Salary structure question

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mdo1738

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Looking at first jobs, found one I really like but curious about if the pay structure seems reasonable.

-hospital group
-joining an expanding practice, there's 1 doc there currently and she is apparently 90-95th%ile MGMA production level the last several years
-there is a salary, but the way it's structured it's essentially 100% production based. The salary is contingent on hitting a wRVU productivity target, if I am below the target then my salary for the next pay period is adjusted downward
-adjusted upward for exceeding target, can make 7 figures at about 90th %ile. Basically ends up being a little over $62 per wRVU with target of 12k RVU per year

Basically almost seems too be good to be true so I'm wondering if I'm missing something. This other lady says she is pulling in just over $1 milli a year, and I don't see any reason why she would lie since she's just a hospital employee too. Is 12k a realistic target? I don't have access to direct MGMA data myself, but what I am told is that 12k is in line with about 66th percentile. I'll be doing implants, kypho etc so will be doing fair amount of higher RVU procedures. Thanks for any advice.
 
mdo1738 said:
Looking at first jobs, found one I really like but curious about if the pay structure seems reasonable.

-hospital group
-joining an expanding practice, there's 1 doc there currently and she is apparently 90-95th%ile MGMA production level the last several years
-there is a salary, but the way it's structured it's essentially 100% production based. The salary is contingent on hitting a wRVU productivity target, if I am below the target then my salary for the next pay period is adjusted downward
-adjusted upward for exceeding target, can make 7 figures at about 90th %ile. Basically ends up being a little over $62 per wRVU with target of 12k RVU per year

Basically almost seems too be good to be true so I'm wondering if I'm missing something. This other lady says she is pulling in just over $1 milli a year, and I don't see any reason why she would lie since she's just a hospital employee too. Is 12k a realistic target? I don't have access to direct MGMA data myself, but what I am told is that 12k is in line with about 66th percentile. I'll be doing implants, kypho etc so will be doing fair amount of higher RVU procedures. Thanks for any advice.
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This is accurate, however if she is the only doctor, you will canabalize summer of her work in theory, so keep that in mind
 
buddababa said:
This is accurate, however if she is the only doctor, you will cannibalize some of her work in theory, so keep that in mind
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I struggle with that. How will they grow the pie rather than slice it into smaller pieces? Do they have projections for growth? Does the person there now want to cut back on work?
 
I was in similar circumstances. Problem was i was booked out 3-4 months to get seen, but management would not increase the pay for the front desk position to over 11$/hr, so I essentially had no/decreasing staff. No one to room patients, no one to answer phones, no one to schedule.
This led to lower production which I had no control of, and my pay continued to decrease despite me working more.
The problem with production based employed gigs is you are paid based on production, but you have no control over your production. You are trusting another entity will work with you in growing your production (whats good for me is good for them) unfortunately doesn’t always play out with admin in the end. Remember, you are really the only person interested in your circumstances.
Secondly, if you do well and do hit high marks, the next phase of hospital employment is how can they continue to get the same amount of revenue while reducing the input cost, and that my friend will be where they look to replace you for someone who will do the same job for less, and then rinse and repeat, the cycle continues
 
What’s the backup plan of the $ per RVU goes down?

Who “owns” the patient? Is the branding and marketing for you or the hospital?

Any ancillary income?

What stops them from hiring someone for $62.99 per RVU next year (essentially undercutting you)?
 
Orin said:
I struggle with that. How will they grow the pie rather than slice it into smaller pieces? Do they have projections for growth? Does the person there now want to cut back on work?
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Current doc is booked out far in advance, and they're expanding new satellite PCP clinics for which this pain clinic is the only internal location to refer patients to from those clinics. So while I would technically be "stealing" some of her patients, it wouldn't decrease her workload or productivity, just decreases how long the patients have to wait to be seen with 2 docs instead of 1.
DrMDAware said:
What’s the backup plan of the $ per RVU goes down?

Who “owns” the patient? Is the branding and marketing for you or the hospital?

Any ancillary income?

