Primary Care contract, guaranteed salary, and productivity bonus.

[Iceman24]

Hi, folks!

I'm asking for a girlfriend who doesn't have an account here.
She is negotiating a contract with guaranteed salary for the first year, and then no base salary but RVU.
She should do 5200 RVUs per year then, but if she do less then that, is she still going to have some minimal amount?
How does it work, I mean she made not 5200, but let's say 4500, what can she expect to be paid?
All the possible scenarios should be reflected in contract, right?
I apologize upfront for the absence of some very basic understanding of simple things since I don't practice direct patient care at this point and not involved in billing/coding/any financial aspect.

Appreciate any input!

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[VA Hopeful Dr]

We need way more information than that.

Have her make an account and post in this thread directly.

 

[deleted87716]

She needs to ask her potential employer those questions.

 

[Iceman24]

She needs to ask her potential employer those questions.

Yep, that what she is trying to do, but they are avoiding straight answers and still "working on contract", though it has been the whole month since the interview...

 

[hallowmann]

Yep, that what she is trying to do, but they are avoiding straight answers and still "working on contract", though it has been the whole month since the interview...

Run... she can find better. These are basic questions that they should be able to answer right away.

 

[deleted87716]

Yep, that what she is trying to do, but they are avoiding straight answers and still "working on contract", though it has been the whole month since the interview...

Really? Those are pretty straightforward questions. That's a red flag, IMO.

 

[deleted480308]

Yep, that what she is trying to do, but they are avoiding straight answers and still "working on contract", though it has been the whole month since the interview...

Huge red flag. They freaking know the answers. Do not sign without basic answers like that

 

[deleted87716]

I don't work in an RVU-based system, so maybe somebody else can explain how it usually works (e.g., $x/RVU with a targeted number of RVUs/year equating to an anticipated annual "salary"?)

 

[hallowmann]

I don't work in an RVU-based system, so maybe somebody else can explain how it usually works (e.g., $x/RVU with a targeted number of RVUs/year equating to an anticipated annual "salary"?)

Most offers I have heard of usually have some kind of incentive for increasing RVUs, like something like $x/RVU up to say 3500, then it increases to something like $y/RVU for the RVUs between 3500 to 5000, where y is marginally more than x and is what would be a reasonable amount per RVU, then its like $z/RVU >5000 or something where z is more than y, but most people don't make much above that. Also, it should be clear how they're calculating RVUs, is it RVU billed, RVU collected, wRVUs, etc. These will significantly change how much they make.

Personally, I'd want a base pay for at least 2-3 years, because it'll take time to build a panel, especially right now.

 

[deleted480308]

I have had friends break down their contracts for me because I nerd out on this stuff. These are some variations

1)X$ per rvu billed. Just a straight number and then benefits on top.
2)90%x per rvu billed straight up, 10%x per rvu billed given to some degree of quality metrics so you get zapped if you don’t make metrics (or some variation of the 90/10). Benefits on top
3) a sliding scale of $x per rvu based off volume. If you bill 30% percentile rvus for the nation you get less money per rvu than if you bill 70% percentile rvus
4) private group, straight eat what you kill off of collections (not billings). Everyone gets taxed a percentage of the overhead based of the totatl income they bring in relative to the group

 

[Iceman24]

Personally, I'd want a base pay for at least 2-3 years, because it'll take time to build a panel, especially right now.

They refused that, the base pay is only guaranteed for the first year.

 

[deleted480308]

They refused that, the base pay is only guaranteed for the first year.

Don’t sign. One year only before being dumped on to production....DURING COVID?!?!

nope

also, your friend needs to know vacation, cme, patients per day, do they need approval to fire a patient, any midlevel supervision (it should be optional, there should be pay involved and they should get to select the midlevel), how many contact hours per week, can they go to 4longer days insteadof 4.5, weekends?, pick their cma?, opiod prescribing policy?, call coverage?

