$ per RVU

Panacea Financial Contract Review
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First off, nobody in anesthesia says RVU. What region are you looking in. As mentioned above, unit values for private payers vary greatly by region. The SE tends to have rates way higher than you see in the W for instance. As a West Coast guy, here is my general breakdown:

< 30$/unit = canine feces (like literally, I'm not getting outta bed for this)

30-35$/unit = LOUSY

35-40$/unit = Eh

40-45$/unit = pretty good, now we're talkin'

45-50$/unit = Yeah boy

>50$/unit =
891.jpg


Working solo MD, you will generate 10-15K units/year. 10K would be pretty mellow like 40hr/wk. 12K pretty average schedule about 45-50hr/wk. 15K would be really bustin' your nuts 60hr/wk. The exception would be if your doing a lot of high value cases like cardiac/thoracic or high volume ortho with lots of blocks. Blended unit value x units/year = total pre-tax income which you then have to deduct all expenses from like billing, insurance, yada, yada, yada.
 
SaltyDog said:
First off, nobody in anesthesia says RVU. What region are you looking in. As mentioned above, unit values for private payers vary greatly by region. The SE tends to have rates way higher than you see in the W for instance. As a West Coast guy, here is my general breakdown:

< 30$/unit = canine feces (like literally, I'm not getting outta bed for this)

30-35$/unit = LOUSY

35-40$/unit = Eh

40-45$/unit = pretty good, now we're talkin'

45-50$/unit = Yeah boy

>50$/unit =


Working solo MD, you will generate 10-15K units/year. 10K would be pretty mellow like 40hr/wk. 12K pretty average schedule about 45-50hr/wk. 15K would be really bustin' your nuts 60hr/wk. The exception would be if your doing a lot of high value cases like cardiac/thoracic or high volume ortho with lots of blocks. Blended unit value x units/year = total pre-tax income which you then have to deduct all expenses from like billing, insurance, yada, yada, yada.
Click to expand...

So people say it's bad to talk about salary during initial interviews with a group. What about asking about their blended unit value? Is that kosher?
 
SaltyDog said:
First off, nobody in anesthesia says RVU. What region are you looking in. As mentioned above, unit values for private payers vary greatly by region. The SE tends to have rates way higher than you see in the W for instance. As a West Coast guy, here is my general breakdown:

< 30$/unit = canine feces (like literally, I'm not getting outta bed for this)

30-35$/unit = LOUSY

35-40$/unit = Eh

40-45$/unit = pretty good, now we're talkin'

45-50$/unit = Yeah boy

>50$/unit =
891.jpg


Working solo MD, you will generate 10-15K units/year. 10K would be pretty mellow like 40hr/wk. 12K pretty average schedule about 45-50hr/wk. 15K would be really bustin' your nuts 60hr/wk. The exception would be if your doing a lot of high value cases like cardiac/thoracic or high volume ortho with lots of blocks. Blended unit value x units/year = total pre-tax income which you then have to deduct all expenses from like billing, insurance, yada, yada, yada.
Click to expand...

$50 per unit?!.....I'm like......

 
0kazak1 said:
So people say it's bad to talk about salary during initial interviews with a group. What about asking about their blended unit value? Is that kosher?
Click to expand...
If you can't talk salary during an initial interview, when are you supposed to?

Maybe not the phone call, but I'd imagine if you're visiting a group, salary should be fair game.
 
0kazak1 said:
So people say it's bad to talk about salary during initial interviews with a group. What about asking about their blended unit value? Is that kosher?
Click to expand...

Ronin786 said:
If you can't talk salary during an initial interview, when are you supposed to?

Maybe not the phone call, but I'd imagine if you're visiting a group, salary should be fair game.
Click to expand...

I think perhaps the advice to not talk about salary during an interview maybe got a little outta hand. I think the main thing is to not seem overly preoccupied with salary. So many things are more important at the end of the day. I know it's hard to imagine as a resident, but once you're at attending level income, you barely even feel a difference of say 20k/year. After taxes that's maaaaaybe 1k/month - not gonna make or break or you. The daily work environment is so much more important.

