Urology RVU question

[peckerchecker50]

Hey everyone, I'm new to this forum and process in general.  I am completing a urology residency in the northeast, and I am looking to stay in the region.  I have been on several interviews, and there is one job I really want.  It is in an under-served area but only a half hour or so away from a major city.  It seems like a good deal, I've been able to negotiate a handful of things.  A reservation is they want a 9000 RVU minimum after a couple years (I know average for a GU surgeon is around 7500-8k).  Most concerning, is they only are offering me $47.50/RVU.  I think this is low as people have told me it is low and the last actual $/RVU data I found on the internet was $57 in 2013.  I've brought this up to negotiate with them a handful of times, but I've been dismissed.  The first two years are guaranteed, but after that I go strictly RVU production based for salary.  At this point this is the only thing holding me back from signing, and since I have addressed it with them already, I'm not sure how to approach this.  I would love anyone's advice on this matter and even if I'm being greedy by wanting more per RVU (I think it's justified but I could be wrong).

Thanks!!

[Matas]

So, they require you produce well over the MGMA mean for RVU productivity, and for that they will compensate you well below the mean conversion factor? Unless there are compensating benefits (retirement, paid vacation, CME, health plan, minimal call, etc), I'd say this is probably not a market competitive offer. if there are other reasons why you want to work there, fine, just go into it knowing what you are giving up.

[q-school]

That’s how the rvu system works.  there's not an assigned $/rvu in the general sense.  the hospital probably subscribes to an approach.  they select a source-amga, mgma, lcs--and that service provides them $/rvu scale.  25%,50%75%, 90% $/rvu.  local numbers and national numbers.

If you are a high producer they pay you less per rvu. They claim they are a not for profit hospital and that they get audited. They cannot pay more than fair market value total income so if you are high rvu producer they cannot pay higher $/rvu.

[Matas]

q-school wrote:

That’s how the rvu system works.  there’s not an assigned $/rvu in the general sense.  the hospital probably subscribes to an approach.  they select a source-amga, mgma, lcs–and that service provides them $/rvu scale.  25%,50%75%, 90% $/rvu.  local numbers and national numbers.

If you are a high producer they pay you less per rvu. They claim they are a not for profit hospital and that they get audited. They cannot pay more than fair market value total income so if you are high rvu producer they cannot pay higher $/rvu.

Click to expand...

I doubt there's is an audit risk for being paid at the median rate per RVU regardless of the total compensation since the higher total comp is justified by the commensurate increase in productivity. As for the OP, at 20% below median per RVU - can't imagine there's a Stark issue. And maybe that's why it's an under-served area.

[q-school]

That’s why I said they claim it.

[Hatton]

Your name is too funny

[VagabondMD]

Great handle. Not sure if it passes "the living room test" in Utah, but it works for me here!

[peckerchecker50]

I appreciate all the input. If I’m producing 1500 more RVUs than another urologist who is getting paid $8 more per RVU and making the same money, why should I get a pay cut for being more productive? That doesn’t make sense but I understand what you guys are saying.

The job does include full benefits, malpractice, good retirement. I really have no extra costs. Call is minimal and what I do take is paid extra.

Previous residents that got hospital employment jobs have all those same things but are at median RVU and good production. I feel like I’m getting hosed a little regardless. I’ve brought this up three times and they literally aren’t budging.

[q-school]

peckerchecker50 wrote:

I appreciate all the input. If I’m producing 1500 more RVUs than another urologist who is getting paid $8 more per RVU and making the same money, why should I get a pay cut for being more productive? That doesn’t make sense but I understand what you guys are saying.

The job does include full benefits, malpractice, good retirement. I really have no extra costs. Call is minimal and what I do take is paid extra.

Previous residents that got hospital employment jobs have all those same things but are at median RVU and good production. I feel like I’m getting hosed a little regardless. I’ve brought this up three times and they literally aren’t budging.

Click to expand...

you are not the first one to ask these questions.  i'm only sharing the responses that we received, not arguing that you are incorrect.  our cmo sits on board of these agencies so i'm just telling you how it is.  higher rvu producers consistently get paid less $/rvu.  yes it still feels bass ackwards when i parrot it to you.

i think you have your answer.  either accept it and move on, or find a different job.  if you are looking for my totally subjective (w.a.g.) you and they do not see eye to eye on this, and as you develop professionally there will be more items you don't see eye to eye on.  if you are totally focused on $/Rvu and not total income, long term this will not work out, no matter how good the other pieces are.  if you are just trying to negotiate the best terms, fine.  just understand they have a lot more experience in negotiating, and if they flex on the RVU issue for you, they likely will be challenged by many other physicians.  organizations generally like a consistent approach to compensation.  their legal/HR teams may be whispering things in their ears.

good luck

 

 

[childay]

Ask the hospital for the MGMA data from last year on average RVU conversion factor, wRVUs produced, total compensation etc.  Then you will be on an even playing field as the hospital.

What happens if you don't hit your RVU "minimum?"

Do you have some other stipend or compensation aside from the RVU?  In my case I have a stipend as well, but am similarly underpaid for the $ conversion factor, which somewhat evens out.

q-school is correct about the hospitals claiming "fair market value" and Stark audit risk as I have had same issue.  Am not sure if our hospital consistently pays low $/rvu to high "producers" as I am not in the C-suite..

[beagler]

Maybe ask for a 2-tier RVU scale? Overhead past a point is same, so over certain RVU you should be paid more.

[beagler]

In my neck of the woods the urologists are the smartest -- all other specialties are basically hospital employees. The urologists formed an independent group of which vast majority of them are part of.

They built their own facility for procedures. They have monopoly pricing power, no hospital admin overseeing them, and capture the whole procedure revenue. General anesthesia for every little procedure. I'd look for a situation like this.

Of course I tell my patients to look elsewhere and do the cystoscopy in office without anesthesia the old fashioned way!

[Zaphod]

Why cant you do less? I mean if you get paid the same, but have more exposure to everything, ie, time working, pts, complications, malpractice, and not your family/hobbies, whats the point. Do less and make more until they pay you for more.

beagler wrote:

General anesthesia for every little procedure. I’d look for a situation like this.

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Does this somehow increase their cut? Doesnt seem right at all, if you dont need that risk you shouldnt do it. You have to pay anesthesia as well.

[q-school]

Zaphod wrote:

Why cant you do less? I mean if you get paid the same, but have more exposure to everything, ie, time working, pts, complications, malpractice, and not your family/hobbies, whats the point. Do less and make more until they pay you for more.

beagler wrote:

General anesthesia for every little procedure. I’d look for a situation like this.

Click to expand…

Does this somehow increase their cut? Doesnt seem right at all, if you dont need that risk you shouldnt do it. You have to pay anesthesia as well.

Click to expand...

and so does the patient.  and society ultimately.

[Zaphod]

q-school wrote:

Zaphod wrote:

Why cant you do less? I mean if you get paid the same, but have more exposure to everything, ie, time working, pts, complications, malpractice, and not your family/hobbies, whats the point. Do less and make more until they pay you for more.

beagler wrote:

General anesthesia for every little procedure. I’d look for a situation like this.

Click to expand…

Does this somehow increase their cut? Doesnt seem right at all, if you dont need that risk you shouldnt do it. You have to pay anesthesia as well.

Click to expand…

and so does the patient.  and society ultimately.

Click to expand...

Exactly. This is why I dont make more money. Always turning people down if they dont actually need it, they are set up to get best result or wont really benefit.