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Rvu expectations per shift and pay per rvu
What is a reasonable rvu expectation Per shift and pay per rvu? Thanks
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56 Replies
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Some of the rates I have been told recently from a variety of groups pretty much range from ~$19-26/RVU, with expected productivity to be anywhere from 8-14 RVU/hr . Future not only doesn’t look bright, it’s very dark.
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$19-26 per rvu is awful. You should be getting >_$50 /RVU assuming no skim job. I read fast and I think 14 rvus per hour would be almost impossible to maintain . 10 is doable but will probably still lead to early burnout (speaking from experience)
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50-60 RVUs per shift is reasonable. That is about what we do.
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Quote from tiger81
$19-26 per rvu is awful. You should be getting >_$50 /RVU assuming no skim job. I read fast and I think 14 rvus per hour would be almost impossible to maintain . 10 is doable but will probably still lead to early burnout (speaking from experience)
Any idea where on earth we can find such jobs?? That rate sounds amazing and could do much more manageable reading rate to avoid burnout.
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RVU per shift highly dependent on what you’re doing. All plain films is going to be low, IR or lots of procedures will be low, neuro and mammo will be high, etc. But if it’s a mix of general stuff without fluoro or procedures, I think 5 to 8 per hour should be your range. Higher if it’s stats, lower for routine
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Quote from Rad9045874
Some of the rates I have been told recently from a variety of groups pretty much range from ~$19-26/RVU, with expected productivity to be anywhere from 8-14 RVU/hr . Future not only doesn’t look bright, it’s very dark.
$19-26 is not good if you’re talking about on-site with consults and occasional procedures. I doubt you have seen a lot of PP practice groups offering that range, sounds like tele or low end corporate.
As others have said, RVUs and effort are only loosely related (though sometimes group leadership enjoys being willfully ignorant of this). 5 RVUs an hour of plain films and barium can be a slog, 10 RVUs an hour of ER CT/US or Neuro work can be a relative breeze.
Unless you know you will be getting exclusively very efficient RVU cases for the majority of your shifts, in my experience most “good” rads can reasonably and safely read in the 6-7 RVU an hour range. The number of rads, even good ones, that can consistently read in the 12-14 RVU/hr range shift after shift is vanishingly small.-
True legit PP – $50-60+ per rvu, my PP at one point was hitting $70 at our peak, but no longer.
Skim job – $20-40 depending on degree of skim job-
Agree with the last. 50s-60s/ wRvu is a good job. 40s can be tolerable depending on case mix
20s ? Run. Relocate. Contract a true PP and you can likely do 1.5x better even off site
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Quote from Radsoxfan
Quote from Rad9045874
Some of the rates I have been told recently from a variety of groups pretty much range from ~$19-26/RVU, with expected productivity to be anywhere from 8-14 RVU/hr . Future not only doesn’t look bright, it’s very dark.
$19-26 is not good if you’re talking about on-site with consults and occasional procedures. I doubt you have seen a lot of PP practice groups offering that range, sounds like tele or low end corporate.
As others have said, RVUs and effort are only loosely related (though sometimes group leadership enjoys being willfully ignorant of this). 5 RVUs an hour of plain films and barium can be a slog, 10 RVUs an hour of ER CT/US or Neuro work can be a relative breeze.
Unless you know you will be getting exclusively very efficient RVU cases for the majority of your shifts, in my experience most “good” rads can reasonably and safely read in the 6-7 RVU an hour range. The number of rads, even good ones, that can consistently read in the 12-14 RVU/hr range shift after shift is vanishingly small.
Hit the nail on the head, the spots I had been talking to are for tele or corporate. But apparently 10 RVU/hr of ER CT/US isn’t too bad, then maybe worth something to consider?
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Quote from Rad9045874
But apparently 10 RVU/hr of ER CT/US isn’t too bad, then maybe worth something to consider?
Still depends on the $/RVU, I wouldn’t do that for $20/RVU.
Plus, not many jobs are going to be offering exclusively ER CT/US to read.-
Good to know, thanks!
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50 – 60 rvu is typically a gross figure.
Take out billing/management and benefits etc, and its a lower number for w2 income.
So lets say you have 30% overhead over all. The W2?wage portion on $50 would be $35.
Now the overhead includes health, malpractice and pension. So your gross per partner pre benefits/post billing/management is likely around $42.
