RVU and Salary/Compensation

[GatorCHOMPions]

For the first time, my job sent us a clear profile of how much work RVU (wRVU) we produced for the last year. I work in a base plus RVU model in academics and there are tons of little "taxes" taken out of my paycheck each month to support various med school/department things. I'm not sure if I'm getting just a little or a lot screwed by my current compensation model.

What would be considered good compensation per wRVU? I've tried searching the web, but there appears to be no consensus. This is one of the more reliable sources I found where ED makes about $51/wRVU if you divide the stated median salary by the wRVU. For those who work in RVU-based compensation, what do you make per wRVU?

2015 physician compensation, work RVU by specialty - Becker's Hospital Review | Healthcare News & Analysis

Physician compensation remained relatively flat in 2015, increasing just 3.1 percent on average, according to AMGA's "2016 Medical Group Compensation and Productivity Survey," which is based on data from 2015 earnings.

www.beckershospitalreview.com

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[ShockIndex]

That number seems high but a lot of factors come into play such as employment type (employee vs. IC). In NC, many employee contracts offered $150/hr base with full benefits and the possibility of up to $50K per year productivity bonus. Assuming 1600 hrs/year, that would be close to $280-290K/year independent of retirement, medical, CME, etc. which could be another $30-40 in value. Most docs were producing 6-8 RVU/hr with no mid-level support and 9-11 with mid-levels. That means something closer to $30/RVU for an employee excluding benefits.

Back in 2010, I think that ApolloMD was offering ~$35/RVU for independent contractors.

Keep in mind that Medicare reimburses roughly $37/RVU and private insurance roughly 115-130% more give or take.

 

[NYEMMED]

That number seems high but a lot of factors come into play such as employment type (employee vs. IC). In NC, many employee contracts offered $150/hr base with full benefits and the possibility of up to $50K per year productivity bonus. Assuming 1600 hrs/year, that would be close to $280-290K/year independent of retirement, medical, CME, etc. which could be another $30-40 in value. Most docs were producing 6-8 RVU/hr with no mid-level support and 9-11 with mid-levels. That means something closer to $30/RVU for an employee excluding benefits.

Back in 2010, I think that ApolloMD was offering ~$35/RVU for independent contractors.

Keep in mind that Medicare reimburses roughly $37/RVU and private insurance roughly 115-130% more give or take.

That sounds like USACS price gimmicks and low pay...

 

[ShockIndex]

No, that’s what a large health system in NC currently pays physicians at their community shops. USACS actually paid lower in Charlotte back when they were EMP - closer to $130/hr base and bonuses were never a given due to their dependence on PG scores. My residents tell me that it came up to $140 base around CLT for USACS.

People come on this forum and talk about big paychecks north of $250/hr. That’s not what is happening for employee positions with benefits around NC unless you are willing to work in the middle of nowhere.

 

[Torsion]

Still seems far lower than what I've seen listed as the NC average on various salary surveys. Are SDGs and Contracted positions much better? From reading this forum I would imagine a lot of frequent posters would have a stroke if told they were working for 150/hr.

 

[e30ftw]

I'm 100% RVU at around $30/wRVU (don't want to be more specific) and average $240/hr. 45k community hospital in a great city in the SE.

$150/hr seems crazy for NC.

 

[Torsion]

As an NC native I can't imagine people taking that level of pay to live in the Triad or anywhere in Eastern NC given the salary averages in the SE. Maybe Charlotte or the Triangle. As far as the Triangle is concerned, outside of Duke/UNC academic sites I know that ERs are staffed by a few well-run SDGs. I've asked around a bit about the market in the SE and I've heard much higher numbers quoted for several desirable areas in other states than what is mentioned above.

 

[TheSingularity]

Literally just LOLd!

130-140/hr. Have you no self respect?!

No, that’s what a large health system in NC currently pays physicians at their community shops. USACS actually paid lower in Charlotte back when they were EMP - closer to $130/hr base and bonuses were never a given due to their dependence on PG scores. My residents tell me that it came up to $140 base around CLT for USACS.

