Please, help me understand this job offer’s proposed wRVU compensation model. An abomination?

[Psych Person]

I have never worked in a wRVU compensation model. I’m a newbie to this stuff.

Despite my inexperience with these payment models, I received a job offer recently that came with this wRVU system. The offer first had me bewildered and confused. Then as I learned more on my own, I began to feel insulted which quickly became angered, and at last left me feeling disgusted and disrespected. I did my research, spending 6 hours straight upon receiving the contract to review, learning as much as I could about these payment models for physicians.

I am hypervigilant about being taken advantage of in my naivety and ignorance by these snakes who seem to be everywhere. The proposed offer seemed so disrespectful that I rejected them outright without any invitation or attempt to negotiate. It seemed so far off from what was acceptable that I closed the door immediately. And this was after they dragged me on for a whole damn month in their pre-employment process, talking all about their mission and values, and how much they value their employees, and how much the organization and I fit together and could have a good future. They seemed too perfect during this process, while also annoying me at the hoops they were making me go through before I saw a contract with a payment model. Perhaps I should have been direct from the moment of my first interaction, though I struggle with it feeling taboo to bring up money too soon.

A few weeks have gone by, and I just want to double check with the many wise folks on SDN who have been so influential to me over the years. I don’t post much, but I lurk like crazy. I must have read every post about job offers with wRVU models with you all critiquing them that I could find here in the past 10 years.

I live in a part of the country where the median salary for a psychiatrist is $290K+.

The contract language was excessively wordy, technical, and convoluted. It was extremely difficult to comprehend at first. It was far more difficult to understand than other contracts that have been proposed to me. This was my first red flag in retrospect I think. There were so many twists and turns in the single-spaced typed, 12 point font, PAGE AND A HALF dedicated to just describing the compensation model. I eventually had to cross out everything that seemed like fluffy nonsense and focused on key points that I learned from my readings online.

I will sum it up below:
-base salary was something like $263K
-target salary was something like $290K (to be paid only if wRVU target was achieved)
-the wRVU TOTAL target that they wanted from me was around 7,500 PER GOD DAMN YEAR
-each wRVU was clearly stated to be compensated at a rate of ONLY $34 (!!!)
-employer clearly stated they had the power to reduce pay below base if at some point in the future (6 months or 12 months or something, biannual review model), the psychiatrist wasn’t hitting the wRVU target.

These people claimed to me that 10-12 patients per day, 30 minutes for follow-ups and 60 minutes for initials was how the organization rolls. They also assured me I could do my own psychotherapy within their organization. My case load would have had to be built from the ground up with them as well. I can’t for the life of me see how what was propose in the contract would even be possible, even if I did sign the contract and attempt the job.

This offer seemed SO BAD that I thought to myself first when I read it “there must be a typo”. I was in disbelief. So much so that I spent hours upon hours learning more about wRVU models to try and figure out what it was that I surely must not be understanding about the contract, because surely these people who treated me as if they valued me and thought the world of me for a whole month—after they dragged me through providing a bunch of references whom they contacted and made me do multiple interviews—wouldn’t seriously try to serve me an abomination of a contract and think I’d be stupid enough to agree to it just because it was worded in such a convoluted way that hardly any sense could be made of it.
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Anyway, I still struggle with self-doubt, as I’m not intimately familiar with wRVU models. For what was proposed in the contract to seem so absurd to me, based on my amateur understanding of wRVU models to begin with, caught me off guard personally. I’m not one to become indignant, especially when I’m so new to something and don’t feel like an expert. I’d like to put it all to rest by getting confirmation or clarification and any additional insights that you lovely people may be willing to kindly offer me. I’m a newbie who would love to learn more. I would be so grateful. I value this community greatly.

Lastly, I just signed a contract for over $300K in a non-wRVU model with an organization that treated me respectfully, behaved with integrity, threw out solid numbers from the start, accommodated my requests during negotiations, and didn’t seem to be trying to deceive me with convoluted language and hollow praise. I’m excited for this opportunity, but I still want to continue learning about the aforementioned, as I know it is unlikely that I will be in this new job forever.

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[Bartelby]

Bullet dodged! Great call taking the salaried option.

99214+90833 yields 3.42 wrvu by the current schedule. In theory:

3.42 RVUs per pt x 10 pts per day x 5 days per week x 48 weeks worked per year= 8208 RVUs per year. In reality, that assumes all follow ups, 10 pts per day, all billing at pretty much the max via a therapy add on. You would end up working very hard to hit your goal, and should be earning much more for that much work.

 

[nexus73]

Abomination is a good word for this offer. RVU should be $60-75.

Salary of 290k? Great! Assuming reasonable patient load and support staff. But not if you’re going to nitpick my RVUs non stop, and then threaten to pay me less when I don’t hit your idiotic target.

 

[PikminOC]

Bullet dodged! Great call taking the salaried option.