What stops them from hiring someone for $62.99 per RVU next year (essentially undercutting you)?
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$ per RVU is contractually set in stone, and the contract automatically renews each year. The initial term is for 3 years, then renews each year after that. The only thing I could see them doing is just enacting the end without cause aspect of it if they decided they didn't want to pay that much anymore and I refused a new/altered contract with a lower $ for RVU (which, if I'm 100% productivity based, is a no-go for me).

Hospital would "own" the patient (there's a no solicitation of patients clause for 1 year after ending employment within 20 miles of the facility), though that just means I can't recruit them, they could still follow on their own accord. The metro area is big enough that I could practice elsewhere outside the 20 mile no solicitation area without having to move or any other hassle.

No ancillaries. 100% wRVU. That's a downside, but to me it's outweighed by the corresponding fact that there is no overhead. Flat rate for every point I score. Nothing more, but nothing taken out of that rate either to pay for the secretary's salary or the lawn boy to keep the grass cut etc.

They are stopped by a 3 year term that would require compensation if they end it early without any of the clearly spelled out reasons (still negotiating what that compensation would entail). Also stopped by the fact that the practice is in an area that is geographically unappealing to most people (but not for my wife and I, we both are from the area and quite fine with it).
 
mdo1738 said:
Current doc is booked out far in advance, and they're expanding new satellite PCP clinics for which this pain clinic is the only internal location to refer patients to from those clinics. So while I would technically be "stealing" some of her patients, it wouldn't decrease her workload or productivity, just decreases how long the patients have to wait to be seen with 2 docs instead of 1.

$ per RVU is contractually set in stone, and the contract automatically renews each year. The initial term is for 3 years, then renews each year after that. The only thing I could see them doing is just enacting the end without cause aspect of it if they decided they didn't want to pay that much anymore and I refused a new/altered contract with a lower $ for RVU (which, if I'm 100% productivity based, is a no-go for me).

Hospital would "own" the patient (there's a no solicitation of patients clause for 1 year after ending employment within 20 miles of the facility), though that just means I can't recruit them, they could still follow on their own accord. The metro area is big enough that I could practice elsewhere outside the 20 mile no solicitation area without having to move or any other hassle.

No ancillaries. 100% wRVU. That's a downside, but to me it's outweighed by the corresponding fact that there is no overhead. Flat rate for every point I score. Nothing more, but nothing taken out of that rate either to pay for the secretary's salary or the lawn boy to keep the grass cut etc.

They are stopped by a 3 year term that would require compensation if they end it early without any of the clearly spelled out reasons (still negotiating what that compensation would entail). Also stopped by the fact that the practice is in an area that is geographically unappealing to most people (but not for my wife and I, we both are from the area and quite fine with it).
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This sounds like a solid deal, and could well be as advertised due to the undesirable location. Make sure you have a good lawyer review the contract (sounds like you already are in negotiations so I’m guessing you already do). For example, you mention a bunch of satellite PCP locations - does your non compete extend to 20 miles from all their locations? I’ve seen that done in a lot of big hospitals’ contracts. Effectively closes off the entire metro area.
 
$62/wrvu sounds low for an undesirable location, no? Aren’t most people seeing more like $70/wrvu in hospital employed positions?
 
DOctorJay said:
$62/wrvu sounds low for an undesirable location, no? Aren’t most people seeing more like $70/wrvu in hospital employed positions?
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New grad: saw $60/RVU in highly desirable northeast city and $68/RVU in midsize central FL city.
 
In popular areas, wRVUs can be as low as $48-52. With hospital work you're leaving so much money on the table, taking in a little, and your workload isn't even less. It's far more stressful with administration breathing down your neck, the turnover with administration is high too so good relationships easily go away, and you have no control. If hospital is awful and staff turnover occurs in your department, that takes a toll on your production.
 
DrSpine said:
In popular areas, wRVUs can be as low as $48-52. With hospital work you're leaving so much money on the table, taking in a little, and your workload isn't even less. It's far more stressful with administration breathing down your neck, the turnover with administration is high too so good relationships easily go away, and you have no control. If hospital is awful and staff turnover occurs in your department, that takes a toll on your production.
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WISDOM
 
you will not hit 12k wRVU. this is unrealistic and a trap, and ive seen it used a lot.


your current partner probably doesnt hit $1 mil, or 12k wRVU. she probably tells potential "partners" that, so that the new guy will sign on with high expectations, ends up taking the hospital clinic based patients, who have a predilection to no show and are not interested in procedures, leaving her with the private insurance procedure interested patients.


you will probably be around 4000k wRVUs your first year as you build up your practice and referral base. after that, you can reasonably expect to get up to 8000 wRVU, but it will require a bit of work on your part if you keep pushing for the office to improve efficiencies. and you will lose a lot of wRVUs based on inefficiencies and patient population.


fyi - if i am doing my math wrong, isnt $1 mil per year at $63/wRVU translate to about 15,300 wRVU per year?
 