$50-60 for w2 would be very high, at least where I am.
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This is where living in certain less desirable states pays off.
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30% overhead? Unless you own imaging center or equipment, overhead should be between 10-15%. Ours was 12% for years and years.
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Billing/management by itself is 10-15%.
Then there is malpractice, health, pension etc which can be 10-15% depending how generous and how much you make.
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Wow – pretty high, we paid 6.5% for billing for years. Ours was professional fee only, however.
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Quote from CoronaRad
Wow – pretty high, we paid 6.5% for billing for years. Ours was professional fee only, however.
Billing/management. Do you have a business manager?
So you collect $100.
You pay $6.50 to billing.
Now you have $93.50 that goes to each partner?
Who pays your bills? Who takes care of your insurance contracts. Who does payroll? Who organizes your pension and insurance plans? Accounting. Legal fees. etc. etc.
If you add in that, it likely is in the 10-15% range.
Unless you are a 1-2 man groups and you do it all yourself. -
We have a manager who handles all of that, she is reasonably compensated but nothing crazy. I don’t consider our retirement money contributions as overhead really because it is going into our pockets. So expenses really are billing service (the big one) and insurance (health, dental, med mal etc). Some minor CPA fee and legal fees. There is just not that many expenses when you are a professional fee only practice imo.
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Malpractice can be 40k some places. Health 25k
It all depends -
What about rent? The price of computer equipment? The licensing costs of PACS and dictation software? Salaries for support staff?
30% sounds much more likely than 12% for the typical practice overhead.
If someone else is covering those costs then its not really an apples to apples comparison. The money has to come from somewhere.
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Rent? We work in hospitals, which provide a reading room, PACS, and workstations. Our home workstations CPUs are provided by the hospital (their choice due to wanting control over them remotely for security reasons etc) but we buy our own monitors and peripherals.
Our group has always tried to keep overhead as low as possible and run the practice efficiently so that each Rad has the highest possible income. Not every practice is like this and many have less efficient methods and even splurge on things that we don’t. Not saying our way is the best, just how we do it. But it is definitely possible to keep overhead very low, especially if you compare to our clinician colleagues who run offices.
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Good point, big difference in business structure even among radiology groups.
Still, 12% is very low overhead even considering the hospital is picking up the tab on most of the expenses. You have an efficient, lean practice. Kudos!
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This is where we get all mixed up in our numbers. It depends what you define as overhead.
I would say billing/practice management is in the 10-15% range most PP groups. 6.5% may be pure cost of collection, but there is a lot more to managing a practice than sending out bills. Most companies charge as one fee as a % of collections.
The next overhead is health insurance, malpractice, pension contributions, and other benefits. Add in the occasional employees, payroll taxes etc. Much of this is a material benefit that would be an expenditure for a 1099. It varies how generous groups are. We have eye, dental etc. This can be 10-15% too. It all affects your w2.
So 20-30% overall from collections.
So when one says $50/rvu; what does that mean? That’s not your w2. $50 less 20% [taking the lower total] is $40/rvu; and that is the w2 income. Add back benefits if you like to ~ $45.
But people saying I wouldn’t work for less that $50/rvu; that just seems over the top; we do. $50/rvu is our collection rate.
Maybe we are suckers. But we have a competitive low cost national biller, and contract most services on a need basis.
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Unavoidable costs:
1) billing – 5-7%
2) Malpractice – 5k to 50k.
3) Office staff — you have to have some and i’d rather pay them than have to worry about CMEs, hospital credentialling, scheduling, etc, etc.
4) Licensure, hospital fees – relatively low cost
5) Health insurance – again, can get away with 18k/family but 25k is probably more average. could be higher depending on your age distribution
6) Disability insurance – that can be about 7-10k .
7) CME – free or charged back to the rad? 5k is typical. can be more or 0 where it’s all charged back to rad
8) PAs (if you have an IR practice) They will make life easier for the IR docs but may or may not bring in enough to cover their salaries.
IT’s hard to run this at <15% i think but not impossible depending on your practice. if it’s purely Dx and no IR and if you do everything yourself with 1 office staff.Costs that go back to the physician (not true overhead)
1) Profit sharing (37k)
2) Cash balance plan?