 

[blue.jay]

I've a question, hoping members in this thread can answer.

What compensation model is ideal for outpatient primary care? Low base pay + bonus + RVU productivity vs Fixed salary employee ?

My wife has 2 job offers for general pediatrics.

1st one in Arizona (pop 50,000) has a 15k sign on bonus and guaranteed salary of 185k for 2yrs, then production based on top of a base 158k (85% of 25th percentile ~185k). The median rate wRVU is 44.05$ and the expected 50th percentile pay (projected RVU 5300) is 232k. We have family in CA and she likes this job as it's M-F clinic hours and near a good school district suburb. There is no call or newborn nursery. CME 3500$ for 5 days a year. Retirement 4% dollar for dollar Match after 1 year of employment. 28 days
vacation.

The second offer is in Wisconsin. Their pay is straight up 235k with no mention of RVU or production but she is on 1:4 call with nursery rounding. This is in a rural area (pop 10,000 but 1.5 hr from chicago) where we don't see ourself living for more than 3 years. She is also not thrilled about being on call every 4th day. She gets 3500$ CME. Retirement is 3% dollar for dollar match and 3% annual company contribution. Vacation/PTO is 33 days weeks.
Income tax in Wisconsin is also higher than Arizona.

The straight salary 235k in Wisconsin seems good but we don't know if that can decrease if she isn't productive and doesnt have a full patient panel.

My question is how common are calls in general pediatrician jobs? Is it sustainable ? Is there better income potential by increasing your patient panel seeing deliveries ? Any differences AZ vs WI I've heard new articles saying WI is the best paying state for pediatricians.

 

[thumbz]

Call sucks. I can't speak to pediatrics specifically but I can tell you that whenever you hear "light" call it never actually is. And there will always, without fail, be calls that come in at the most inconvenient times.

For compensation models - that's gonna depend on your wife. I can give you an example of two of my outpatient colleagues (we are strait salary):

Coworker A - more than happy to see 14 patients a day, have ample time to document, chat with the nurses, go get a coffee, etc. Makes $240.

Coworker B - gets super bored when they have down time. Sees 20-24 patients a day (despite an expectation of seeing 14). Fits in same day visits during lunch or between other patients. Typically spends an hour extra every day finishing up charts, etc. Makes $240.

Coworker A would make $185k/yr on a production model and coworker B would make $300k. So it sucks for B, but A loves it. If your wife is more of a coworker B personality she should do a production gig. If she's more of a coworker A (absolutely no shame in that, I'm more of an A) then find a strait salary job.

Edit - realized this was a thread hi-jack. To OP - never do a 1 year guaranteed base, not worth the potential paycut. Also, any employer that can't put wRVU into writing you need to run away from. Suddenly you find out you're getting $20/RVU and making $125k/yr working your butt off while they pocket the rest.

 

[deleted87716]

^ This is why straight salary is always the wrong answer. It encourages mediocrity.

 

[VA Hopeful Dr]

^ This is why straight salary is always the wrong answer. It encourages mediocrity.

And it's very rare to come out ahead on salary. It's much more commonly used to pay less for more work.

 

[deleted87716]

^ This is why straight salary is always the wrong answer. It encourages mediocrity.

Or, as we say in my group, "If you give them a floor, they'll sit on it."

 

[deleted480308]

^ This is why straight salary is always the wrong answer. It encourages mediocrity.

Yeah, I 100% wpuld not be seeing 24 a day while someone sees 14 for the same money.

 

[sloh]

14 patients per day on salary model? I used to work for Kaiser and FM there sees way more than that

 

[deleted87716]

14 patients per day on salary model? I used to work for Kaiser and FM there sees way more than that

I see more than that before lunch.

 

[Bacchus]

I've a question, hoping members in this thread can answer.

What compensation model is ideal for outpatient primary care? Low base pay + bonus + RVU productivity vs Fixed salary employee ?

My wife has 2 job offers for general pediatrics.

