RVU based vs Salary + quality bonus

[Neurologo]

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I am posting my question here so other residents looking for jobs may also benefit.

One of the jobs I interviewed said they are trying to catch up with national trend and move away from RVU based to a set salary plus bonus based on quality. They say this is to make themselves as competitive as other hospitals in attracting new hires. I have not heard this and am not clear which is better for physicians especially for inpatient jobs. And how is "quality" measured? Patient outcome? Readmission? Satisfaction surveys? Your views are welcomed.

 

[RustBeltOnc]

This is an important topic for new grads.

Pros/Cons of the two systems:

1. RVU:
pro: if all docs on level playing field, incentivizes getting work done, prevents laziness
con: docs not always on level playing field with respect to facilities, driving, referrals, making it much easier for some to rack up RVUs
system can always hire more docs, so you never hit RVU targets and get income you expected

2. Fixed salary + quality metrics
pro: if docs face differing challenges, it's all good, you still get paid
con: you don't get paid for working harder
quality metrics always nebulous, sometimes outright bogus

For both systems, it's "all about the base" -- you need to have a guaranteed income you are OK with.

 

[Arcan57]

The key to either system is going to be what the average doc is bringing in and how closely you'll fit that average doc profile. RVUs are going to depend on the factors mentioned by RustBelt. Unless you're replacing a doc, your presence is going to be diluting the pool of possible RVUs for the group and it's also possible that the RVU targets they are quoting are going to be only achievable at facilities at which you don't work.

The salary + quality is going to depend on what the base salary is, how possible the metrics are to achieve, and whether the projected workload is reasonable based on the salary. Relatively low fixed salary, impossible to meet quality metrics, and unevenly distributed workload is soul-crushing in a way that a similar gross pay wouldn't be in an RVU system.