3) Medical reimbursement plan
4) cell phone/internet
5) computer / ipad/tech reimbursement
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So these numbers seem to be for general, in hospital PP groups. If doing a tele position as W2 and your net income, including benefits, is roughly estimated around $30/rvu, is that too low (for a new grad). Would it be rude to ask for closer to ~$35/rvu being a new grad? Very new to this and never heard much about this topic before this post. So thanks everyone for your input/advice.
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Quote from Rad9045874
~$19-26/RVU, with expected productivity to be anywhere from 8-14 RVU/hr .
$19-26/RVU is abysmal and 14 RVU/hr is astronomical
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The Sullivan survey that MedPac uses to determine reimbursement has the average radiologist pay per RVU after benefits to be $57. Don’t accept ridiculously low pay per RVU. You’ll be busting your tail, increasing your liability, and making someone with half your education and ethics wealthy!
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Quote from JTG
The Sullivan survey that MedPac uses to determine reimbursement has the average radiologist pay per RVU after benefits to be $57. Don’t accept ridiculously low pay per RVU. You’ll be busting your tail, increasing your liability, and making someone with half your education and ethics wealthy!
I’m guessing those numbers are for on site PP jobs. How low would you say is acceptable for a tele position? I haven’t seen much variation with the lower rates amongst many different tele positions for either PE or PP.
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Quote from Rad9045874
Quote from JTG
The Sullivan survey that MedPac uses to determine reimbursement has the average radiologist pay per RVU after benefits to be $57. Don’t accept ridiculously low pay per RVU. You’ll be busting your tail, increasing your liability, and making someone with half your education and ethics wealthy!
I’m guessing those numbers are for on site PP jobs. How low would you say is acceptable for a tele position? I haven’t seen much variation with the lower rates amongst many different tele positions for either PE or PP.
How much are you ok with being exploited? They’re lowballing you assuming that you don’t know your worth-
That 20 dollar/rvu number works for the corps because there are takers. Too many rads.
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Quote from JTG
How much are you ok with being exploited? They’re lowballing you assuming that you don’t know your worth
Exactly. I don’t know what I’m worth because throughout all of our training, not a single piece of financial advice was given on any level. Particularly what our work is worth. So I’m trying to find that out.
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26/wrvu is the highest I’ve seen in all teleradiology jobs.
7 wrvus/per hr is reasonable to avoid burnout? I don’t quite understand this. If a ct ap w/contrast is 1.82 wruvs, then you can only read <4 cts per hr to avoid burnout?
I don’t remember ever reading this low in residency both on call and not on call.
Can someone explain this to me?-
Figure it out for plain films maybe thatll help you understand. Its not all high RVU or easy studies. What about phone calls and other interruptions.
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Quote from chudat
7 wrvus/per hr is reasonable to avoid burnout? I don’t quite understand this. If a ct ap w/contrast is 1.82 wruvs, then you can only read <4 cts per hr to avoid burnout?
I don’t remember ever reading this low in residency both on call and not on call.
Can someone explain this to me?
Do you get a list with only CT AP with contrast to read from? Without procedures, consults, X-rays, Barium, etc? wRVUs are only loosely correlated to time and effort unfortunately.
Of course if you’re mainly reading CT AP, non con head CT, Abd US, lower ext venous US, brain MR, etc you can and should be expected to be reading more RVUs per hour.
To look at the other extreme, in a 9 hour shift at 7 wRVU an hour you’re looking at 350-400 X-Rays a day. That’s pretty mind numbing and potentially burnout inducing if you ask me.
The number of wRVU per hour goal is essentially meaningless without the details of what you are doing.
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Quote from JTG
The Sullivan survey that MedPac uses to determine reimbursement has the average radiologist pay per RVU after benefits to be $57. Don’t accept ridiculously low pay per RVU. You’ll be busting your tail, increasing your liability, and making someone with half your education and ethics wealthy!
$57 after benefits sounds crazy high to me.
Maybe some groups make that gross prebilling.
We dont.-
Quote from boomer
Quote from JTG
The Sullivan survey that MedPac uses to determine reimbursement has the average radiologist pay per RVU after benefits to be $57. Don’t accept ridiculously low pay per RVU. You’ll be busting your tail, increasing your liability, and making someone with half your education and ethics wealthy!
$57 after benefits sounds crazy high to me.
Maybe some groups make that gross prebilling.