1st one in Arizona (pop 50,000) has a 15k sign on bonus and guaranteed salary of 185k for 2yrs, then production based on top of a base 158k (85% of 25th percentile ~185k). The median rate wRVU is 44.05$ and the expected 50th percentile pay (projected RVU 5300) is 232k. We have family in CA and she likes this job as it's M-F clinic hours and near a good school district suburb. There is no call or newborn nursery. CME 3500$ for 5 days a year. Retirement 4% dollar for dollar Match after 1 year of employment. 28 days
vacation.

The second offer is in Wisconsin. Their pay is straight up 235k with no mention of RVU or production but she is on 1:4 call with nursery rounding. This is in a rural area (pop 10,000 but 1.5 hr from chicago) where we don't see ourself living for more than 3 years. She is also not thrilled about being on call every 4th day. She gets 3500$ CME. Retirement is 3% dollar for dollar match and 3% annual company contribution. Vacation/PTO is 33 days weeks.
Income tax in Wisconsin is also higher than Arizona.

The straight salary 235k in Wisconsin seems good but we don't know if that can decrease if she isn't productive and doesnt have a full patient panel.

My question is how common are calls in general pediatrician jobs? Is it sustainable ? Is there better income potential by increasing your patient panel seeing deliveries ? Any differences AZ vs WI I've heard new articles saying WI is the best paying state for pediatricians.

I have a straight base pay based on production I guarantee to the organization. Under, you pay back. Over, you get paid more. Bonuses are additional.

What I feel like at this point is ideal, is getting a flat salary with incentives blended in or paid at the end of the year without worries for production. The production model is not all it’s cracked up to be unless you’re comfortable with working your ass off. You get stuck in it and unless you want to take a significant pay cut (almost 50k) to reduce your FTE, you’re screwed. That 50k is me reducing my RVUs linearly based on FTE reduction from 1.0 to 0.8.

Basically, I don’t feel the productivity model is good for anyone’s mental health unless financially you’re able to sacrifice.

It’s been a trying few weeks and I’m cranky so don’t mind me.

I would love to go to a Kaiser Payment Model based on what I know about them.

 

[AMEHigh]

^ This is why straight salary is always the wrong answer. It encourages mediocrity.

Ehh I’m fine with mediocrity if it means I’m not running around like a chicken with my head cut off and taking 2 hours at the end of day to finish notes.

 

[VA Hopeful Dr]

I have a straight base pay based on production I guarantee to the organization. Under, you pay back. Over, you get paid more. Bonuses are additional.

What I feel like at this point is ideal, is getting a flat salary with incentives blended in or paid at the end of the year without worries for production. The production model is not all it’s cracked up to be unless you’re comfortable with working your ass off. You get stuck in it and unless you want to take a significant pay cut (almost 50k) to reduce your FTE, you’re screwed. That 50k is me reducing my RVUs linearly based on FTE reduction from 1.0 to 0.8.

Basically, I don’t feel the productivity model is good for anyone’s mental health unless financially you’re able to sacrifice.

It’s been a trying few weeks and I’m cranky so don’t mind me.

I would love to go to a Kaiser Payment Model based on what I know about them.

To each his own. I'm still on my year 1 guarantee (after that its straight production with bonuses on top of that) but I started out-earning that last month and am thrilled about it.

Even if I had a decent straight salary, I like being busy. If I'm not actively seeing patients, I'd rather be at home. I'm happiest around 25-30 patients in a full day. More than 30, unless its all single problem visits, and its a bit hectic, much less than 25 and I have too much down time.

 

[VA Hopeful Dr]

Ehh I’m fine with mediocrity if it means I’m not running around like a chicken with my head cut off and taking 2 hours at the end of day to finish notes.

I'll never understand people that take that much time. I'm hitting low-mid 20s per day currently, notes are 100% done by 5 at the latest. We have people doing upper 20s-low 30s without scribes who manage the same.

