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How do you negotiate RVUs when looking at offers?

Home Practice Management How do you negotiate RVUs when looking at offers?

  • Zaphod Zaphod 
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    Thanks Joseph and Zaphod. We are expecting two more offers to come in this week to go w the one she already has. The two hospital systems have indicated that the offers are coming. The one where folks have been departing seems pretty business savvy and aggressive. They told her its professional to get an answer “very, very soon” when they extend an offer. She has two more interviews left and would like to see what they put on the table before pulling the trigger. Obviously the more aggressive negotiating hospital thats had the 2 ppl leave doesnt want her to have those two offers to compare to theirs and thus is trying to push her to take theirs before she knows all her options. Any experience on how long to hold out until you give a hospital a decision? I suggested she tell them she would decide in 4-6 weeks to allow time for contract reviews, talking with family, etc 

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    I had similar pressure when trying to make a decision. My gut feeling is that if they really want you and feel you are the right fit, they’ll give you a reasonable period of time to make a decision (4-6 weeks is probably a bit long unfortunately)

    I would be honest and tell them there are 2 more interviews forthcoming. If they have to move on to their next candidate, that’s fine. If they can sweeten the offer, that could convince you guys to make a decision earlier.

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    agree. this kind of decision has serious implications, and I literally still see ads from the same places for the same positions for 5 years now…it can be very costly for them to over pursue. Not sure thats the environment best suited to a good long term relationship. They cant simply hire someone and take your place immediately, and they would pressure you the same even if theyve already sent offers to others and and are just waiting for the first response.  This is unfortunately like so many things that shouldnt be, a game.

    #15843 Reply
    Avatar kiddoc1 
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    I do make more than 10,000 RVUs for my speciality which is more than 99th percentile (MGMA) Currently I am paid at 67th percetile pay(Flat pay)again MGMA .How do I negotiate with my employer to pay me via RVU s.. Thanks for the help everyone and moderator, your input is greatly appreciated.

    #41138 Reply
    Avatar StarTrekDoc 
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    Status: Physician
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    Wow.  That’s a lot of wRVUs — must be dermatologist with high procedure rate.  Internist here and fulltime 36hours 50/75th MGMA are about 4800-5300 range IIRC.

    Our structure is: base pay guaranteed;  RVU above 50/75 depending on status and type of roles, will garner $25/RVU — again we’re Internal Med so low procedure and mostly Office Visits RVU generated.    We’re also transitioning over from RVU to value based /panel based system to more closely align with all the programs out there (medicare, medical, commercial value programs).

    #41160 Reply
    WealthyDoc WealthyDoc 
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    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

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    OMG.  Where to begin.  First of all you are being outgunned.  I don’t think you or your gf are experiences in negotiations or physician comp.  Her potential future employer is experienced in both.

    They are low balling you with wRVU.  And it sounds like the guarantee isn’t really a guarantee.  If they are afraid you will compare this opportunity to others, that is a bad sign.  They know they are paying on the lower end.

    Consider a 2 year guarantee fixed at 60th percentile or something.  No risk.  Just to build up the clinic.  Then it can be productivity after, but at a much higher wRVU rate.

    You don’t necessarily get what you deserve, you get what you negotiate.

    Wealthy Doc is a FI (Financially Independent) physician. He enjoys financial freedom and wants to help others achieve that as well. See more at http://www.WealthyDoc.org

    #41207 Reply
    WealthyDoc WealthyDoc 
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    I do make more than 10,000 RVUs for my speciality which is more than 99th percentile (MGMA) Currently I am paid at 67th percetile pay(Flat pay)again MGMA .How do I negotiate with my employer to pay me via RVU s.. Thanks for the help everyone and moderator, your input is greatly appreciated.

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    Physician contract negotiation is more complex than a 100 character blog post comment.  I think WCI posts and forums are great but they aren’t a substitute for basic business/success skills like negotiation.  You need to read, practice, and grow.

    The gist of what you have going on though is a major discrepancy.  In that situation I would likely go to my employer and explain that there is a substantial disconnect between your productivity performance and the current compensation.  You are being underpaid by objective data.  It is not just your opinion.  (appeal to objective criteria -as per Getting to Yes).  Then, in order to decrease your risk of burnout, you will be intentionally decreasing your productivity to the 60th percentile.  This is the only way within your power that you can align comp and production. … other than leaving the organization to be paid market comp… which they surely don’t want either.

    They may decide to renegotiate your contract to boost your comp or make it based on production so that you do not cut back.  I did something similar.  A 25% pay cut was discussed for me.  I said great, I have been looking for an opportunity to cut back my hours and enjoy life more.  They were shocked but understood that I wasn’t going to work the same for 3/4 of the salary.  They wanted to keep my current production level and decided not to cut my salary.  I actually got a raise… but that is a different story.

     

    Wealthy Doc is a FI (Financially Independent) physician. He enjoys financial freedom and wants to help others achieve that as well. See more at http://www.WealthyDoc.org

    #41209 Reply
    Avatar racelari 
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    Status: Physician
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    Hi guys not sure if anybody is still listening to this thread but as a neurologist I get $40 per RVU- not sure if this is normal for my specialty, but each year I have produced 9000 RVU’s and make 360K, which is on the higher spectrum in my specialty in terms of compensation but not sure if I should be asking for more money per RVU?  I have been working a crapload and even now I am typing this at 9:45pm Thursday night and not seeing my kids and I still have another video EEG to read.