We dont.I did some back of the napkin math of the practices for here in North East Ohio (based on open conversations with friends and colleagues working at many different practices) and that $57 / RVU is about right for here.
Highest estimate was the VA, clocking in around mid $60s to $70.
The academic lite hospitals in 45-60 range.
The country hospital in the 55 ish range
The large private practices in 55-60 range
(Here I am talking about a simple calculation of total comp annual versus total RVU expectations annual)
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Total collections?
Gross income after billing management?
Total comp, including retirement and health care? This is the comparable number for the 1099 folks.
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Btw, jtg quotes 57 after Benifits; like it is w2 gross. Pretty generous number.
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Maybe because I’m a new grad?? But any remote positon I’ve seen, the highest I’ve ever seen is ~$30/RVU. I guess you have to be on-site to make fair pay.
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Quote from boomer
Total collections?
Gross income after billing management?
Total comp, including retirement and health care? This is the comparable number for the 1099 folks.None of these things have anything to do with wrvu comp. Healthcare, retirement, malpractice, and cme are not included in rvu comp.
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Well people throw around numbers at AM pretty randomly.
In my groups $rvu is collections, and then we pare it down.
So rvu comp, by definition is gross, after billing/management?
Let’s make that clear.
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All I know is my group collects about $40/rvu and has been slowly declining as it has for everyone. I think this is close to the national average and we have a decent payer mix. I know Wrvu is different but these numbers seem way too high in my opinion as well.
We have seen salaries increase as total volume and growth have outpaced the cut in reimbursement. We have had pretty crazy growth. All this while hiring and adding rads.
The ER at all the hospitals we cover just continue to lower their threshold for scanning someone. It use to just be pan scans for trauma patients. Now CAP CT has basically replaced the chest xray. Half the time there is no reason for one or the other but either the patients are old or sick and they just scan them head to toe since they are going to the scanner anyways.
Recent papers pushing CTA head and neck use in the ER for stroke workup has gone up like crazy.
Finally, noncon use of chest CT has slowly gone up as well which is the one that makes the least amount of sense. There are actuall docs and noctors who will scan someone for pneumonia work up if they have a normal chest xray. What ever happened to pneumonia being a clinical diagnosis?-
Let me give you an example.
If you are collecting 40/rvu and an AP ct is roughly 2.4 RVu , you have made $96 on that study.
The wrvu is 1.896/1.8 = 53.3/wrvu
You are not that far off.
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Thanks for the conversion.
We run pretty lean on overhead but billing, malpractice, retirement, slow partners, procedures that take longer and pay less, etc add up and would significantly reduce what someone theoretically takes home from reading that study. I just think it is really hard to ballpark this number.
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This is meaningful.
Many times the numbers on AM are delusional.
I am with you on this.
Also, your previous posts re defined contribution plans etc., I have found to be right on too.
Thanks…Tank. -
thanks boomer!
I run the financial stuff for my group so this is my thing. We use accountants but I am on top of collections, bills, retirement and payroll. wRVU’s however are not and not something we use or discuss -
Quote from frank the tank
thanks boomer!
I run the financial stuff for my group so this is my thing. We use accountants but I am on top of collections, bills, retirement and payroll. wRVU’s however are not and not something we use or discuss
You don’t use RVU’s !!!
You and your group are enlightened.
When my group started using RVUs in the distant past, it was the beginning of the end. A previously harmonious group was grandually ripped apart with arguments about who was most valuable, etc. An MR guy announced that he was going to demand RVU based pay since he was “working much harder than anyone else” (note – He always left before anyone else. Prior to his demand, I was sympathetic – family reasons, etc. After that – not so much). I told him, fine, if you do that, I quit mammo and you can do it. He seemed then to understand. -
@ Phil – proprietary but I can confirm. Pm me
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Quote from Phil Shaffer
Quote from frank the tank
thanks boomer!
I run the financial stuff for my group so this is my thing. We use accountants but I am on top of collections, bills, retirement and payroll. wRVU’s however are not and not something we use or discuss
You don’t use RVU’s !!!
You and your group are enlightened.
When my group started using RVUs in the distant past, it was the beginning of the end. A previously harmonious group was grandually ripped apart with arguments about who was most valuable, etc. An MR guy announced that he was going to demand RVU based pay since he was “working much harder than anyone else” (note – He always left before anyone else. Prior to his demand, I was sympathetic – family reasons, etc. After that – not so much). I told him, fine, if you do that, I quit mammo and you can do it. He seemed then to understand.The thing about RVU’s is that some people use them as a weapon, and twist the data in their favor.