People come on this forum and talk about big paychecks north of $250/hr. That’s not what is happening for employee positions with benefits around NC unless you are willing to work in the middle of nowhere.

Sent from my Pixel 3 using SDN mobile

 

[e30ftw]

Again not to be specific but there is a SDG group in coastal NC whose partners gross 400-550k annually. I've seen the books and was offered a job after graduating. Was a great job but I chose elsewhere and am perfectly happy.

Seems like admin at certain hospital systems near "research centers" are taking advantage of EM physicians.

 

[ShockIndex]

Literally just LOLd!

130-140/hr. Have you no self respect?!

Sent from my Pixel 3 using SDN mobile

That is probably a better question for those who choose to work there. I have not worked for a CMG in 7 years.

 

[ShockIndex]

As an NC native I can't imagine people taking that level of pay to live in the Triad or anywhere in Eastern NC given the salary averages in the SE. Maybe Charlotte or the Triangle. As far as the Triangle is concerned, outside of Duke/UNC academic sites I know that ERs are staffed by a few well-run SDGs. I've asked around a bit about the market in the SE and I've heard much higher numbers quoted for several desirable areas in other states than what is mentioned above.

The $150/hr (plus bonus) is in the Triad....the largest EM employer in the Triad, in fact.

 

[NYEMMED]

No, that’s what a large health system in NC currently pays physicians at their community shops. USACS actually paid lower in Charlotte back when they were EMP - closer to $130/hr base and bonuses were never a given due to their dependence on PG scores. My residents tell me that it came up to $140 base around CLT for USACS.

People come on this forum and talk about big paychecks north of $250/hr. That’s not what is happening for employee positions with benefits around NC unless you are willing to work in the middle of nowhere.

Tell your residents to keep looking. You can easily find non-USACS sites around Charlotte for $230/hr

 

[Torsion]

The $150/hr (plus bonus) is in the Triad....the largest EM employer in the Triad, in fact.

Interesting. That's the number I've seen quoted on this forum for academic jobs in Charleston. I love my home state and am originally from the Triad, but Greensboro/High Point/ W-S does not compare in desirability to other areas in the SE that I've heard host much higher salaries. I'm genuinely surprised that this is the case. At least cost of living in that area is very favorable.

 

[GatorCHOMPions]

Seems like this thread totally derailed from my original question...

 

[carbonizedeyesockets]

This seems to have your answer.

http://www.medpac.gov/docs/default-source/contractor-reports/jan19_medpac_disparities_physiciancompensationreport_cvr_contractor_sec.pdf

You can't talk about pay here without the conversation turning in to a dick measuring contest.

Also, if you're part of an academic group, it should be understood that you do not eat what you kill. Those teaching, doing research, doing admin functions will be subsidized by those working clinically. If you can't stomach that, move on. But, unless you get in a true democratic group, you'll likely be subsidizing nonphysician execs and physician execs, which is far far far worse, IMO.

 

[thegenius]

Seems like this thread totally derailed from my original question...

I agree..

It is hard to identify a fair or competitive RVU multiplier because compensation models are much more complicated than that....I often think it's easier just to compare hourly rates. RVU multipliers are affected by
- payor mix
- insurance contracts
- management fees
- whether you are 100% RVU or a hybrid model
- and there are others

$51/RVU I don't buy, I just don't believe it unless everything in the list above is 100% optimized. Medicare pays $36 and private insurers pay 20-40% more as someone noted above.


Here is another question. All other things considered equal, which job would you rather have?
Job 1: $32/RVU, annual average hourly rate $280/hr
Job 2: $25/RVU, annual average hourly rate $350/hr

If everything else is equal, the choice is easy (#2)!!

 

[carbonizedeyesockets]

I agree..

