actually hires an MA to help make your charting easier so you can concentrate on the exam.

Thanks again!
 
Last edited:
This is great advice, and much appreciated. I was taking the other perspective and thinking there would be more pressure to over prescribe or push for procedures for the higher RVU base, but it sounds like you guys think those RVUs aren't unreasonable.

I actually worked for the guy in the established group before. I did pain for a year before deciding I needed to go and do a fellowship. I didn't love how he practiced (gave people too many chances for opioid violations, mainly) but I have been assured by all of his group (one of whom is a good friend) that he does not in any way influence the way the practice. So if 9000 RVU sounds reasonable he might be the better choice. The PMR has offered to hire a consultant but you guys are right, there would still be a ton of things to sort out that would be done for me with the other guy. Oh, and by the way, the established group guy doesn't make you pinch pinkies with needles and such. He actually hires an MA to help make your charting easier so you can concentrate on the exam.

Thanks again!

"Pinch pinkies", nice. Pinch pennies.
 
You want to be a partner with that group. You are going to be running an office by yourself.

I know, man, but he won't budge. That's his offer. He says his people make make 600 working four days per week after three years and he sees no reason to sweeten the pot.
 
Ok that is fine. I thought you were getting in a situation where there were multiple partners not one boss.
 
can I ask which general part of the world you will be working, and if this is urban, suburban or BFE?
 
Ok that is fine. I thought you were getting in a situation where there were multiple partners not one boss.

I see. Two guys started the group and are the only true partners. Everyone else (six or seven total spread across three clinics) has the same deal I detailed.
 
can I ask which general part of the world you will be working, and if this is urban, suburban or BFE?

It's in the south. Definitely not BFE, very desirable area for anyone who doesn't need to be in a big city necessarily. So let's call it suburban.
 
whats the up to date MGMA median hi and low RVU look like??
 
375k to 400k base is pretty sweet --- it is about 25%th for MGMA nationally

never work for somebody who will not offer partnership.... those arrangements never lead to happiness...
 
375k to 400k base is pretty sweet --- it is about 25%th for MGMA nationally

never work for somebody who will not offer partnership.... those arrangements never lead to happiness...

I hear ya'. Tough situation. He won't budge and it's where my family and I want to be. But it does bother me.
 
You need to sit down with the CEO for the hospital and show him how much money they will make off of every injection.
 
You need to sit down with the CEO for the hospital and show him how much money they will make off of every injection.

Not a bad thought. I left two voice mails and sent two emails to their physician recruiter and never heard back. I guess at this stage in the game starting something new seems a bit scary. The established group guy wants to hear something soon.
 
375k to 400k base is pretty sweet --- it is about 25%th for MGMA nationally

never work for somebody who will not offer partnership.... those arrangements never lead to happiness...
Is thr median that high? Just 3 years ago, i remenber it being $350k...
 
Ok, sorry to throw a whole new scenario at you guys, but your responses got me thinking. I've had this other offer for a while but don't know what to make of these numbers so I had sort of put it out of my mind. So, here goes.

Guaranteed base of $400 for first two years. Bonus based on revenue, not in RVU, so that's where I'm lost.

First year bonus is 15% of revenue between 900k and 1.5 million. 20% of anything over 1.5. Second year add five percent to each of those.

This one comes with an option to buy the practice after four or five years. I don't know those terms and that would obviously be a key piece of info, I'm going to get more details this weekend.

For now, are these numbers reasonable? I have no idea whether that's an unattainable revenue number or completely reasonable.

As always, thanks for your help.
 
devil is in the details. collecting 1.5 mil requires great contracts. which you may indeed have in your area. too many variables.
 
base seems relatively high- would not count on achieving bonus. Thats probably why base is high. Could negotiate better bonus w loer base then bonus may be achievable. You have to pick the priority- is it salary guarantee w/o likeliness of getting bonus or would you rather try to achieve bonuses based on lower collections which would mean a lower base.
 
devil is in the details. collecting 1.5 mil requires great contracts. which you may indeed have in your area. too many variables.

Thanks. Asked for details and waiting to hear back.
 
base seems relatively high- would not count on achieving bonus. Thats probably why base is high. Could negotiate better bonus w loer base then bonus may be achievable. You have to pick the priority- is it salary guarantee w/o likeliness of getting bonus or would you rather try to achieve bonuses based on lower collections which would mean a lower base.

Thanks. That's what I figured. The salary gets really good at the higher RVU's, but I wasn't sure how realistic 12000 or so was.
 
when we are talking about RVUs in terms of physician compensation, are we talking about workRVU or total RVU?
 
First year bonus is 15% of revenue between 900k and 1.5 million. 20% of anything over 1.5. Second year add five percent to each of those.

I am in a similar situation, where I will soon he negotiating for a position that determines bonus based in total revenue rather than RVU. Seems like there's consensus that ~$50/RVU is a fair target, but does anyone have any advice as to what is a fair target when creating a bonus structure based on total revenue? What should the percentages be and what should the cutoffs be?


Sent from my iPhone using SDN mobile
 
Bump

Can you guys please help me please?

2018 mgma says median work rvus is around 6500

How much do you guys usually generate working a full 5 day per week schedule?

Is that 6500 number seem low?
 
Thanks. That's what I figured. The salary gets really good at the higher RVU's, but I wasn't sure how realistic 12000 or so was.
I would love to see a system where you generate 12000 wrvu per year by working 4 eight hour days per week. I will seriously question the quality of patient care provided.
 
its called being a needle jockey.

technically, by doing 4 procedures per hour, all ESI, 8 hours a day, 4 days a week, 48 weeks a year, one gets 11059 wRVU per year.
since there is a 1% chance of vasovagal reaction, do conscious sedation on all of them, and can add 1536 wRVU for grand total of 12,595 wRVU per year.


and best part, dont have to say a word to a patient.... ever...
 
its called being a needle jockey.

technically, by doing 4 procedures per hour, all ESI, 8 hours a day, 4 days a week, 48 weeks a year, one gets 11059 wRVU per year.
since there is a 1% chance of vasovagal reaction, do conscious sedation on all of them, and can add 1536 wRVU for grand total of 12,595 wRVU per year.


and best part, dont have to say a word to a patient.... ever...
who can consciously do this
 
1000 wrvu a month really isn’t that hard, I hit this number, and I don’t over inject.

Again, you’re doing a combination of things procedurally. ESIs are only worth 1.8 wrvu, but a b/l lmbb or cmbb is basically 5-6. For the same amount of time. And then of course SCS trials are ~15. So combination of procedures, plus a busy office, 12k wrvu in a year isn’t that difficult honestly
 
1000 wrvu a month really isn’t that hard, I hit this number, and I don’t over inject.

Again, you’re doing a combination of things procedurally. ESIs are only worth 1.8 wrvu, but a b/l lmbb or cmbb is basically 5-6. For the same amount of time. And then of course SCS trials are ~15. So combination of procedures, plus a busy office, 12k wrvu in a year isn’t that difficult honestly
it is if you are actually seeing the patient. someone else has to evaluate the patient, decide on which procedure, follow up on the results of the procedure and decide on the next one. if it was so easy to do 12k wRVU, then why is it that only the top 0.5% of pain doctors get to that height? are the rest of us sooo lazy?



my understanding was that MBBs are 1.5 for first level, 1 for additional level, the mod -50 pays 150% of the original, so 2.5 x 150% or 3.75 wRVU (which is about a single level RFA)
 
Top