Even my overly detail oriented internist wife spends about 20 minutes every morning prepping for patients but everything else is done by 5.

 

[deleted87716]

Ehh I’m fine with mediocrity if it means I’m not running around like a chicken with my head cut off and taking 2 hours at the end of day to finish notes.

It doesn't have to be one extreme or the other. Just make sure you're the one in charge of your schedule, and pay attention to your workflow. I see 20'ish per day, and I'm usually out of the office by 5pm. I get my notes done as I see the patients. Always have, even when I was on paper charts. My notes aren't crap, either.

 

[Bacchus]

I'll never understand people that take that much time. I'm hitting low-mid 20s per day currently, notes are 100% done by 5 at the latest. We have people doing upper 20s-low 30s without scribes who manage the same.

Even my overly detail oriented internist wife spends about 20 minutes every morning prepping for patients but everything else is done by 5.

Out of curiosity, what’s your yearly predicted RVU total?

 

[Bacchus]

It doesn't have to be one extreme or the other. Just make sure you're the one in charge of your schedule, and pay attention to your workflow. I see 20'ish per day, and I'm usually out of the office by 5pm. I get my notes done as I see the patients. Always have, even when I was on paper charts. My notes aren't crap, either.

20ish a day is manageable. Do you mind sharing your RVU total for the year?

 

[deleted87716]

20ish a day is manageable. Do you mind sharing your RVU total for the year?

We aren't paid on RVUs, we're paid on revenue. I billed $1.4M last year, with collections of $650K (the difference being contractual write-offs.) Total overhead is around 50%.

 

[VA Hopeful Dr]

Out of curiosity, what’s your yearly predicted RVU total?

So its hard to say for me. I was hired last May to take over from a retiring doctor. He left 3 weeks ago. So prior to that (and ignoring the 2 really bad COVID months), I was around 400 wRVUs/month give or take. For most of 2019 I was in the mid 300s, non-COVID months low 400s for 2020. Last month as he was slowing down I hit 580. This month as of end of day yesterday I'm at 420, so on track to hit somewhere between 750-800 this month and expect to stay somewhere in that range for months where I don't take time off. Probably in the mid-600s for months I take time off.

So my annualized (which is actually 18 months) number from May 2019 through Dec 2020 is predicted at 7300. For 2020 alone, probably right around 6000.

 

[deleted87716]

So its hard to say for me. I was hired last May to take over from a retiring doctor. He left 3 weeks ago. So prior to that (and ignoring the 2 really bad COVID months), I was around 400 wRVUs/month give or take. For most of 2019 I was in the mid 300s, non-COVID months low 400s for 2020. Last month as he was slowing down I hit 580. This month as of end of day yesterday I'm at 420, so on track to hit somewhere between 750-800 this month and expect to stay somewhere in that range for months where I don't take time off. Probably in the mid-600s for months I take time off.

So my annualized (which is actually 18 months) number from May 2019 through Dec 2020 is predicted at 7300. For 2020 alone, probably right around 6000.

If your pay per work RVU is around the national median of $50, we're in the same ballpark.

 

[AMEHigh]

I'll never understand people that take that much time. I'm hitting low-mid 20s per day currently, notes are 100% done by 5 at the latest. We have people doing upper 20s-low 30s without scribes who manage the same.

Even my overly detail oriented internist wife spends about 20 minutes every morning prepping for patients but everything else is done by 5.

It totally depends on where you work and how your office runs and what the patient visits are for and who you’re seeing.

I’ve never been on an rvu model, so not sure what that feels like. I just know that working in under sourced areas can often make the day have some challenges. I love what I do and think I do a good job, so I bulk at the idea that seeing 14 patients is "mediocrity."

Initial prenatal care visits are ones that seem to take up a lot of time for me. Between doing the dating US if they need one and then delving in to any medical or social problems, it’s a lot. I put the basics in my note but often have to go back and finish the details at the end of the day.