It is hard to identify a fair or competitive RVU multiplier because compensation models are much more complicated than that....I often think it's easier just to compare hourly rates. RVU multipliers are affected by
- payor mix
- insurance contracts
- management fees
- whether you are 100% RVU or a hybrid model
- and there are others

$51/RVU I don't buy, I just don't believe it unless everything in the list above is 100% optimized. Medicare pays $36 and private insurers pay 20-40% more as someone noted above.


Here is another question. All other things considered equal, which job would you rather have?
Job 1: $32/RVU, annual average hourly rate $280/hr
Job 2: $25/RVU, annual average hourly rate $350/hr

If everything else is equal, the choice is easy (#2)!!

Except it is not equal. You're working 8.75 RVUs/hr at job # 1 and 14 RVUs/hr at job 2, yet job 2 only has 25% more pay despite having 60% more work. Job #2 has non physicians and/or nonworking physicians making bank off of your hard work. There is nothing better about that. You're screwing yourself and the profession in that scenario.

 

[thegenius]

No no no!!!! Everything is equal. That is the deal with my scenario.
- same payor mix
- same PPH
- same acuity
- same medical system
- same medmal
- same fees
- same work

Everything is exactly the same.

The difference here is that the compensation models are different. I purposely didn't put that in. Job 2 makes more because it's a hybrid model or there are other ways to make money in that system.

Comparing hourly rates is better than RVUs, all things considered.

 

[inspirationmd]

The $150/hr (plus bonus) is in the Triad....the largest EM employer in the Triad, in fact.

Yeah I’m not sure where you got this information but I have real ongoing information about the NC market and work in it. This is not true.

ApolloMD just took over the contract for 3 hospitals in the triad area, VEP has another and Wake Forest is staffing the rest for the most part. $200/hr base with $10-$25/hr RVU bonus is the norm. Additional $10 per hour can be obtained depending on the CMG and some quality participation stuff. No one I know would work for $140/hr.

The usual desperate shifts are offered even higher than that. Ie. $40/hr bonus for staffing New Year’s Day AM shift at one hospital in the Triad area.

Raleigh triangle area they don’t pay well because everyone wants to be there. $120/hr for 3 years sweat equity in the main SDG there. Too much risk in my opinion but they regularly have people beating down the door for it to join. Partners do well -$275-$300/hr well if to be believed. Was personally offered $149/hr by Duke Raleigh a few years ago previously. UNC was paying $185/hr after you hit the minimum obligation for faculty position. I’m not sure about the VA or Duke academic hospital.

I am aware of 2 hospital systems that pay $250+ in non-ideal places in the state and with one particular dumpster fire being $265/hr which is the highest I’ve heard of consistently here. Truly a Wild West risk your license kind of place from what I hear.

Eastern NC on average is about $200-$210/hr almost completely across the board. Very rural though and a lot of time you’re on your own especially with the tertiary hospitals being full and always being on a wait list.

The Coastal SDG that was alluded to does very well again from what I hear. I’ve never seen their books though. Couple of my residency classmates work for them though.

I don’t know about the Charlotte market aside from it being saturated. Rates could be that low there.

 

[EctopicFetus]

Again not to be specific but there is a SDG group in coastal NC whose partners gross 400-550k annually. I've seen the books and was offered a job after graduating. Was a great job but I chose elsewhere and am perfectly happy.

Seems like admin at certain hospital systems near "research centers" are taking advantage of EM physicians.

Wilmington surely.

 

[EctopicFetus]

Yeah I’m not sure where you got this information but I have real ongoing information about the NC market and work in it. This is not true.

ApolloMD just took over the contract for 3 hospitals in the triad area, VEP has another and Wake Forest is staffing the rest for the most part. $200/hr base with $10-$25/hr RVU bonus is the norm. Additional $10 per hour can be obtained depending on the CMG and some quality participation stuff. No one I know would work for $140/hr.

The usual desperate shifts are offered even higher than that. Ie. $40/hr bonus for staffing New Year’s Day AM shift at one hospital in the Triad area.