99214+90833 yields 3.42 wrvu by the current schedule. In theory:

3.42 RVUs per pt x 10 pts per day x 5 days per week x 48 weeks worked per year= 8208 RVUs per year. In reality, that assumes all follow ups, 10 pts per day, all billing at pretty much the max via a therapy add on. You would end up working very hard to hit your goal, and should be earning much more for that much work.

Are salaried positions really salaried? My friend has a "salary" but has to hit rvu goals to keep it.

 

[hamstergang]

I will sum it up below:
-base salary was something like $263K
-target salary was something like $290K (to be paid only if wRVU target was achieved)
-the wRVU TOTAL target that they wanted from me was around 7,500 PER GOD DAMN YEAR
-each wRVU was clearly stated to be compensated at a rate of ONLY $34 (!!!)
-employer clearly stated they had the power to reduce pay below base if at some point in the future (6 months or 12 months or something, biannual review model), the psychiatrist wasn’t hitting the wRVU target.

Was it $34/wRVU after the 7500 target? Because $34x7500 = $255k, so I thought that the $34/wRVU was just describing the base pay. Usually there's be some bonus to the conversion above your target.

Also, if you're just building up your caseload with them I feel it would also be normal and reasonable for some guaranteed salary without a target for the first 6-12 months to compensate.

It seems this job would likely be too much of a grind for too long, but I don't know that these factors would have been non-negotiable.

 

[annoyedpsychiatrist]

When I was interviewing a job not too long, I learned that if the contract was enough pages to published into a nonfiction book and the word contingent was in it more than 10x, then there was a high probability the job sucked. I make >300k with no rvu minimums. I dont have to fight and beg my way for those 34 dollar rvus, lol. Im pretty happy with just a nice guaranteed base salary and a reasonable caseload.

 

[forchinet121]

Let me guess this is mindpath? I interviewed with them they are a SCAM….

 

[Merovinge]

First of all, no one in medicine has a 1 month pre-employment process if the employment is good. They are trying to use your brain against you by giving you a sunk cost and liking them by mere association with them. Speak to two of the docs currently working there, a few meetings with admin, and that's plenty to get an idea of the place (beyond the typical reputation, glassdoor etc.)

Second, the contract sucks as you expected. Lots of places looking for young docs to enter as widgets in the machine. They know you have debt and are hungry for a job. They make bigger bonuses by keeping labor costs low (i.e. your salary). I interviewed at a child inpatient unit that paid a flat rate of $55 per encounter (no bonus for admissions or discharges) with no benefits. That's right, a robust $264,000 a year for 20 patients a day. And you got to take call for free. I'm not sure how they get people take those types of jobs but somehow the hospital is still open.

Congrats on the better job. Good organizations either pay you a base appropriate salary or have reasonable RVU/collection setups. You'll learn a lot more about them as you progress in your career.

 

[annoyedpsychiatrist]

Let me guess this is mindpath? I interviewed with them they are a SCAM….

lol i get so many emails from these people. I would never work for them but what are they offering these days?

 

[forchinet121]

lol i get so many emails from these people. I would never work for them but what are they offering these days?

Exactly what the OP said, 34 per wrvu..which is literally half the average rate nationally..it’s like they think we have an intellectual disability or something

 

[Bartelby]

I interviewed at a child inpatient unit that paid a flat rate of $55 per encounter (no bonus for admissions or discharges) with no benefits. That's right, a robust $264,000 a year for 20 patients a day. And you got take call for free. I'm not sure how they get people take those types of jobs but somehow the hospital is still open.

I wonder this too. Who ends up taking these jobs? I can at least understand if it is an academic center with a relaxed schedule, or if it is in effect part-time work, but for someone to take jobs like the one proposed to the OP or this 20 child inpatients per day for the rates they are offering is just confusing.

 

[J ROD]

First that offer is trash......

Next, you want something manageable like 4500 wrvu as the mark. Most places will pay like $65 per wrvu up to a certain point and then cut down the pay to like $30 per each additional one after a cap of 75% of max pay for the position. So even though you get paid more for seeing more, it cuts down so you cannot make but so much. Why my job works so well if you are a hard worker. I have no wrvu cut. I have worked around 10,500 - 11,000 wrvu leach year and get paid at near 60 for each and every one. I basically have two FT jobs...lol

 

[annoyedpsychiatrist]

I wonder this too. Who ends up taking these jobs? I can at least understand if it is an academic center with a relaxed schedule, or if it is in effect part-time work, but for someone to take jobs like the one proposed to the OP or this 20 child inpatients per day for the rates they are offering is just confusing.

filled with midlevels and they get some random doctor to attach their name as supervisor who is located nowhere near the unit

 

[Merovinge]

filled with midlevels and they get some random doctor to attach their name as supervisor who is located nowhere near the unit

Yup, it's either this or a doc who "sees" 50 patients a day. Seen it both ways around here. These docs change 1 med, keep the kid 5 days then DC. No collateral, eval is copy and pasted from SW note, avoid all calls with parents, add zero value to care for what is likely one of the toughest times in a child's life. They do drive nice cars though...