Let’s face it, some RVU’s are harder to come by; especially if only a minority of people do a particular procedure/modality.
You always have some people boasting their RVU production, especially if they are in an RVU-philic environment.
This is where leadership comes into play. The RVU numbers do have value as data points, but have to be put in perspective. If there is no strong leadership managing the practice, it will veer off course into bad places.
Ultimately we all need each other. If there is no one else to do a particular function, RVU’s are relatively moot, the practice must go on, the work has to get done. If someone has limited skill sets, their value is finite, regardless of RVU’s, because typically they are easily replaced. That’s the reality. When these conversations are had, egos are bruised, cohesion is frayed, and group functionality diminishes.
It certainly is a slippery slope.
Many years ago, mammo was a loss leader. It was a necessary burden to carry on a practice. Now, it’s an RVU gold mine. It’s relative value, however you might define it, really has not changed. So much for RVU’s.
BTW, in my group, there is no direct use of wRVU’s re remuneration etc.; but they are hanging there, easily accessed, whispered about, and misused to justify bad behavior by some. It’s unavoidable in any practice with data mining features which are more and more prevalent in our pacs/emr centric practices. -
Exactly
And depending on how The legal climate is In a particular location is, it can be easy or difficult to practice mammo -
Once you start using rvus, youll start seeing all types of crappy behavior like cherry picking, ruined collegiality, low rvu cases hanging around the list, people not following workflow rules.
Then you feel like the sucker if your reading the tough low rvu cases and following the rules while others game the system and are admins favorites while you worry about your job.
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RVU’s are only of use in measuring productivity when comparing a radiologist amongst the peers in the group who are reading the SAME type of studies. If you only read neuro, your rvu comparison is only meaningful to another person who only reads neuro. If you only read plain films, your rvu comparison is only meaningful to compare with another person who reads plain films. Comparing Rvu’s from one practice to another practice for the same type of study is also problematic – A guy who only reads plain films for the ER will have much higher RVU’s than someone who only reads inpatient plain films for the VA (va has a lot more older and complicated patients). RVU’s can be used as some measure of productivity but there are a number of caveats many administrators probably dont realize – we radiologists realize it but only the ones who have thought hard about it or those with experience. For example, a new neuroradiologist may think he’s a big hot shot generating a lot of rvu’s when in fact neuro is suppose to generatve high rvu’s. Even when you finally have a meaningful comparision – 3-4 guys who do the same rotation reading the same studies – There is always variance within the population – you have slow careful readers on one extreme and fast careless readers on the other…a lot of which is tied to personality and there are limitations on how much you can really change this.
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Very, very well said Stryker
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Your right Stryker, unfortunately, those who make decisions often view rvus at the same level my school aged son does.
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Quote from striker79
RVU’s are only of use in measuring productivity when comparing a radiologist amongst the peers in the group who are reading the SAME type of studies. If you only read neuro, your rvu comparison is only meaningful to another person who only reads neuro. If you only read plain films, your rvu comparison is only meaningful to compare with another person who reads plain films. Comparing Rvu’s from one practice to another practice for the same type of study is also problematic – A guy who only reads plain films for the ER will have much higher RVU’s than someone who only reads inpatient plain films for the VA (va has a lot more older and complicated patients). RVU’s can be used as some measure of productivity but there are a number of caveats many administrators probably dont realize – we radiologists realize it but only the ones who have thought hard about it or those with experience. For example, a new neuroradiologist may think he’s a big hot shot generating a lot of rvu’s when in fact neuro is suppose to generatve high rvu’s. Even when you finally have a meaningful comparision – 3-4 guys who do the same rotation reading the same studies – There is always variance within the population – you have slow careful readers on one extreme and fast careless readers on the other…a lot of which is tied to personality and there are limitations on how much you can really change this.
Well said.
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Quote from JTG
The Sullivan survey that MedPac uses to determine reimbursement has the average radiologist pay per RVU after benefits to be $57. Don’t accept ridiculously low pay per RVU. You’ll be busting your tail, increasing your liability, and making someone with half your education and ethics wealthy!
do you have a link for this. Would be VERY valuable for any radiologist particularly in negotiations.
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