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is 10 rvu per hour a normal expectation for neuro
Just started working for a private practice. They expect you to read 10 rvu per hour when doing outpatient neuro CT or MR cases. Is this normal? I can imagine doing this for short bursts of time, but can anyone actually sustain this pace?
If doing MSK or body, it’s 6 rvu per hour, which i find more palatable but still a stretch for me
The RVUs are not a hard rule but a guideline
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69 Replies
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yeah id get another job.
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Ha ha. You already know the answer.
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This is always the question. RVU or wRVU?
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idk, i know spines are 1.48 and MSK MR are 1.35. Whatever that is
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basically, the expectation is to read 7 MR spines or 5 MR MSK per hour
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Quote from stonks
basically, the expectation is to read 7 MR spines or 5 MR MSK per hour
You have it backwards since MSK MRIs are worth less than Spine MRI.
If the expectation is 10 wRVU/hr, it’s 7.4 MSK MRI or 6.7 Spine MRI.
If it’s daytime remote and only MRI… not great but doable. If it’s on site and also reading X-Rays/doing procedures, for sure a terrible job.
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Seems easy enough til you get a few dumpster fire post op spine or a few dumpster fire post op msk mixed in there
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The expectation for msk is 6 rvu per hour
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I will say that this is for remote moonlighting that u can do at any time at home
But seems like the consensus is that it sucks and that im not a lazy bum
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I think i can do most degenerative spine in under 10 min even if its garbage. Problem is once i have a prior to compare to then all bets are off
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That volume is more than I read when on MRI.
I dont imagine its fun reading that volume over time, eg when you have complex cases that slow you down. I worked in the hospital doing breast today, grabbed brunch in cafeteria, left at 11:15am to go to Jiu Jitsu class and got back a sweaty mess at 1:30pm, cleaned up in between cases in the PM, and was out the door by 5pm. I understand that work from home jobs maybe require you to read more than average but unless comparing to a long commute, it doesnt seem worth it if its that busy. If reading at home, there should be enough slack to enjoy being at home. like having the kids come in to visit you or poking the wife over lunch.
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Dude, that is a very leisurely job Flounce.
I don’t ever feel like I am overworked but it is still steady throughout the day, no time to even pleasure myself, forget poke the wife. -
Mr. Stonks, the volume is high.
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The math for neuro is easy. Basically 1.5 RVUs for every spine and brain (expect with and without contrast which increases it to about 2.2).
10 RVUs per hours / 1.5 RVUs per case = 6.6 cases an hour.
If you have a good mix of normal/semi-normal younger brains and the spines, this is easily doable in a telerad setting or in a “relatively quiet” imaging center. -
10wRVU/hr of near normal spines ordered by primary care noctors: easy
Throw in anything ordered by neuro-onc, spine surgery or the head and neck clinic and it is not.Group must be run by a MSK or body imager….
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Quote from Waduh Dong
Dude, that is a very leisurely job Flounce.
I don’t ever feel like I am overworked but it is still steady throughout the day, no time to even pleasure myself, forget poke the wife.
Forget time, something about working in the digital “sweatshop” that kills my libido. Perhaps too much SNS stimulation
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I realize this is a tangent, but on that note, I feel that evening and night work really impede my love life, my ability to make gains in strength training, and my ability to maintain a healthy diet. I cant help but imagine that evening and night work have the same effect on many others, and that even if your sleep schedule can tolerate a certain night job, you are really sacrificing those other physical aspects in your life. Long-term, its just too big a sacrifice for any compensation, even if it means giving up 300 K a year or living in a better location.
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Quote from Flounce
I realize this is a tangent, but on that note, I feel that evening and night work really impede my love life, my ability to make gains in strength training, and my ability to maintain a healthy diet. I cant help but imagine that evening and night work have the same effect on many others, and that even if your sleep schedule can tolerate a certain night job, you are really sacrificing those other physical aspects in your life. Long-term, its just too big a sacrifice for any compensation, even if it means giving up 300 K a year or living in a better location.
I would agree. Think I am at one end of the spectrum though (require 8-9 hour of sleep and in bed by 9/930 most normal work days). Evening shifts just throw me off as it takes me at least a few hours to unwind before getting to bed. Overnights (which are rare) are pretty horrendous. Aside from the factors you mentioned, sleep disruption also triggers my dysthymia. -
I believe it’s been shown that continued night work shaves years of lifespan. No amount of money is worth it to me.
As far as wRVU’s, I think 6rvUS is fair for general radiology. For strictly neuro, 8wRVU/hr is what I would expect
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Problem is if you get tough cases/post ops, etc. No way- unless you give crap reports or gamble. Throw in some complex meningioma in the optic canal for fun. Even if all normal and young too much IMO. I sure some of the “gods” on here will disagree. Case mix means a lot in Neuro.