In my experience, groups (the ones you wanna work for) are usually fairly upfront about expected salary. More often than not, they will give you at least a ballpark. If they don't mention it at all, I think it's ok to tactfully ask, but if they are being coy don't push it. Now, once a job offer is made, then there should be full disclosure. You should know exactly what a realistic salary will be, and this is the time to negotiate as well. Please don't try to negotiate anything before you've even been offered a position.

When it comes to blended unit value, if the group pays on a blended unit production based scheme, then it's relevant to have an idea what it is (if that's not how they pay themselves, then it's not super relevant). Again, on interview day usually someone will throw out a ballpark figure. They may also keep that info close to the vest, as they probably don't want the group down the street to know what it is. With regards to asking, see above. There are sly ways to ask about unit value though - things like "What percentage of MediCare do you guys see? How much trauma/indigent care? Etc, etc."
 
Last edited by a moderator:
User21218 said:
Where in the US can you make $50/RVU. Anywhere outside BFE?
Click to expand...

Your contracted commercial insurance rates should exceed 50$. Yes, even out West. Guys in the Southeast talk about rates approaching and sometimes exceeding $100 :wideyed::wideyed:.

After that, it's all about payer mix. Find a hospital in a nice part of town. Suburbia. Somewhere where the surrounding neighborhoods are full of working middle class families - not homeless drug addicts or octogenarians. Lots of ASC work, insured high volume OB. In places like this, it isn't hard to get close to $50/unit.

Unit values tend not to be high in BFE. In fact, often times they are very low. But, the hospital is desperate for warm bodies who want to live/work there, so the throw huge $$ at the docs in the form of stipends. Being reliant on a big stipend is a double edged sword.
 
SaltyDog said:
Oooooooh! What happened??
Click to expand...

They discovered that they’re really only a 600 pound gorilla and they got dropped by some carriers as preferred providers. Oops. There’s a lot of competition in Boston, so that wasn’t necessarily the best play.
A large carrier threatened to drop us a few years ago because we wouldn’t accept their cut rate offer and the Hospital said to go ahead. Where are your sick and complex kids going to get care? At the community hospital? Drive a few hours in hellish traffic to another metropolitan area children’s hospital?
They played hard ball, press releases that the company was going to make us an out of network facility, bills would go up dramatically, etc. Families freaked out. The insurance company blinked and we all bought Mercedes. Well I did.
#800PoundGorilla


--
Il Destriero
 
IlDestriero said:
They discovered that they’re really only a 600 pound gorilla and they got dropped by some carriers as preferred providers. Oops. There’s a lot of competition in Boston, so that wasn’t necessarily the best play.
A large carrier threatened to drop us a few years ago because we wouldn’t accept their cut rate offer and the Hospital said to go ahead. Where are your sick and complex kids going to get care? At the community hospital? Drive a few hours in hellish traffic to another metropolitan area children’s hospital?
They played hard ball, press releases that the company was going to make us an out of network facility, bills would go up dramatically, etc. Families freaked out. The insurance company blinked and we all bought Mercedes. Well I did.
#800PoundGorilla


--
Il Destriero
Click to expand...

When you got them by the balls you should squeeze harder.

Maybe you'd have a Bentley instead.
 
SaltyDog said:
I think perhaps the advice to not talk about salary during an interview maybe got a little outta hand. I think the main thing is to not seem overly preoccupied with salary. So many things are more important at the end of the day. I know it's hard to imagine as a resident, but once you're at attending level income, you barely even feel a difference of say 20k/year. After taxes that's maaaaaybe 1k/month - not gonna make or break or you. The daily work environment is so much more important.