    #211935 Reply
    Avatar GoBlueMD 
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    Neuro should be in this attachment

     

     

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    #211938 Reply
    Avatar SLC OB 
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    Hi guys not sure if anybody is still listening to this thread but as a neurologist I get $40 per RVU- not sure if this is normal for my specialty, but each year I have produced 9000 RVU’s and make 360K, which is on the higher spectrum in my specialty in terms of compensation but not sure if I should be asking for more money per RVU?  I have been working a crapload and even now I am typing this at 9:45pm Thursday night and not seeing my kids and I still have another video EEG to read.

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    Per the chart, you should be making way more. I know our neurologist make a good living (My guess is about $200-$250 but see only 8-12 patients per day). Sounds like you are cranking it out with 9000wRVU’s, you need to renegotiate.

    #211942 Reply
    Liked by Zaphod
    Avatar Tim 
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    This MGMA data was the academic only >67% billable.
    There is a separate section for non-academic.
    Because of different pay rates (region, urban/rural, employer type (hospital, large group, single vs multiple specialties) just “A number” can be a little miss leading.
    There is a page for each sub specialty that you need.
    Total comp and wRVU’s by % (25,50,75,90) in a similar situation (for your region).
    You don’t want comp at 50 a wRVU’s at 90.
    Do you have the MGMA data? Build your case with facts. It may be worth hiring a contract review or a healthcare attorney that will provide you with the MGMA and an analysis that is more than just “I want a higher rate”. You produce quality work and want to be fairly paid for your volume. For example, it would be helpful to have your billings, collections, wRVU’s, and Comp. Good luck.

    #213359 Reply
    Avatar bean1970 
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    Status: Physician
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    RVU  reimbursement rates are generally a mix of specialty, geography, and market rate which depends also on payer mixes. An institution with a low payer mix, pay payer contracts and poor record of chasing every dollar in collections isn’t going to be able to reimburse as well for the long haul  as an institution where it’s a well oiled highly reimbursed by payer machine.  Basically the institution pot to operate, overhead, benefits and pay physicians has to come from the harmony of contracts (payers), volume (physician work) and collections…  They can then use an RVU rate to come up with a reasonable quanitifcation of payment for the work you do (patient care).  My advice is also ensure the RVU target is reasonable based on the dollar/RVU.

    most academic institutions will also tend to follow AAMC table (or MGMA). Welcome to academics but our place sets RVU targets at 75th percentile and pays at 50th percentile. if you are in a desirable area where people are knocking on doors trying to get in because they want to live and work at X, the market drives this….

    i realize now this was an old post…half awake…..

     

    #213360 Reply
    Avatar gvs.psych 
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    There are so many factors! I think it can also be helpful to look at what you will earn ‘per hour’. I’ll illustrate:

    Person A (basically me): Work at an academic hospital, pretty low insurance reimbursement, but very well run clinical services. Work about 6500 RVU’s per year as a child psychiatrist, and make about $380 000 (excluding weekend work). My RVU $ rate is not super high, but my overall pay is excellent, and I can get this done between 8 and 5. This is because my entire team is super skilled, write most of my notes, and everything is very optimized. So I could probably go anD grumble about MGMA, but would I rather be…

    Person B (a colleague): Works at a community hospital, gets $75/per RVU. However, gets about 4500 RVU’s per year, and is writing notes till 7pm, because there EMR is clunky, there are a ton of insurance denials, and families have endless questions because they aren’t being updated by other members of the care team. And they probably can’t grumble about MGMA.

    I am not saying people shouldn’t be aware of RVU’s but it is, in my humble view, more important to consider the gestalt of the job and what you are being paid relative to the effort you put in.

    #213373 Reply
    abds abds 
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    Since this thread got bumped up 3 years after it was started I’m really curious how it all worked out for the OP.

    #213381 Reply
    Avatar Judge 
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    Status: Physician
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    My gripe is aimed at my spouses employer. She is currently pulling in approx 10,000 RVU’s in Gen Peds and at a rate of $10.25/RVU!! According to the AMGA Data I have for her specialty the average Gen Peds doc does anywhere from 5-6k RVU’s per year at avg of $30/RVU. She’s basically working harder than most while getting paid the least! Something has got to give! This isn’t a mom and pop shop either. This is large well oiled machine with the resources available to optimize patient through put. I am sure some of it is geographic, but none the less I can’t help but feel she is getting the short end of the straw.

     

     

    #229682 Reply
    q-school q-school 
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    She is producing an exceptional level of rvu. Most large systems have a reimbursement approach that is generally not negotiable. Most consistently high producing areas get paid less than average $/ rvu. Regression to ‘fair market value’. Or else they would rather hire more people than have superstars continually be in the top 1 percent of earners per specialty. There are of course exceptions to the rule.

    Something doesn’t sound right. I know Peds is a low paying specialty but she’s making 102500? While doing some unimaginable amount of work to get 10,000 rvu’s seeing patients?

    #229687 Reply
    abds abds 
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    My gripe is aimed at my spouses employer. She is currently pulling in approx 10,000 RVU’s in Gen Peds and at a rate of $10.25/RVU!! According to the AMGA Data I have for her specialty the average Gen Peds doc does anywhere from 5-6k RVU’s per year at avg of $30/RVU. She’s basically working harder than most while getting paid the least! Something has got to give! This isn’t a mom and pop shop either. This is large well oiled machine with the resources available to optimize patient through put. I am sure some of it is geographic, but none the less I can’t help but feel she is getting the short end of the straw.

     

     

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    I can’t imagine your wife is making $100,000 a year producing 10,000 RVU. I’m not calling you a liar; I think there is a mathematical error somewhere.

    #229688 Reply

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