DrSpine said:
In popular areas, wRVUs can be as low as $48-52. With hospital work you're leaving so much money on the table, taking in a little, and your workload isn't even less. It's far more stressful with administration breathing down your neck, the turnover with administration is high too so good relationships easily go away, and you have no control. If hospital is awful and staff turnover occurs in your department, that takes a toll on your production.
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Where are the "Anesthesia Pain" MGMA numbers coming from then?

The wRVU numbers on the "surveys" are all over the place with very high $/wRVUs in many cases which I can't find in the real world.

There is also the issue of how many wRVUs can be done at these high $ numbers? Maybe the job has few wRVUs but at higher $/RVU bringing it to a similar compensation?

The real question for me is what is the Total Compensation at 90th percentile and how many wRVUs to get there?
 
Median $/wrvu nationally is $75.02 for anesthesia pain.

Our large hospital employed ortho group in a desirable area pays median $/wrvu for all our surgeons and pain docs.

Set your own salary/ wRVU threshold and everything is reconciled every 3 months using median $/wrvu.

Pretty easy to hit 8k wrvu working part time 4 days a week (8-4). Full time closer to 10k wrvu. We are a busy group with internal injection referrals.
 
I don't get your math. If it is just wrvu based 62 * 12k = 744000$ Still good but not 1M. Agree with people as well depending on where you are 62$ is not amazing. I live in a highly desirable area on the west coast and made 64$. Also 12k is tough to hit for most people, I think that might take a few years to get to.
 
Yeah, 12k isn’t easy. I hit 12k once, in 2019. I have no desire in working that hard again. Life is too short for all that. I hover around 10 yearly now.
 
paindoc007 said:
Very low. I work in bfe and make 75/wrvu. And I feel I’m still underpaid
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How many wRVUs can you do per year? Maybe your yearly wRVUs are low and you do more high paying procedures?

Is 75/wRVU for doing anesthesia as well or 100% just pain? Are there specific extra procedures you need to do that?
 
I did 10k last year fairly easily and that’s using the 2020 values. Left 1000 units on the table because of that. Definitely would take time for a second guy to hit 10k in my practice
 
Brown Striker said:
How many wRVUs can you do per year? Maybe your yearly wRVUs are low and you do more high paying procedures?

Is 75/wRVU for doing anesthesia as well or 100% just pain? Are there specific extra procedures you need to do that?
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100% pain.
I’m around 10k wrvu a year
 
Hawkeye prob did numbers like that for yrs in his heyday.
 
Not difficult to make 10k wrvu without working too hard.

20 patients a day * 2 wrvu per pt (average factoring in new, FU, procedures) * 20 days per month * 12 months = 9600 wrvu (salary of $600-720k depending on $/wrvu). This assumes 20 working days off.

In my opinion, this is great pay for not too much work. Hospital employed isn't too shaby as long as your admin is reasonable.
 
I begin seeing patients at 7am. I don’t take lunch and leave at 3:00 or 3:15 on my clinic days. These are office visits only and we have the new patients scheduled in protected blocks before lunch and the end of the day. If they show up, I have time to take good care of them.

One day a week I either do a huge amount of advanced procedures or a huge amount of minor procedures. I try to only go to the hospital during my block day or at 7am for one case. Like today I removed a pain pump at 7am (I didn’t put it in) and spent the rest of the day in clinic.
 
drusso said:
Most HOPD docs are getting at least $750K.
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this is pure speculation and completely not in line with MGMA data.

what is the average salary on MGMA?

let me refresh your memory - MGMA 75% percentile is $560,000-603,000. meaning only 25% make $560 or higher. 90% percentile is $806,000-$826,000.....
 
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