 

[deleted87716]

For the record, I never meant to imply that you or anyone else was a mediocre physician, only that straight salaries do nothing to motivate people to do anything more than the minimum amount of work required to keep their job. Or course, most employers include some sort of bonus as a performance incentive, so there's that.

 

[Bacchus]

So its hard to say for me. I was hired last May to take over from a retiring doctor. He left 3 weeks ago. So prior to that (and ignoring the 2 really bad COVID months), I was around 400 wRVUs/month give or take. For most of 2019 I was in the mid 300s, non-COVID months low 400s for 2020. Last month as he was slowing down I hit 580. This month as of end of day yesterday I'm at 420, so on track to hit somewhere between 750-800 this month and expect to stay somewhere in that range for months where I don't take time off. Probably in the mid-600s for months I take time off.

So my annualized (which is actually 18 months) number from May 2019 through Dec 2020 is predicted at 7300. For 2020 alone, probably right around 6000.

I committed to 6000. It feels overly busy but I think I’m in a burnout funk right now.

 

[VA Hopeful Dr]

It totally depends on where you work and how your office runs and what the patient visits are for and who you’re seeing.

I’ve never been on an rvu model, so not sure what that feels like. I just know that working in under sourced areas can often make the day have some challenges. I love what I do and think I do a good job, so I bulk at the idea that seeing 14 patients is "mediocrity."

Initial prenatal care visits are ones that seem to take up a lot of time for me. Between doing the dating US if they need one and then delving in to any medical or social problems, it’s a lot. I put the basics in my note but often have to go back and finish the details at the end of the day.

I didn't mean to imply you were mediocre in any way and if I came off that way, you have my apologies. In fact about 10 minutes after I posted I remembered that you did FQHC work and prenatal stuff so your visits were likely WAY more involved than mine are which would lead to more information/chart and longer visits.

 

[VA Hopeful Dr]

I committed to 6000. It feels overly busy but I think I’m in a burnout funk right now.

I could see that, 500/month isn't a light schedule.

We have the option here to set how much we want our bi-weekly pay to be (as a function of monthly RVUs). I plan to keep mine at 5000 for the year (400/month) precisely to prevent feeling like I HAVE TO be super busy.

Every quarter my employer does a reconciliation, so if I earned more then they make things even every 3 months. That way I get a nice bonus every quarter and don't ever really have to worry about owing them money or working more than I want to since 400 RVU/month is not a taxing number.

 

[sloh]

I have a straight base pay based on production I guarantee to the organization. Under, you pay back. Over, you get paid more. Bonuses are additional.

What I feel like at this point is ideal, is getting a flat salary with incentives blended in or paid at the end of the year without worries for production. The production model is not all it’s cracked up to be unless you’re comfortable with working your ass off. You get stuck in it and unless you want to take a significant pay cut (almost 50k) to reduce your FTE, you’re screwed. That 50k is me reducing my RVUs linearly based on FTE reduction from 1.0 to 0.8.

Basically, I don’t feel the productivity model is good for anyone’s mental health unless financially you’re able to sacrifice.

It’s been a trying few weeks and I’m cranky so don’t mind me.

I would love to go to a Kaiser Payment Model based on what I know about them.

I worked at Kaiser as PM&R. The burnout rate for FM there is very high. They definitely see way more than 14 patients per day. It’s not the patient load that is onerous though. It’s the inbox messages and patient phone calls. With their emphasis on patient satisfaction and your lack of control who they hire as your back office staff, the brunt of those responsibilities fall on you (in a timely manner) and the patient complaints are always dealt in a way where the goal is “it’s not the patient’s fault. What can you do to satisfy them?”

 

[deleted87716]

Every quarter my employer does a reconciliation, so if I earned more then they make things even every 3 months. That way I get a nice bonus every quarter and don't ever really have to worry about owing them money or working more than I want to

We have a draw system that works similarly. Rather than being paid based on collections (which can vary month to month), you can choose to be paid a fixed monthly amount based on something like 80-90% of your previous year's collections, with a quarterly true-up based on actual collections. I'm not sure of the exact formula, as I've never done it that way (few people do, as most would rather have the money now).

