RVU

[DrProtonX]

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How hard is it to hit 18000-20000 RVUs in a year?

 

[Bequerel]

Honestly not hard if you have a steady stream of patients. I’ve been doing more then that for last decade and average 450-500 new starts per year. I’d say 400 new starts a year would get you close which is just 8-10 consults/week. Very doable if you have referral source.

 

[HolySmokes]

I average about 30% SBRT, 40% hypofx, and 30% conventional fx and that gets me an average of ~45 RVU/new start. So probably 400-450 new starts would get you in that range.

Edit: This was 2025 data, for the same work I've estimated ~5-6% decrease in RVU so maybe 42-43/RVU with 2026 values.

 

[Ray D. Ayshun]

400 new starts will undoubtedly get you there. The question is, how easy is it to get 400 new starts?

 

[TheWallnerus]

Honestly not hard if you have a steady stream of patients. I’ve been doing more then that for last decade and average 450-500 new starts per year. I’d say 400 new starts a year would get you close which is just 8-10 consults/week. Very doable if you have referral source.

With 6000 rad oncs doing 400 new starts per year there would be 2.4m new starts per year. However there are only about 1.2m new starts per year in America. So 400 is several standard deviations about the average; I’d estimate at least 3 or more above.

 

[Mandelin Rain]

How hard is it to hit 18000-20000 RVUs in a year?

It's a busy, but very doable practice. Especially if at a single site with an efficient staff.

The problem is finding the volume to get there (as others have indicated).

 

[BobbyHeenan]

It's a busy, but very doable practice. Especially if at a single site with an efficient staff.

The problem is finding the volume to get there (as others have indicated).

Single site , efficient staff that knows how you run things it is very do able.

I like the level of busy-ness at 20k wRVU.

I’ve been up at high 20s and it gets very busy, but low 20s with great support is doable and honestly I enjoy living at that level of volume.

 

[6FFF]

I have to imagine all you guys doing 400 new starts a year are outsourcing most of your follow ups to an APP?

 

[Ray D. Ayshun]

I have to imagine all you guys doing 400 new starts a year are outsourcing most of your follow ups to an APP?

Soon I hope. Still doing it without an app, but hiring. Life will become substantially better.

 

[metallica81788]

I have to imagine all you guys doing 400 new starts a year are outsourcing most of your follow ups to an APP?

When you're solo and busy for a while, follow ups become the bane of existence
I'm trying to decide either how to get rid of them or get an APP to handle them
Can't make money without seeing new patients

 

[ramsesthenice]

How hard is it to hit 18000-20000 RVUs in a year?

Depends if you are asking in general or about a specific job. There 2 main variables are patient volume and complexity. You typically have more control over complexity than volume though the PA systems in some regions are trying very hard to prove me wrong. I’ve lived in main site academics and no, those numbers are typically not doable because of FTE allocations to non clinical activities. That said, at my old job I routinely hit 13-15K with a 0.5 FTE without killing myself. It’s very easy for me to see hitting those numbers as someone fully clinical in a reasonably busy center without feeling overwhelmed at all.

But to my initial point, if you are looking at a specific job that they are selling to you as a great opportunity “if” you hit those numbers, I’d damn sure want to see evidence it’s doable in that set up. Hard work, the three As, and being creative can get you somewhat of a bump, but the primary variables are largely out of your control in many markets despite what admins like to think.

 

[6FFF]

When you're solo and busy for a while, follow ups become the bane of existence
I'm trying to decide either how to get rid of them or get an APP to handle them
Can't make money without seeing new patients

Right, same. I did about 300 new starts in the last 12 months and it felt quite busy. I can’t imagine doing 30% more. Wouldn’t be nearly so bad without having to deal with follow up clinic. I like seeing my folks do well but it certainly is a time sink that detracts from the lucrative activities

 

[HolySmokes]

Also depends on how many days you're in clinic. I did about 325 new starts last year, ~14k RVUs, but I'm (unfortunately) required to be here 5 days a week so even with inefficient staffing and very limited NP support for follow up I still had quite a lot of time twiddling my thumbs. If I'd been at 3.5 to 4 days I think it'd have felt a bit more consistently busy.

