RVU-based ER Psych

[clement]

---

Members don't see this ad.

Curious if any ER or crisis stabilization unit attendings in an academic setting have an RVU reliant (base) salary?

Admittedly, I’ve never heard of this (and perhaps didn’t realize it when I was in academia doing ER psych). I do know RVU based CL is unpopular, and that academic employers started moving toward a model where it mainly incentivizes bonuses.

Some early career advice I stumbled across the hard way: If it’s a new role in the hospital and the volume isn’t defined (and won’t ever be), only accept it in a very part time capacity.

 

[comp1]

Nope, ER psych (as opposed to combined with CL) jobs are rare as it is and academic jobs are almost always salaried. The fact that a bonus is even involved with RVUs is pretty impressive. Remember, academic jobs primarily pay in "prestige."

 

[clement]

Nope, ER psych (as opposed to combined with CL) jobs are rare as it is and academic jobs are almost always salaried. The fact that a bonus is even involved with RVUs is pretty impressive. Remember, academic jobs primarily pay in "prestige."

I’ve always understood most academic jobs have an underlying base salary rvu formula. In this case both the base and bonus are incentivized by volume. If RVU’s drop, so does base.

 

[Atreides]

I doubt it. My current academic job offered me the option to do ER instead of outpatient psychiatry for a higher salary but the marginal increase in salary (something like 20k) definitely doesn't making up for the higher patient volume, lack of remote work (I'm 50% virtual), and abysmal parking situation at the main campus (easily adds 30-45 minutes a day of uncompensated time).

 

[TexasPhysician]

Curious if any ER or crisis stabilization unit attendings in an academic setting have an RVU reliant (base) salary?

Admittedly, I’ve never heard of this (and perhaps didn’t realize it when I was in academia doing ER psych). I do know RVU based CL is unpopular, and that academic employers started moving toward a model where it mainly incentivizes bonuses.

Some early career advice I stumbled across the hard way: If it’s a new role in the hospital and the volume isn’t defined (and won’t ever be), only accept it in a very part time capacity.

Yes. Some academic centers realized that they had collected psychiatrists that love teaching but don’t want to see many patients. The solution was to implement a RVU minimum for the department with bonus structure. Non-patient activities were given a RVU equivalent so teaching wasn’t necessarily punished. The RVU minimum for base salary wasn’t hard to hit for an average psychiatrist. It was actually more of a bonus structure designed to increase productivity with the fear of a salary reduction.

This resulted in improved productivity and increased desire to take home call supervising residents. It also made supervising resident clinics super desirable as you get their RVU’s.

This wasn’t an ER initiative as it was a department-wide change. Everyone had to fall in line.

 

[Stagg737]

Curious if any ER or crisis stabilization unit attendings in an academic setting have an RVU reliant (base) salary?

Admittedly, I’ve never heard of this (and perhaps didn’t realize it when I was in academia doing ER psych). I do know RVU based CL is unpopular, and that academic employers started moving toward a model where it mainly incentivizes bonuses.

Some early career advice I stumbled across the hard way: If it’s a new role in the hospital and the volume isn’t defined (and won’t ever be), only accept it in a very part time capacity.

This was my first job out of residency and I don’t recommend it for a few reasons. For me, the first year was straight salaried but after 12 months it was RVU-based calculated by looking back at the previous 12 months production which updated quarterly. I switched over to “full-time” CL after 1.5 years and haven’t regretted it one bit (and I don’t mind RVU based CL at all). Reasons for the switch:

1. In the first year I only hit ~2000 RVUs from the ER role (only mornings) and I needed to be hitting closer to 3000-3500 RVUs to maintain the income I wanted. RVUs were often feast or famine and I’d have days where I’d see 6-7 new patients in 6 hours and then go a day or two with no consults at all. I got around 15 RVUs per week from 5ish hours of outpatient/week and made up the remaining RVUs by covering the consult team and ECT when people needed it. I was fortunate that our department subsidized my income quite a bit in the 6 months I was RVU based or else I would have taken a significant pay hit (probably around 30%). Seemed silly to be doing only ER and scrounging for RVUs elsewhere working alone vs just shifting to full CL mostly staffing residents and hitting well over my personal minimum (hitting >4000/yr now).

2. The ER had a RN/SW team I worked with. It was great because they could take care of most of the social stuff, but they also saw the straightforward psych patients (suicide attempt now asking for inpatient admission, etc) so I only saw the more complex or higher liability cases. After a while, it starts to take a mental toll only seeing train wrecks and having to make the hard decisions for everyone else, so was ready to move out of that role. That wouldn’t have been nearly as bad if I saw all the straightforward cases to get easy RVUs and patients that were less mentally/emotionally taxing for me, but towards the end I was definitely starting to hit burnout.

3. The time some of these patients require is often not appropriately reimbursed by RVUs. There are some patients who due to administrative issues surrounding their complexity may take several hours throughout the day to address appropriately and a 90792 or just using 99417/8 add-ons don’t earn the RVUs concordant with the work put in.

Feel free to DM me with specific questions. These positions are out there (we recently filled this position after previous psychiatrist left to become a PD) but they certainly aren’t the standard.

 

[clement]

This was my first job out of residency and I don’t recommend it for a few reasons. For me, the first year was straight salaried but after 12 months it was RVU-based calculated by looking back at the previous 12 months production which updated quarterly. I switched over to “full-time” CL after 1.5 years and haven’t regretted it one bit (and I don’t mind RVU based CL at all). Reasons for the switch:

1. In the first year I only hit ~2000 RVUs from the ER role (only mornings) and I needed to be hitting closer to 3000-3500 RVUs to maintain the income I wanted. RVUs were often feast or famine and I’d have days where I’d see 6-7 new patients in 6 hours and then go a day or two with no consults at all. I got around 15 RVUs per week from 5ish hours of outpatient/week and made up the remaining RVUs by covering the consult team and ECT when people needed it. I was fortunate that our department subsidized my income quite a bit in the 6 months I was RVU based or else I would have taken a significant pay hit (probably around 30%). Seemed silly to be doing only ER and scrounging for RVUs elsewhere working alone vs just shifting to full CL mostly staffing residents and hitting well over my personal minimum (hitting >4000/yr now).

2. The ER had a RN/SW team I worked with. It was great because they could take care of most of the social stuff, but they also saw the straightforward psych patients (suicide attempt now asking for inpatient admission, etc) so I only saw the more complex or higher liability cases. After a while, it starts to take a mental toll only seeing train wrecks and having to make the hard decisions for everyone else, so was ready to move out of that role. That wouldn’t have been nearly as bad if I saw all the straightforward cases to get easy RVUs and patients that were less mentally/emotionally taxing for me, but towards the end I was definitely starting to hit burnout.

3. The time some of these patients require is often not appropriately reimbursed by RVUs. There are some patients who due to administrative issues surrounding their complexity may take several hours throughout the day to address appropriately and a 90792 or just using 99417/8 add-ons don’t earn the RVUs concordant with the work put in.

Feel free to DM me with specific questions. These positions are out there (we recently filled this position after previous psychiatrist left to become a PD) but they certainly aren’t the standard.

When you say, “…aren’t the standard?” in your experience is ER psych (even if just 0.5 FTE’s) in academic settings not RVU reliant?