 

[blue.jay]

Apologize for thread hijack. This is for gen peds. I'm confused about this tier system. Shouldnt the worked rvu rate go up with higher tiers (being more productive)? I don't understand this payment structure. Could some one explain ? This is for my spouse and I doubt she will get any higher than 50th percentile; she will be happy with 230k. Is this a good offer ?

 

[VA Hopeful Dr]

If your pay per work RVU is around the national median of $50, we're in the same ballpark.

Its... complicated.

My base is $40, but most of our bonuses are done as a function of wRVU. For example, if I hit the CMS goal for A1c, my RVU value goes up $2. AWV, mammograms, colon screening, BP goals, BMI counseling, closing charts on time, patient satisfaction are each worth $1/RVU. So if I hit all my metrics, its worth a total of $15 on top of the $40.

We have a draw system that works similarly. Rather than being paid based on collections (which can vary month to month), you can choose to be paid a fixed monthly amount based on something like 80-90% of your previous year's collections, with a quarterly true-up based on actual collections. I'm not sure of the exact formula, as I've never done it that way (few people do, as most would rather have the money now).

My previous employer worked that way. Last year's total RVU, then 90% of that with quarterly corrections.

 

[yeasports]

My contract is that way, I get a 5% bonus to my wrvu to hit 5000 wrvu and 10% to hit 6300 wrvu. My base wrvu is $50. (this basically gets bumped to 55 once I hit my 10% (i always hit 10 by a lot) and paid as a yearly bonus.
My regular pay is a 98% projected draw on my projected wrvus assessed quarterly.

so lets just say I only hit 6300 for some reason
base 6300 x 50 = $315,000
bonus of 10% = extra $5 per rvu so 6300 x 5 = $31,500 paid as yearly bonus

 

[AMEHigh]

For the record, I never meant to imply that you or anyone else was a mediocre physician, only that straight salaries do nothing to motivate people to do anything more than the minimum amount of work required to keep their job. Or course, most employers include some sort of bonus as a performance incentive, so there's that.

Got it, so I'll guess we'll have to agree to disagree then! I certainly seem to think me and my colleagues bust our butts for our patients even though we're on salary. So I don't think it's necessarily true that being on salary doesn't motivate people to work above the bare minimum to keep a job. But I guess we'll never know Seeing 2 more patients on top of a busy schedule in order to make more money doesn't necessarily mean better patient care or that one is more motivated, that was my point.

 

[deleted87716]

My contract is that way, I get a 5% bonus to my wrvu to hit 5000 wrvu and 10% to hit 6300 wrvu. My base wrvu is $50. (this basically gets bumped to 55 once I hit my 10% (i always hit 10 by a lot) and paid as a yearly bonus.
My regular pay is a 98% projected draw on my projected wrvus assessed quarterly.

so lets just say I only hit 6300 for some reason
base 6300 x 50 = $315,000
bonus of 10% = extra $5 per rvu so 6300 x 5 = $31,500 paid as yearly bonus

That's decent money, but it should be, given that the median RVUs for FM is closer to 5000.

 

[VA Hopeful Dr]

Got it, so I'll guess we'll have to agree to disagree then! I certainly seem to think me and my colleagues bust our butts for our patients even though we're on salary. So I don't think it's necessarily true that being on salary doesn't motivate people to work above the bare minimum to keep a job. But I guess we'll never know Seeing 2 more patients on top of a busy schedule in order to make more money doesn't necessarily mean better patient care or that one is more motivated, that was my point.

I would say you're the exception that proves the rule.