 

[DrProtonX]

It’s good to hear that it’s not extremely hard to hit those numbers. Based on the job postings I’ve seen the average $/RVU was about $50-60 so I figured to hit 7-figure, you’d need 18,000-20,000 RVU. So it seems like you don’t necessarily need to be in private practice for 7-figure paycheck. You can get there as a hospital employed with good RVU incentives, good referral base and efficient staff

 

[JustAdocInBox]

It is becoming more difficult with hypofrac and the drop in wRVU for IGRT. You would need an efficient clinical staff, competent dosimetrist, and the right patient mix otherwise you will burn out. Brachytherapy and a lot of inpatients will make it tougher, FUs can eat up a lot of time, but I believe seeing your own definitive FUs is good standard practice, Unfortunately even you wanted to and had the capacity to produce at that level, wRVUs per new start are only going down. We are doing less 5 week breast, less 3 week breast, lost a good portion of esophagus volume, prostates are mostly 20-28 fx. Sure we are adding Osteoarthritis and Radiopharmaceuticals but those don't generate as many wRVUS. If you can't hit those wRVUs numbers for whatever reason, then the right play is advocating for more time off and better quality of life. That is typically in the form of a 4 day work week and more PTO. 10-14k wRVUs is no problem working 3-4 days a week with generous PTO and CME.

 

[drowsy12]

It’s good to hear that it’s not extremely hard to hit those numbers. Based on the job postings I’ve seen the average $/RVU was about $50-60 so I figured to hit 7-figure, you’d need 18,000-20,000 RVU. So it seems like you don’t necessarily need to be in private practice for 7-figure paycheck. You can get there as a hospital employed with good RVU incentives, good referral base and efficient staff

this is true in theory but you need to consider the low likelihood of having the setup to get these numbers in the vast majority of places.

 

[Ray D. Ayshun]

It is becoming more difficult with hypofrac and the drop in wRVU for IGRT. You would need an efficient clinical staff, competent dosimetrist, and the right patient mix otherwise you will burn out. Brachytherapy and a lot of inpatients will make it tougher, FUs can eat up a lot of time, but I believe seeing your own definitive FUs is good standard practice, Unfortunately even you wanted to and had the capacity to produce at that level, wRVUs per new start are only going down. We are doing less 5 week breast, less 3 week breast, lost a good portion of esophagus volume, prostates are mostly 20-28 fx. Sure we are adding Osteoarthritis and Radiopharmaceuticals but those don't generate as many wRVUS. If you can't hit those wRVUs numbers for whatever reason, then the right play is advocating for more time off and better quality of life. That is typically in the form of a 4 day work week and more PTO. 10-14k wRVUs is no problem working 3-4 days a week with generous PTO and CME.

As someone who has gone from 12-21k in the last few years, I'd say my preference is less busy with more time off, which presently isn't possible. Unfortunately, I think that if you're solo, there's an added level of stress even if you were to be at home 1 day a week given that all the problems are ultimately your responsibility. My feeling about ideal job at this point is around 15k rvus with at least one day off a week, 8 weeks vacation, and 1+ partners. And beam matched machines.

 

[TheWallnerus]

I'm (unfortunately) required to be here 5 days a week

What’s the powers that be’s stated rationale behind that

 

[HolySmokes]

What’s the powers that be’s stated rationale behind that

As is all too common, they lack rationale for many of their poorly thought out decisions.

 

[Bequerel]

It’s all about support staffing and efficiency. If you find a hospital that will support you with multiple RNs, and NP and an MA then 20k+ wRVU’s and a 4 day work week is very attainable.

 

[BobbyHeenan]

I have to imagine all you guys doing 400 new starts a year are outsourcing most of your follow ups to an APP?

Im 5 days/week to make it happen. Very busy 5 days.

As someone who has gone from 12-21k in the last few years, I'd say my preference is less busy with more time off, which presently isn't possible. Unfortunately, I think that if you're solo, there's an added level of stress even if you were to be at home 1 day a week given that all the problems are ultimately your responsibility. My feeling about ideal job at this point is around 15k rvus with at least one day off a week, 8 weeks vacation, and 1+ partners. And beam matched machines.

Agree completely with this.

Unicorn job but 2-3 docs, one center, two matched machines and a HDR afterloader would be heaven. Everyone has same work ethic and similar styles. Doing around 15 wRVU each.

Absolute dream scenario.

 

[goodluck1234]

Agree completely with this.

Unicorn job but 2-3 docs, one center, two matched machines and a HDR afterloader would be heaven. Everyone has same work ethic and similar styles. Doing around 15 wRVU each.

Absolute dream scenario.

Agree 100%. Only thing I’d add is APP for follow ups, 1:1 nursing, 80% conversion rate.

 

[yesmaster]

The main issue is not whether you can take care of patients to generate 20k RVU’s without burning out. The main issue is if your setup allows you to be that busy based on your referral base, competition, etc. Hospital systems and AMC’s pay a lot of money for attorneys to tell the CEO’s why they can’t pay too much to their employed docs without violating some dummy law written by a dummy legislator.