Raleigh triangle area they don’t pay well because everyone wants to be there. $120/hr for 3 years sweat equity in the main SDG there. Too much risk in my opinion but they regularly have people beating down the door for it to join. Partners do well -$275-$300/hr well if to be believed. Was personally offered $149/hr by Duke Raleigh a few years ago previously. UNC was paying $185/hr after you hit the minimum obligation for faculty position. I’m not sure about the VA or Duke academic hospital.

I am aware of 2 hospital systems that pay $250+ in non-ideal places in the state and with one particular dumpster fire being $265/hr which is the highest I’ve heard of consistently here. Truly a Wild West risk your license kind of place from what I hear.

Eastern NC on average is about $200-$210/hr almost completely across the board. Very rural though and a lot of time you’re on your own especially with the tertiary hospitals being full and always being on a wait list.

The Coastal SDG that was alluded to does very well again from what I hear. I’ve never seen their books though. Couple of my residency classmates work for them though.

I don’t know about the Charlotte market aside from it being saturated. Rates could be that low there.

Had a few residents recently take jobs around there. Yes low 200s per hour if you include all the stuff.

Also I highly doubt the $51/wRVU. The exception is a SDG with a bunch of MLPs per doc.

Also, to those of you who say commercial insurance is only paying 20-40% more than medicare are either in a situation which is terrible, you are in a place where an insurer has a monopoly like in NC or alabama with BCBS. Its not uncommon for CMG contracts to be at 400% of medicare. Ask your friends to see their EOBs. I have...

 

[TooMuchResearch]

I'm fine with us paying our physician directors what they're paid because they handle everything I don't really want to know the nitty gritty about and only filter the important stuff to us. And they still work the pit, have to hit a minimum clinical hour number which works out to I think at least 7 shifts/month to maintain partnership.

This seems to have your answer.

http://www.medpac.gov/docs/default-source/contractor-reports/jan19_medpac_disparities_physiciancompensationreport_cvr_contractor_sec.pdf

You can't talk about pay here without the conversation turning in to a dick measuring contest.

Also, if you're part of an academic group, it should be understood that you do not eat what you kill. Those teaching, doing research, doing admin functions will be subsidized by those working clinically. If you can't stomach that, move on. But, unless you get in a true democratic group, you'll likely be subsidizing nonphysician execs and physician execs, which is far far far worse, IMO.

 

[coachB]

Wilmington surely.

Yes, I've heard that Wilmington is even making a lot more than what has been quoted here. Maybe even in the range of SEA money.

 

[EctopicFetus]

Yes, I've heard that Wilmington is even making a lot more than what has been quoted here. Maybe even in the range of SEA money.

not quite.. close though..

 

[scoKraz4]

I am aware of 2 hospital systems that pay $250+ in non-ideal places in the state and with one particular dumpster fire being $265/hr which is the highest I’ve heard of consistently here. Truly a Wild West risk your license kind of place from what I hear.

Can you pm me specifics/names on these places?

 

[Janders]

It is reasonable to generate/collect $51/wRVU.

However generating $51/wRVU doesn't mean you get PAID that much, at least not straight salary.

Salary+Bonus+Retirement Contribution+HSA contribution+Health Insurance+Dental Insurance+Umbrella Insurance+Disability Insurance+Malpractice Insurance+ PA salaries and expenses (help you generate revenue!) + coding&billing overhead+ group admin overhead+random small group expenses = could easily be in the neighborhood of $50wRVU, +/- depending on acuity, insurance, region, payor mix, etc.

This is supported by the lovely document that was linked by carbonizedeyesockets

If you scroll through, you see a median ED physician produced 6,647 wRVU (makes me feel good about my productivity...).
You see the TOTAL CASH VALUE compensation for that was $351,022. Not base salary, TOTAL CASH COMPENSATION.
The gave a median of $52.65 per wRVU.

So yeah, assuming easily 30% of that income goes to benefits, PA salaries (w/ their wRVU assigned to you), group overhead... you might receive 70% of that which would be $36.8 / wRVU. Much more in line with what other posters told you.


