OOOOO YUMMY. My favorite topic. Allow me to divulge.
First and foremost, you need to grab a copy of the latest MGMA statistics that breaks compensation into regional groups. It also allows you to see medium and median compensation per specialty. That is the best place to begin. I believe most contracts go kinda like this.... Base salary is somewhat arbitrarily set around MGMA mean. I don't recall that number off hand, but it is upper 200's. Let's say base is $275k. That's the first piece of the puzzle, but not the most important piece. Now it's time to decide RVU value. MGMA also has data on what the mean RVU value should be per specialty. I believe that is around $52ish/RVU for Path. So now you have a base salary which is set at $275k and an RVU value of $52. You now have an RVU base which is $275k/$52 = 5288 RVU/year. So if you're able to sign out 5288 rvu's/year then your compensation is only your base (275k) and do won't get to walk to Bonusville. Oftentimes employeers will want to insert an "RVU Floor". Mine (I think) was 90% of my base. The clause stated that if I did not meet my FLOOR per anum, then my BASE would be renegotiated the following year. I've never had a problem hitting floor. So any RVU's above base should kick into bonusville. Bonusville is a very delightful place to visit every quarter. I get 100% of the RVU's (wRVUs) after I meet my base RVU. I chose to have mine tallied and paid quarterly, as I just didn't trust the corporation to agree to paying me such a large sum once a year.
You should be able to keep 100% of the RVU's you generate after meeting your BASE. The most important part of the contract negotiating is your RVU $ value. I've known individuals that landed in a sweet spot because they had leverage. If you're in the mid to low 50's for a dollar value on RVU's, you should be making at least medicare rate, if not a little better (depending on your region/expenses etc). On average I at least double my RVU goal per month. PM me if you'd like more details.
How is taking call in Pathology/Lab credited in a pure RVU system? What is the RVU/call day? Because all the data Ive seen from people at a $52 per RVU you would getting 1.2-2.0 RVUs per day of call and that is INSANELY low for being responsible for the entire lab 24-7.
The RVU system has massive flaws the least of which is guys like me would game the living hell out of it.
There are also an incredible number of flaws in your general argument:
1.) Hospital based pathologists often have zero ability to affect their volumes. What comes in, comes in. So the entire idea that you are being incentivized to do more makes no sense when you have zero ability to do more.
2.) This then creates the incentive to be absolutely as wasteful as possible. I need 3 immunos on a case before RVU, now I do 30. You might argue that happens now, but in a system where you pushed to count every little unit, this will get out of control fast.
3.) You can guarantee the base level of RVUs needed each year will go up and up ad infinitum. Anyone with lots of experience in workplace productivity realizes most large organizational management strategies involve raising the bar inch by inch until it is literally impossible to meet. I dont see how you will win this game EVER.
I would rather have a flat salary, zero bonus whatsoever and at least know what my slavemasters will let me keep at the end of the day than that trash business model.
RVU based incentive pay systems are literally the worst hybrid of private practice and employment models I could imagine.
Personally though I would love to negotiate a big RVU based contract with a hospital administrator because I can think of million different ways to hose an institution with this. I would assume they would fire me after my initial term, but I would walk away with an epic pile of loot and sit on the beach in Mexico sipping coronas for the remainder of my days!
