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How do you negotiate RVUs when looking at offers?

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  • How do you negotiate RVUs when looking at offers?

    Girlfriend is in the midst of looking at various urogyn offers she's getting in. All academic institutions. One of them is offering RVU incentive comp in the mid 30s. I look at stuff from medical HR companies and they say that the median RVU payment rate for pediatricians is $38 and $60 for ortho. So is she getting lowballed or do academic institutions that offer RVUs tend to pay on the lower end in exchange for a higher base salary? Anyone have any experience in this department? She would rather have a higher base than the possibility of making more with RVU structure, but she'd like to understand what exactly they're asking of her / offering

  • #2
    That is very low.  You need to give more information but RVU reimbursement rates of $80 per are what I look for along with a solid basepay and benefits.


    • #3
      Any advice you all could offer is extremely appreciated. Thank you Joseph. Here's some more details

      wRVU 4500-5500 : paid at $35

      wRVU 5500-6800 : paid at $35

      wRVU 6800-8400:  paid at $36

      solid base salary. Slightly lower than what she expected, but its a state without income tax and low cost of living so that part seems equivalent to us.

      First off : Can someone explain what an RVU is to us? She's a new attending and not familiar with all the lingo. We understand that its basically how many patients you see, how many procedures you do, etc. We have no idea how hard it is to fall in a particular range listed above.

      Second: Do others get paid in RVUs at academic research hospitals? She is really trying to have a mix of research teaching and clinical work in her role. We know that will come at a financial cost compared to just doing lots of procedures in a less academic setting. However, I was wondering how many other folks out there have experience getting paid in RVUs? I'm assuming urogyn and urology would be similar but I have no information on that.

      She would be an employee of the hospital and as such she doesn't pay her licensing fees, gets marketing support from them, gets benefits, etc. etc. Are those $80 RVU reimbursements if you have a private practice or work in a clinically focused setting? We will probably employ the services of one of the physician contract firms that WCI recommends, but we would love to come into a session with our head screwed on the right way first.

      Thanks to all


      • #4
        MGMA gives averages for the number of wRVU each specialty typically produces.

        the median for ENT is 6,754 for example.

        a brand new doc, especially doing research part of the time would likely produce less.

        however, if she has residents seeing a bunch of patients to improve throughput and efficiency then the sky is the limit.

        i would simply try to get an idea of how many wrvu's other members of the department are billing out per year.  take about 20% off that as she is just starting out and that should give you a good idea.


        • #5
          forgot to mention that u can use this site to look up wrvu's for each procedure and E&M code that exists.  Im sure your specialty has a cheat sheet for the most common codes used in ur specialty.



          • #6
            Not too familiar with the site or the codes, but thanks for that link, and for the advice on checking with current attendings.

            What do you mean about working with the residents? Do you mean she would have more time for high RVU activities if she had the residents filling out the paperwork and doing the busywork?

            Joseph, is that $80 RVU figure for private practice or with an academic hospital system?


            • #7
              not necessarily high rvu activities, just that by having residents do tons of the busy work that has to be done will allow her to see more patients and do more cases.  the same way she is currently doing a bunch of work for her attendings now.

              it's going to be hard to generalize what the average compensation per wrvu should be.  again, MGMA gives averages for that but it really depends on the base pay.  in all of my negotiations and with most other docs ive spoken with- it is always best to get a high base salary.  the wRVU is an incentive bonus that is often unobtainable or barely obtainable.  if you get sick or pregnant or do a lot of research you are not going to hit the wrvu bonus.  wRVUs are basically how many patients you see and how many surgeries you do.  more complex, longer operations give more wRVUs.

              but it is very hard to generalize.  some offers, for example are 100% based on wRVUs.  no base salary.  in that case i would want around $60 per wRVU.  that would be very fair in my specialty of ENT


              • #8
                so w a 280s base salary, what would u say you would want to see for RVUs for a middle level comp'ed specialty like uro/urogyn?

                maybe the right negotiating tactic is just asking for higher base pay instead of leaving it in their hands with RVUs


                • #9

                  Joseph, is that $80 RVU figure for private practice or with an academic hospital system?
                  Click to expand...

                  You should realize that rvu's are highly dependent on geographic area.

                  The $80/RVU reimbursement that I see written into contracts is at a non-profit hospital.

                  It is easily obtainable.  For instance, it makes up 2/3 of my pay with base the other 1/3.

                  Travis, those numbers you have given are just paltry and very sad.

                  The breakdown I get is $65/$75/$85 for the different levels of productivity.

                  You need to do some research to better understand RVUs. They make my life very very good.


                  • #10
                    Realize that not only are the RVU pay rates regional but also vary by specialty.

                    A quick google turned this up:


                    I would love to get 70$ per RVU I would be making a killing!

                    You absolutely need to understand how RVUs work.  Basically every code you bill for has an associated wRVU value.  You can look them up on the CMS website though it is a bit clunky.  It gets complicated if you do a lot of different procedures.  For me it is simple as I only bill a few different codes.  Agree with asking about current employees averages and if they are hitting their bonuses etc.  RVU based pay is quite common in employed settings.  The values per procedure code change some yearly as CMS adjusts the values periodically.


                    • #11
                      A couple websites to learn more about rvu and compensation:




                      Basically each CPT code has an assigned RVU to it - so each patient she sees or procedure she performs will generate wRVU.  the wRVU (work RVU) is the physician's portion of it.  Hospitals will assign a dollar value to each wRVU based on formula's and MGMA data etc.  Your compensation seems to be a mix of base salary + incentive if over a certain wRVU value.

                      Definitely try to get the highest base possible if she's going to do a mix of research/teaching and clinical.  the research/teaching does not generate RVU as she's not seeing patients, so she might be seen as "less productive".  Also read the contract to see if the base is just guaranteed for only like the first 1-2 years then moving on to another form of compensation afterwards.


                      • #12
                        Man, my moonlighting place is 23 per RVU and average pay is roughly 200/ hr.    The place I too a job starting in July is also 23 but we bill for pas work and average is 260/ hr.   Why such the variation?


                        • #13
                          Couple more relevant points

                          -she would be the only surgeon in her specialty for the region if she goes there. Ie no preexisting patient base. I'm assuming she would not come close to meeting her rvus as she struggles to get the private practice obgyns to let go of some of the procedures they have been doing .

                          -no income tax state, so I'm assuming you discount the rvu number accordingly for comparison purposes.

                          How much would you ask for in extra base pay to take rvu possibility off the table ? Just curious as to what peoples point of indifference here is for rvus vs base salary all things equal.

                          We haven't received the details of other larger academic hospital offers yet. I'm imagining those will be more base salary oriented since they'll have higher research expectations (70% clinical 20% research 10% teaching)


                          • #14
                            Joseph this is for full time employed hospital physicians? I'm assuming these numbers are for people without research and teaching responsibilities. Imagining base salary is higher but lower rvus in that case


                            • #15

                              no income tax state, so I’m assuming you discount the rvu number
                              Click to expand...

                              No. That is not correct at all.  But if you want to sell yourself short...