This complexity is why I like true open books... I see the CASH i generate monthly, and where every penny goes. I can look up the wRVU if I care, but cash is king.

 

[thegenius]

It is reasonable to generate/collect $51/wRVU.

However generating $51/wRVU doesn't mean you get PAID that much, at least not straight salary.

Salary+Bonus+Retirement Contribution+HSA contribution+Health Insurance+Dental Insurance+Umbrella Insurance+Disability Insurance+Malpractice Insurance+ PA salaries and expenses (help you generate revenue!) + coding&billing overhead+ group admin overhead+random small group expenses = could easily be in the neighborhood of $50wRVU, +/- depending on acuity, insurance, region, payor mix, etc.

This is supported by the lovely document that was linked by carbonizedeyesockets

If you scroll through, you see a median ED physician produced 6,647 wRVU (makes me feel good about my productivity...).
You see the TOTAL CASH VALUE compensation for that was $351,022. Not base salary, TOTAL CASH COMPENSATION.
The gave a median of $52.65 per wRVU.

So yeah, assuming easily 30% of that income goes to benefits, PA salaries (w/ their wRVU assigned to you), group overhead... you might receive 70% of that which would be $36.8 / wRVU. Much more in line with what other posters told you.


This complexity is why I like true open books... I see the CASH i generate monthly, and where every penny goes. I can look up the wRVU if I care, but cash is king.

Yes...or to put it succinctly, just look at the hourly wage. 🙂

 

[Janders]

Hourly wages + any meaningful benefit aside from standard health insurance (i.e. if company-side puts $30k in your 401k annually, thats way better than a 1% corporate match).

 

[BoardingDoc]

Yes...or to put it succinctly, just look at the hourly wage. 🙂

Umm, no. 200/hr as an IC vs 190/hr as a w2 who gets health insurance and 30k/year contributed to their 401k is clearly a better deal for the w2 despite the lower hourly.

This is obviously just an example but the entire point is that you should NOT just look at the hourly rate, unless you don't actually care about what you're getting paid

 

[TooMuchResearch]

Right. It's all about total compensation divided by hours worked.

There were residents in classes above me that passed on the democratic group I'm with because they looked at the partnership track pay way wrong and went with another group that provides a full color multi page document that makes their pay look so much better although initial compensation overall is the same and ours is generally higher for a less stressful/corporate/BS management job long term.

Sorry for the run on sentence. Bad English is my first language. #leeloodallasmultipass

Umm, no. 200/hr as an IC vs 190/hr as a w2 who gets health insurance and 30k/year contributed to their 401k is clearly a better deal for the w2 despite the lower hourly.

This is obviously just an example but the entire point is that you should NOT just look at the hourly rate, unless you don't actually care about what you're getting paid

 

[EctopicFetus]

Right. It's all about total compensation divided by hours worked.

There were residents in classes above me that passed on the democratic group I'm with because they looked at the partnership track pay way wrong and went with another group that provides a full color multi page document that makes their pay look so much better although initial compensation overall is the same and ours is generally higher for a less stressful/corporate/BS management job long term.

Sorry for the run on sentence. Bad English is my first language. #leeloodallasmultipass

Keep in mind the wRVU is only a portion of what your company collects. They get total rvus. In the end what really matters is compensation and work environment.
Personally I would rather see 2 pph and generate 9 rvus and get $50/Rvu (which is way high imo) that see 0.5pph and generate 2 rvus per hour at $100/Rvu.
Situation 1 is a normal job and they get $450/hr. Situation 2 is an easy job and you get $200/hr. Though on a per Rvu basis you get double.
I value my time too much. Both would be great jobs though.

 

[ShockIndex]

Yeah I’m not sure where you got this information but I have real ongoing information about the NC market and work in it. This is not true.

ApolloMD just took over the contract for 3 hospitals in the triad area, VEP has another and Wake Forest is staffing the rest for the most part. $200/hr base with $10-$25/hr RVU bonus is the norm. Additional $10 per hour can be obtained depending on the CMG and some quality participation stuff. No one I know would work for $140/hr.