In my experience, groups (the ones you wanna work for) are usually fairly upfront about expected salary. More often than not, they will give you at least a ballpark. If they don't mention it at all, I think it's ok to tactfully ask, but if they are being coy don't push it. Now, once a job offer is made, then there should be full disclosure. You should know exactly what a realistic salary will be, and this is the time to negotiate as well. Please don't try to negotiate anything before you've even been offered a position.

When it comes to blended unit value, if the group pays on a blended unit production based scheme, then it's relevant to have an idea what it is (if that's not how they pay themselves, then it's not super relevant). Again, on interview day usually someone will throw out a ballpark figure. They may also keep that info close to the vest, as they probably don't want the group down the street to know what it is. With regards to asking, see above. There are sky ways to ask about unit value though - things like "What percentage of MediCare do you guys see? How much trauma/indigent care? Etc, etc."
Click to expand...
SaltyDog said:
I think perhaps the advice to not talk about salary during an interview maybe got a little outta hand. I think the main thing is to not seem overly preoccupied with salary. So many things are more important at the end of the day. I know it's hard to imagine as a resident, but once you're at attending level income, you barely even feel a difference of say 20k/year. After taxes that's maaaaaybe 1k/month - not gonna make or break or you. The daily work environment is so much more important.

In my experience, groups (the ones you wanna work for) are usually fairly upfront about expected salary. More often than not, they will give you at least a ballpark. If they don't mention it at all, I think it's ok to tactfully ask, but if they are being coy don't push it. Now, once a job offer is made, then there should be full disclosure. You should know exactly what a realistic salary will be, and this is the time to negotiate as well. Please don't try to negotiate anything before you've even been offered a position.

When it comes to blended unit value, if the group pays on a blended unit production based scheme, then it's relevant to have an idea what it is (if that's not how they pay themselves, then it's not super relevant). Again, on interview day usually someone will throw out a ballpark figure. They may also keep that info close to the vest, as they probably don't want the group down the street to know what it is. With regards to asking, see above. There are sky ways to ask about unit value though - things like "What percentage of MediCare do you guys see? How much trauma/indigent care? Etc, etc."
Click to expand...
now that is a solid post right there chaps.
The “don’t ask salary” bull crap definitely got blown out of proportion. Generally, a group that is interested in a candidate will bring it up later in the interview. Usually as the day ends or at dinner. If it is a private group they will blow smoke somewhat and inflate the numbers. If it is an employed group, they will tell you to the “T”. The po8nt is, don’t go in there worried about the money only. There is so much more to worry about that makes a job a good one or bad one.
 
chocomorsel said:
Practice makes perfect!! I try to improve my moves when I don't know what I am doing.
Click to expand...
Well I know when I’m fighting s losing battle.
Maybe you can teach me someday but you are going to have to get me real f’in drunk first. And at the current level of my ETOH tolerance, that’s going to be nearly impossible.
 
Noyac said:
Well I know when I’m fighting s losing battle.
Maybe you can teach me someday but you are going to have to get me real f’in drunk first. And at the current level of my ETOH tolerance, that’s going to be nearly impossible.
Click to expand...
It's a date. One day you will learn to move those hips and dance the Lingala/Ndombolo!!
 
SaltyDog said:
Your contracted commercial insurance rates should exceed 50$. Yes, even out West. Guys in the Southeast talk about rates approaching and sometimes exceeding $100 :wideyed::wideyed:.

After that, it's all about payer mix. Find a hospital in a nice part of town. Suburbia. Somewhere where the surrounding neighborhoods are full of working middle class families - not homeless drug addicts or octogenarians. Lots of ASC work, insured high volume OB. In places like this, it isn't hard to get close to $50/unit.

Unit values tend not to be high in BFE. In fact, often times they are very low. But, the hospital is desperate for warm bodies who want to live/work there, so the throw huge $$ at the docs in the form of stipends. Being reliant on a big stipend is a double edged sword.
Click to expand...

Isn't medicare around $36/RVU and private insurance +20% (so around $43/RVU)? Hard to see how anyone can get up to $50 given that the majority of patients needing anesthesia are typically medicare. Most practices will also have some degree of medicaid and self -pay (no-pay), which will further dilute average RVU.