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I have no idea how many RVUs I produce per hour, no one has ever expressed interest in that metric to me in over a decade working.
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Quote from stonks
Just started working for a private practice. They expect you to read 10 rvu per hour when doing outpatient neuro CT or MR cases. Is this normal? I can imagine doing this for short bursts of time, but can anyone actually sustain this pace?
If doing MSK or body, it’s 6 rvu per hour, which i find more palatable but still a stretch for me
The RVUs are not a hard rule but a guideline
10 RVU per hour is going to put you at the top 10-15% of rads by volume I would guess. If you are paid accordingly it might be OK if you like to work really hard and make a lot of money.
6 RVU per hour is pretty standard.-
Group leadership is msk and body
Yeah the neuro numbers dont make any sense
I would rather do 3-4 ct ap or 4-5 mr msk rather than 6-7 mr spines per hour
Probably explains why the neuro list is always so long
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Groups run by neuro or mammo like to use wRVUs of course, it’s highly beneficial to them.
Groups run by MSK and body like to adjust (and sometimes overshoot).
None of this is surprising, inequity is common if you aren’t careful.
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Spines dont take much time. Yall are being princesses. 10 rvu an hour is doable but busy. Not anything dangerous for a neurorad.
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For sure doable in most settings.
What is “doable” is rarely the issue, more importantly, what is “equivalent”?
10 wRVU of brains is not equivalent to 10 wRVU of spine.
10 wRVU of spine MR is not equivalent to 6 wRVU of MSK MR.
As an aside… people who read OP spine MR and just give a couple run-on sentences as the entire report without going level by level are embarrassing us all.-
Spine MRI reporting is all over the place. One persons severe is another persons moderate. Normal facet to one person, moderate arthrosis to another. Even amongst the same reader youll get differences in reporting between unchanged studies (myself included).
Many level by level analyses are unreadable and useless. I do it for 80-90% of cases but there are some terrible spines where detailing all the changes at every level is silly. Its better to provide a synthesis statement about where there is severe stenosis, any big discs, synovial cysts, etc.
You also have to realize there are only a few treatment options:
-Conservative tx
-Injections (ideally targeted at something specifically bad and correlating to symptoms but most pain docs will inject anyone to get paid)
-Surgery – theoretically for bad stenoses and bad discs refractory to other conservative treatments and affecting quality of life but we all know many surgeons will operate on anyoneMy point is that our detailed analysis is not as useful as you might think. There is not good inter observer consistency, treatment options are not directed in a standard or consistent fashion, and many treating docs dont even really care what we say since they want to treat.
Dont waste your time writing novels on spine mri reports nor on the minutiae of mild degenerative changes. Focus on the big things like bad/potentially symptomatic stenoses, big discs, tumor/infection, and hardware failure or easily missed stuff like foraminal discs or renal mass on the localizers.
Spine medicine is closer to voodoo than science.
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I don’t disagree in a general sense, though non-trauma OP spine imaging deserves a level by level interpretation. If you don’t do it, plenty of times someone will complain and someone else has to do it for you.
Certainly there are some cases that going level by level is overkill, but I would say 95%+ of the reports I see with a single run on sentence as the entire report are the same people that butcher every case in the name of wRVU maximization.
And those same people miss the big disc, tumor/infection, hardware failure etc that actually is important. It’s possible to go (kinda) fast and not be negligent.-
Level by level isn’t bad if you make the right template in powerscribe. Create different fields for everything so that its easy to edit and change mild/moderate/severe with a few other details here and there.
Once I did this it made spines a lot more manageable, faster, and concise.-
context matters, but 10 wRVU an hour is busy but nothing extraordinary or unusual. We dont typically look at hourly #s but our neuro rads produce around 12-13 wRVU/hr assuming an 8 hour day, body/msk around 10/hr. Mammo rads so far beyond anyone else not even worth comparing, they are in a world of their own. Busy outpatient practice with lots of time off.
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U guys are crazy for those who say u can do it. U deserve $1 + mil salary
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this your first job?
If you think 6/hr is reasonable, thats roughly 50 wRVU per day. Lets say you have 10 weeks off. So in a year you’re producing 10-11k wRVU. I would say thats low average for PP and you shouldnt be expecting to make the big bucks unless youre in a very favorable situation, rare, not typical. Rads making the big #s are reading 15-20k+ per year, from there its not hard to back into what that equates to on an hourly basis. -
Quote from tigershark06
this your first job?
If you think 6/hr is reasonable, thats roughly 50 wRVU per day. Lets say you have 10 weeks off. So in a year you’re producing 10-11k wRVU. I would say thats low average for PP and you shouldnt be expecting to make the big bucks unless youre in a very favorable situation, rare, not typical. Rads making the big #s are reading 15-20k+ per year, from there its not hard to back into what that equates to on an hourly basis.