I can't of course speak for everyone everywhere, but speaking for myself and my internist wife - if I was on salary I'd figure out what I thought was a fair amount of work to do for that salary and that's exactly what I'd do. All of the extra stuff - working in sick patients on a pretty full schedule, working more than my contracted minimum, not using 100% of my vacation days; wouldn't happen. As far as actual patient care, I think I do a good job already so that wouldn't change. But how many patients I did my customary good work on would absolutely decrease. If seeing 15 patients per day and seeing 25 patients per day paid the same, what's my incentive to have a busy day instead of a more relaxed one?

 

[Bacchus]

I would say you're the exception that proves the rule.

I can't of course speak for everyone everywhere, but speaking for myself and my internist wife - if I was on salary I'd figure out what I thought was a fair amount of work to do for that salary and that's exactly what I'd do. All of the extra stuff - working in sick patients on a pretty full schedule, working more than my contracted minimum, not using 100% of my vacation days; wouldn't happen. As far as actual patient care, I think I do a good job already so that wouldn't change. But how many patients I did my customary good work on would absolutely decrease. If seeing 15 patients per day and seeing 25 patients per day paid the same, what's my incentive to have a busy day instead of a more relaxed one?

And what’s the problem with that exactly? Haha.

 

[VA Hopeful Dr]

And what’s the problem with that exactly? Haha.

That's actually the nice thing with production, you can work exactly as hard as you want and you will be paid accordingly. Want to see 15 patients/day? You can do that. You'll make less money than me at 25 patients/day, but you can still do it. At my current job, so long as you earn 3400 RVUs/year they won't say a word to you. You'll only earn 136k/year but as that's roughly 10-12 patients/day it seems fair.

The guy who took over my old practice when I moved to the current one averages around 4100 RVUs per year. He doesn't want to work hard and so he doesn't. He won't be breaking 200k anytime soon, but he's OK with that.

 

[Postictal Raiden]

That's actually the nice thing with production, you can work exactly as hard as you want and you will be paid accordingly. Want to see 15 patients/day? You can do that. You'll make less money than me at 25 patients/day, but you can still do it. At my current job, so long as you earn 3400 RVUs/year they won't say a word to you. You'll only earn 136k/year but as that's roughly 10-12 patients/day it seems fair.

The guy who took over my old practice when I moved to the current one averages around 4100 RVUs per year. He doesn't want to work hard and so he doesn't. He won't be breaking 200k anytime soon, but he's OK with that.

level 3 f/u is ~1 wRVU, level 4 is 1.5 and the wRVUs for new visits are ~1.5 and 2, respectively. I think it's fair to assume that the average encounter nets the physician 1.5 wRVUs. 3400 total wRVUs a year = 2270 encounters. If we assume 47 work weeks, that's 235 work days (M-F). That amounts to no more than 10 encounters a day!

From my observation, FM docs see 20+, and some 30+ pts a day. This should net you at least 6800 wRVUs/year.

Am I missing anything? Why is the average national wRVU is so low? (I also see that in neurology surveys)

 

[Bacchus]

level 3 f/u is ~1 wRVU, level 4 is 1.5 and the wRVUs for new visits are ~1.5 and 2, respectively. I think it's fair to assume that the average encounter nets the physician 1.5 wRVUs. 3400 total wRVUs a year = 2270 encounters. If we assume 47 work weeks, that's 235 work days (M-F). That amounts to no more than 10 encounters a day!

From my observation, FM docs see 20+, and some 30+ pts a day. This should net you at least 6800 wRVUs/year.

Am I missing anything? Why is the average national wRVU is so low? (I also see that in neurology surveys)

National median for FM is around 5150. People are afraid to bill aggressively. It’s a catch 22 for some like myself. I want to be a bit LESS busy. I can’t accommodate my 1600+ panel effectively because I precept 0.1 to 0.2 FTE out of the week. This is my choice. It gives me downtime, allows me to teach and not see patients directly 36 hours a week. There is no way to be “less busy” unless I remove physical sessions from my schedule going to 0.9 or 0.8 on paper because the appointment slots still exist. I can’t can’t/won’t do more 40 minute slots, too much downtime. We have templates that certain appointments warrant 40 minutes. I don’t comprehend how people have less RVUs when working full time. It must come down to billing.

