I have been interviewing for jobs and those that use wRVUs for compensation seem to range from about $55-$70 in wRVUs. I don't really have much to compare this to. What is a good $ per wRVU in an employed position?
What is a good $ per wRVU?
- Thread starter abcc6
- Start date
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
I haven’t been an employee for a very long time so others can comment on the market rate.
I believe the national average for a general derm encounter is about 1.3 or 1.4 wRVUs. Obviously that varies probably a lot between different dermatologists but you can do the math about how much you’d expect to be paid at those rates based on seeing X patients a day for Y days.
We pay new our dermatologists on base salary for a couple years with a production bonus so not sure what market rate is for straight wRVU compensation.
I believe the national average for a general derm encounter is about 1.3 or 1.4 wRVUs. Obviously that varies probably a lot between different dermatologists but you can do the math about how much you’d expect to be paid at those rates based on seeing X patients a day for Y days.
We pay new our dermatologists on base salary for a couple years with a production bonus so not sure what market rate is for straight wRVU compensation.
Most the jobs i'm seeing pay a base salary for 2 years with a target wRVU target, then bonus at a certain rate thereafter. For some, the initial target adds up to less $/wRVU than the bonus. For others, it is simply a flat rate with a 2 year safety net.
examples i've seen:
2-year guarantee of $425,000 with wRVU target of 7,115... (comes to $59.73/wRVU), followed by production bonus of flat rate of $67/wRVU
vs
2-year guarantee of $525,000 with wRVU target of 8,750 ... (comes to $60/wRVU), followed by production bonus of flat rate $60/wRVU
It seems as if, assuming I will be moderately productive, the base is irrelevant and I should focus on the weighted average of the $/wRVU. Nobody will give me a $/wRVU for year 3 when I would move to production only, as they will typically say it will depend on whether or not CMS has increases/decreases.
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
The wRVU numbers you state above are reasonable to hit but “assuming you will be moderately productive” depends on if you walk into a practice that 1) gives you adequate support and 2) has a referral base / demand that will let you be as busy as you want from day 1.
Both are big assumptions and need to be researched. How many rooms/support staff will you have? Scribe? What EMR? How long is the current wait for patients in the practices? How do new patients (and follow up’s) get assigned by the staff? Do you have 100% say how to treat all tumors or do they “encourage” certain threshold for sending to their mohs team? Cosmetics? Any fine print/ stipulations about collections or payor mix?
8000 wRVU for a general dermatologist can either be easy to hit or excruciating hard, depending on the setup…. Many places it would be near impossible for a new guy to hit year 1 - but maybe in an well setup practice with a scarcity of derm in the area not so much. I know our new dermatologists don’t hit that wRVU level because they are less busy for a bit but then again we are private practice in a pretty saturated area and maybe you are talking about private equity? After partnership the take home pay (after overhead between all the partners) per wRVU is significantly higher.
Last edited:
All good points. Is it typical to have listed in a contract the # of rooms/support staff? Everyone tells me 3-4 nurses, 4-6 rooms, a scribe, and EPIC, but I suppose it could just be talk. And I am only searching rural, mostly just hospital systems, all booked 6-12+ months out (or at least that is what they say). One practice is telling me their 2 MD's averaged just over 17,000 RVUs last year.... sounds ridiculous (and no I am not expecting to reach anywhere near that).
"After partnership the take home pay (after overhead between all the partners) per wRVU is significantly higher." - how much higher? This seems much more complicated to quantify and compare.
- Joined
- Jul 2, 2017
- Messages
- 180
- Reaction score
- 329
if you want something make sure it is in your contract, never just assume or take them at their word
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
17000 wRVU per doc? Unless they are biopsy mills (where no patient leaves without getting a few biopsies) that’s probably like 50-60 patients a day, 5 days a week…. Unless these docs are both mohs? There are practices like that — but sounds atypical.
Something sounds strange. Unless they produced 17000 together.
For reference most of the well established gen derm in our practice generate 6-10k wRVU /yr once their schedules are completely full depending how many days they work. I think our collections minus all overhead was about 100 per last time I checked.
The exact quote is: "MDs in 2021 averaged 8,000 patients and 17,630 RVUs. "
My math comes to 2.2 RVUs per patient and 35 pt/day (5 days/week and 46 weeks). If a 99213 is 1.3 RVUs and a 99214 is 1.92 RVUs then I don't think 2.2 per patient on average is that crazy once you add procedures? (0.66 RVUs for single tangential, 0.61 for destruc premal, 0.7 for destruc benign + more with multiple procedures, excisions). But yeah, basically sounds like majority of patients get a freeze or a biopsy.
Last edited:
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
Seems like a pretty fair deal if they can pay you 60 per wRVU especially if you are a straight employee and have no risk in managing the practice (the 95+ I quoted is for partners with ancillary revenue streams and margin from employees). I couldn’t pay our new docs that - but maybe in a rural area there is a better contract and more of a monopoly, which makes sense in getting a higher overall salary.