Problem with finding a job in desirable suburbia is saturation so hospitals/practices can low-ball physicians in general despite the better payor-mix. My friend who is in anesthesia was making about 25% more in BFE (economically depressed WV despite lousy payor mix) versus upper class suburbs on Long Island, NY. Much more vacation time as well in WV
 
My billing people in Vegas told me that Medicare and Medicaid paid about the same. Around $20-22 a unit. If it was $36 I would have been making a ton more money.
 
vm26 said:
Isn't medicare around $36/RVU and private insurance +20% (so around $43/RVU)? Hard to see how anyone can get up to $50 given that the majority of patients needing anesthesia are typically medicare. Most practices will also have some degree of medicaid and self -pay (no-pay), which will further dilute average RVU.

Problem with finding a job in desirable suburbia is saturation so hospitals/practices can low-ball physicians in general despite the better payor-mix. My friend who is in anesthesia was making about 25% more in BFE (economically depressed WV despite lousy payor mix) versus upper class suburbs on Long Island, NY. Much more vacation time as well in WV
Click to expand...

No. MediCare is 21-22$/unit. In other specialties, private insurance pays around 120% of MediCare, but in anesthesia the difference is closer to 300%. Medicaid (MediCal here in CA) is aweful - 12$/unit and 16$/unit on OB but not so terrible in other states.

Your friend’s practice in WV was likely heavily subsidized, and NY is AMC country. Gotta find the fair/equitable PP’s out there. They’re not quite unicorns as some would have you believe - just gotta be a little flexible on location.
 
Thanks for the input. Yes, I meant per unit (not RVU).

Is 3 years reasonable for a partnership track? Does it make sense for me to take a job with a blended unit of $30 as long as in 3 years, my blended unit value goes up significantly?



SaltyDog said:
First off, nobody in anesthesia says RVU. What region are you looking in. As mentioned above, unit values for private payers vary greatly by region. The SE tends to have rates way higher than you see in the W for instance. As a West Coast guy, here is my general breakdown:

< 30$/unit = canine feces (like literally, I'm not getting outta bed for this)

30-35$/unit = LOUSY

35-40$/unit = Eh

40-45$/unit = pretty good, now we're talkin'

45-50$/unit = Yeah boy

>50$/unit =
891.jpg


Working solo MD, you will generate 10-15K units/year. 10K would be pretty mellow like 40hr/wk. 12K pretty average schedule about 45-50hr/wk. 15K would be really bustin' your nuts 60hr/wk. The exception would be if your doing a lot of high value cases like cardiac/thoracic or high volume ortho with lots of blocks. Blended unit value x units/year = total pre-tax income which you then have to deduct all expenses from like billing, insurance, yada, yada, yada.
Click to expand...
 
RCA said:
Thanks for the input. Yes, I meant per unit (not RVU).

Is 3 years reasonable for a partnership track? Does it make sense for me to take a job with a blended unit of $30 as long as in 3 years, my blended unit value goes up significantly?
Click to expand...

Why would your blended unit rate go up in three years? If anything, with a higher percentage eligible for Medicare in three years, I would expect it to go down unless you have a significant influx of private pay patients. Do the partners get a higher blended rate than the associates and that is the buy in?
 
sethco said:
Why would your blended unit rate go up in three years? If anything, with a higher percentage eligible for Medicare in three years, I would expect it to go down unless you have a significant influx of private pay patients. Do the partners get a higher blended rate than the associates and that is the buy in?
Click to expand...

Yes, that’s one way to structure the buy in.

3 years is on the longer side, but whether it’s too long depends on a number of factors. Is it in AMC country? Is there a buy-out likely in the time before you make partner? Does the group have a habit of cutting people loose just shy of making partner? Just how much are the partners making? Are you sure you want to be there long term? Is the buy-in graduated at all over those 3 years? These are all things you need to know before deciding if it’s a decent deal or not.
 
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