Some numbers:
36 patient hours at 20 minute slots is 108 appointments a week.
The same with 75%-20min/25%-40min is 81+10=91 slots.

We get 5 weeks PTO and 1 week CME so assume 46 weeks of work.

The average RVU/encounter is 1.5 for our department.

Doing the math this is:
1)108X1.5X46=7452 RVUs
2)91X1.5X46=6279 RVUs

I’m the second scenario. Last year with the pandemic I had 5750 RVUs, the year before I had about 6200. Above doesn’t factor in no-shows or unfilled slots. We have a 95%+ utilization rate. In that case, those RVU numbers would be 7080/5965 respectively.

 

[Postictal Raiden]

National median for FM is around 5150. People are afraid to bill aggressively. It’s a catch 22 for some like myself. I want to be a bit LESS busy. I can’t accommodate my 1600+ panel effectively because I precept 0.1 to 0.2 FTE out of the week. This is my choice. It gives me downtime, allows me to teach and not see patients directly 36 hours a week. There is no way to be “less busy” unless I remove physical sessions from my schedule going to 0.9 or 0.8 on paper because the appointment slots still exist. I can’t can’t/won’t do more 40 minute slots, too much downtime. We have templates that certain appointments warrant 40 minutes. I don’t comprehend how people have less RVUs when working full time. It must come down to billing.

Some numbers:
36 patient hours at 20 minute slots is 108 appointments a week.
The same with 75%-20min/25%-40min is 81+10=91 slots.

We get 5 weeks PTO and 1 week CME so assume 46 weeks of work.

The average RVU/encounter is 1.5 for our department.

Doing the math this is:
1)108X1.5X46=7452 RVUs
2)91X1.5X46=6279 RVUs

I’m the second scenario. Last year with the pandemic I had 5750 RVUs, the year before I had about 6200. Above doesn’t factor in no-shows or unfilled slots. We have a 95%+ utilization rate. In that case, those RVU numbers would be 7080/5965 respectively.

5965 for working 36 hrs is pretty good. This brings your wRVUs/hr to 3.6.

This further raises my suspicion that the national average is too low. People are either under billing or choose not to be efficient.

 

[VA Hopeful Dr]

5965 for working 36 hrs is pretty good. This brings your wRVUs/hr to 3.6.

This further raises my suspicion that the national average is too low. People are either under billing or choose not to be efficient.

Or, as discussed above, different practice setups and populations can significantly slow things down.

You can have a high no show rate.

Do lots of procedures - most of the time I can make more seeing patients than doing procedures.

Inefficient staff that you have no control over.

New doctors, of which there are roughly 4000 per year take time to build up a practice.

You also have to remember that FM has lots of boomer doctors and many of them are choosing to not be busy. That doesn't mean that the national average is too low, it means the national average is showing what the middle of the bell curve is which is exactly what it's supposed to do.

 

[yeasports]

That's decent money, but it should be, given that the median RVUs for FM is closer to 5000.

I just do sports medicine but lets see: I did 8600 wrvu's last year, was on target for 9100 (covid)
I pay a portion of medical dental and eye insurance
they pay full short term and long term disability and term insurance
I have 403a 403b and 457. 2 of those are like a 401k that i can contribute to tax free 19500 each a year but no match from employer, I do get the 3rd one as a pension I contribute nothing they contribute around 11k a year.
Free food (all i want) cafeteria
4k cme
they pay all licensure
I only mention all of this because I was thinking of asking for a raise. I have a guarantee of 285,000 as you can see I far surpass that. I was thinking of getting rid of my guarantee and asking for $62 per wrvu up from 55. I do work about 45 hours a week. What do you think? The reason for high $per rvu is because I generate a lot outside my billing with xray/mri/emg.