The usual desperate shifts are offered even higher than that. Ie. $40/hr bonus for staffing New Year’s Day AM shift at one hospital in the Triad area.

Raleigh triangle area they don’t pay well because everyone wants to be there. $120/hr for 3 years sweat equity in the main SDG there. Too much risk in my opinion but they regularly have people beating down the door for it to join. Partners do well -$275-$300/hr well if to be believed. Was personally offered $149/hr by Duke Raleigh a few years ago previously. UNC was paying $185/hr after you hit the minimum obligation for faculty position. I’m not sure about the VA or Duke academic hospital.

I am aware of 2 hospital systems that pay $250+ in non-ideal places in the state and with one particular dumpster fire being $265/hr which is the highest I’ve heard of consistently here. Truly a Wild West risk your license kind of place from what I hear.

Eastern NC on average is about $200-$210/hr almost completely across the board. Very rural though and a lot of time you’re on your own especially with the tertiary hospitals being full and always being on a wait list.

The Coastal SDG that was alluded to does very well again from what I hear. I’ve never seen their books though. Couple of my residency classmates work for them though.

I don’t know about the Charlotte market aside from it being saturated. Rates could be that low there.

I actually worked for one of the employers that you mentioned. The employee salary was as follows: 150/hr + RVU bonus that was roughly 50-60K/yr. Employees got full health, retirement (roughly 10% salary) and CME.

Assuming someone worked 38 hrs/week for 48 weeks/year or 1800 hrs/yr, that would mean $325-335K per year of salary alone. Add in the employer retirement contribution (roughly $30K), CME allowance ($8K I think) and the amounts approach $360-370K/year. That doesn’t even count the healthcare benefits.

For that amount, you get to work at a nice, well-staffed hospital with access to everything you need, and see about 1.8-2 pph. Feel free to drive to Kenston, NC and make $225/hr...

 

[thegenius]

Umm, no. 200/hr as an IC vs 190/hr as a w2 who gets health insurance and 30k/year contributed to their 401k is clearly a better deal for the w2 despite the lower hourly.

This is obviously just an example but the entire point is that you should NOT just look at the hourly rate, unless you don't actually care about what you're getting paid

Fine....I'll be more pedantic. Compare the total value of the compensation packages (including benefits.)

The point is that RVU multipliers are not all that useful for determing how much you make.

 

[deleted109597]

Yes, I've heard that Wilmington is even making a lot more than what has been quoted here. Maybe even in the range of SEA money.

Yeah, but nobody is getting a job at Cape Fear right out. They're being farmed out to Goldsboro for a decade or so, guaranteed.

 

[Apollyon]

Yeah, but nobody is getting a job at Cape Fear right out. They're being farmed out to Goldsboro for a decade or so, guaranteed.

Cape Fear is a dump, or, at least, it was a total cess pool 15 years ago. Hell, they even had a wrong side surgery there. When did that place become good for EM?

 

[ShockIndex]

Yeah, but nobody is getting a job at Cape Fear right out. They're being farmed out to Goldsboro for a decade or so, guaranteed.

Are you talking about New Hanover in Wilmington or Cape Fear in Fayetteville?

10 years ago, Cape Fear was paying ridiculous per hour rates for locums. It was a dumpster fire back then but seems to have pulled itself together as of late as a quasi-academic place that sees a boatload of really sick people.

New Hanover has been staffed by the same group for a while, but their future is uncertain as the county seems intent on selling the hospital and HCA has been thrown around since October as a buyer.

 

[deleted109597]

Are you talking about New Hanover in Wilmington or Cape Fear in Fayetteville?

Sorry, New Hanover in Wilmington. I knew when I interviewed with the group it was known that you had to work in the interior for some time. Same was true for a different group in Charleston.

 

[deleted109597]

Seems like this thread totally derailed from my original question...

Dude, we are ER docs. SQUIRREL