2.2 per encounter would be hard to get in my area given how aggressive insurance is about denying 25 modifiers, audits on LOS, and also patients getting mad about their cost share (and not coming back)…. that also is dependent on demand and payor mix though, so if your colleagues are doing it then certainly possible. Working 5 days is also atypical and wears on you so isn’t the average practice (even though I do it - although see fewer than 35).
Last edited:
- Joined
- Jun 1, 2013
- Messages
- 293
- Reaction score
- 195
With the Medicare wRVUs changes, wRVUs have increased significantly for dermatology (easier to get level 4 visit and the wRVU rates are much higher now). However, a lot of larger healthcare institutions have also decreased wRVU conversion rates to coincide with the wRVU increases. This is because most private insurers aren't increasing actual reimbursement for E/M codes like Medicare is, even though the wRVUs for E/M codes increased. I think our wRVU conversion factor decreased from ~$72 to ~$65 between 2020 and 2021 because of this. But the overall increase in wRVUs generated in the new 2021 E/M system is greater than the corresponding decrease in wRVU conversion.
I work in academic center and my schedule works out to about 3 days (25 clinic hours) per week. I usually have about 110 patients scheduled, but about ~95-100 checked-in visits due to no-shows or last-minute cancellations. I average about 1.9-2.0 wRVUs/patient, although I see more complex patients (I bill Level 5 E/M codes sometimes) and one of my 1/2 day specialty clinics is an incredibly high biopsy rate. Remember, however, that some patients (e.g. wart cryotherapy follow-ups) don't actually generate much wRVUs because you can't always bill an E/M code. With vacation, holidays, conference travel, etc. it works out to 7000-8000 wrVUs per year in the 2021 system. From prior post about rooms, I'm less familiar with private practice, but most larger institutions the typical expectation is 2-3 rooms, 2 MAs. and a scribe (that's pretty generous). 4-6 rooms with 3-4 MAs sounds like a lot, but maybe this is more normal in very busy private practices.
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
It’s not normal. How would you even use 4-6 rooms and 4 MAs efficiently for 1 doctor? Unless your visits are like 5 minutes.
Not to sound rude but…aren’t they usually 5-10 minutes? Even the level 4s?
- Joined
- Jun 2, 2018
- Messages
- 285
- Reaction score
- 806
There's a huge difference between 5 and 10 minutes... Thats the difference between 6 patients an hour (busy but doable with good staff) and 12 patients per hour (literally impossible without being a terrible doctor).
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
Exactly. I can do 10 minute visits, as can many dermatologists with an efficient setup — but 5 minutes requires an assembly-line setup, possibly doing a superficial job AND refusing to help certain patients that present to your dermatology practice (not to mention pissing off a significant proportion of patients).
So on an average clinic day you are seeing 36-50 patients a day. Do you just chart in the room or have a scribe do it? I’m trying grasp how this constant volume doesn’t burn people out.
- Joined
- Jun 1, 2013
- Messages
- 293
- Reaction score
- 195
I know dermatologists who see 100 patients per day - this usually means long clinic days (7-7 PM) and a high reliance on MA/scribes to provide most of the actual care outside of medical decision making. While there are some patients who actually like this model, I can say from personal experience that many patients do not and eventually catch on to the "hustle" and go elsewhere. Personally, I don't think I could ethically practice like that.
I’ve heard of one lady in NYC works 2 days a week as a Derm and sees about 75-100 per day.
I agree it does appear to be excessive and probably exceeds the limit to practice safely and effectively. the volume just seems daunting I gueee you just get really good at it.
How do you even remember any of your patients at that point?
- Joined
- Jan 15, 2019
- Messages
- 631
- Reaction score
- 558
That has to be 7 figures, no?
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
Easily.
But there are easier ways to make 7 figures in derm than seeing 100 patients yourself a day.
- Joined
- Oct 4, 2002
- Messages
- 798
- Reaction score
- 600
Nice discussion...I'm a rad so its interesting to see how the whole wRVU works in a clinical setting...its a flawed system as is CMS. If possible I would recommend getting into cash only practice (I know, probably pretty challenging to do so particularly in certain geographic areas)
On a side note has private equity infiltrated derm?
On a side note has private equity infiltrated derm?
- Joined
- Oct 22, 2006
- Messages
- 2,267
- Reaction score
- 754
Yes, PE has very heavily infiltrated derm
- Joined
- May 24, 2009
- Messages
- 4,672
- Reaction score
- 9,713
Private equity has probably infiltrated derm more than any specialty out there.
- Joined
- Jul 9, 2003
- Messages
- 1,696
- Reaction score
- 5,168
Not sure about that. Look at EM, anesthesia, radiology and pathology. They are basically owned by large PE groups or academics, aren’t they? I would say derm still has a decent number of truly private groups (50%?+) compared to most specialties (although decreasing quickly, admittedly, given PE in derm was basically non existent 10 years ago).