Think 11-12K wRVU is mean (?median) for PP. In the above scenario you would also have to factor in wRVUs from call shifts.
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Quote from Radsoxfan
For sure doable in most settings.
What is “doable” is rarely the issue, more importantly, what is “equivalent”?
10 wRVU of brains is not equivalent to 10 wRVU of spine.
10 wRVU of spine MR is not equivalent to 6 wRVU of MSK MR.As an aside… people who read OP spine MR and just give a couple run-on sentences as the entire report without going level by level are embarrassing us all.
level by level spine reporting is idiotic.
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I think level by level is a personal preference. Also depends on the nature of the study (i.e. ER vs outpatient). Also may depend on the preference of the ordering clinician.
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Quote from drad123
Quote from Radsoxfan
For sure doable in most settings.
What is “doable” is rarely the issue, more importantly, what is “equivalent”?
10 wRVU of brains is not equivalent to 10 wRVU of spine.
10 wRVU of spine MR is not equivalent to 6 wRVU of MSK MR.As an aside… people who read OP spine MR and just give a couple run-on sentences as the entire report without going level by level are embarrassing us all.
level by level spine reporting is idiotic.
Why idiotic? Maybe not a proven rationale but wouldn’t say idiotic.
Level by level is what 90% of rads do for C spine and L spine.
For T spine, most do not do level by level. For C/T/L spine combination, most do not do level by level.
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In 15 years, somebody will post asking if 20RVU/HR is reasonable. The imaging volume will just continue to grow, and unless we find a whole lot of new Radiologists, or unless AI comes to the rescue, everybody better buckle themselves to a chair, stay reasonably hydrated, and dictate!
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Quote from W24
Quote from drad123
Quote from Radsoxfan
For sure doable in most settings.
What is “doable” is rarely the issue, more importantly, what is “equivalent”?
10 wRVU of brains is not equivalent to 10 wRVU of spine.
10 wRVU of spine MR is not equivalent to 6 wRVU of MSK MR.As an aside… people who read OP spine MR and just give a couple run-on sentences as the entire report without going level by level are embarrassing us all.
level by level spine reporting is idiotic.
Why idiotic? Maybe not a proven rationale but wouldn’t say idiotic.
Level by level is what 90% of rads do for C spine and L spine.
For T spine, most do not do level by level. For C/T/L spine combination, most do not do level by level.Narrative much better than template trash. Read an ER template sometime vs hospitalists dictated paragraph of what is actually going on.
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I agree Flounce, but I am turning 47 yo next week. No way I could do the volume I see posted here by many young Rads, but then I try to remember these guys are young and hungry.
I put in some years in my 30s where I cleared $750k routinely and even $900k one year just from volume. But I gained weight, my dong would not function at top level and in general I was less happy.
At this age, would take $1M+ easy to get me to do a difficult job. Nights are out of the question period.-
Quote from Waduh Dong
I agree Flounce, but I am turning 47 yo next week. No way I could do the volume I see posted here by many young Rads, but then I try to remember these guys are young and hungry.I put in some years in my 30s where I cleared $750k routinely and even $900k one year just from volume. But I gained weight, my dong would not function at top level and in general I was less happy.
At this age, would take $1M+ easy to get me to do a difficult job. Nights are out of the question period.
750 to 900 not bad especially if no state income tax and lower cost of living area.
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Yeah but I think Tele guys are routinely banking over $1M working from home.
If you have a nice home setup and are willing to crank….. maybe not that painful a job. -
Over $1M in tele? No. I have never even heard of that.
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Quote from Waduh Dong
Yeah but I think Tele guys are routinely banking over $1M working from home.If you have a nice home setup and are willing to crank….. maybe not that painful a job.
Probably what I would do if starting the biz now.
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drad123 – you have $19M right? At what age did you hit 5M, 10M etc?
What was your primary strategy – location arb? -
Quote from Waduh Dong
drad123 – you have $19M right? At what age did you hit 5M, 10M etc?
What was your primary strategy – location arb?
Started making pp money at 29. had like 30k at that time. Location arb definitely part of my strategy plus saving and not making any significant investing mistakes. Now I am used to rural general work. Would like to move to a bigger city but don’t want to be pigeon holed in a specialized practice. Maybe tele in the next 10 years.
First mil was the hardest. 1 mil in 3 years, 5 mil by 10 years, peaked at 19 now down 17-18 at 20 years.
Saved 300-350k per year for 20 years. 80% equity.
que Lil Wayne – A Milli -
If that is true they are probably taking no vacation and working 10 hour days.
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I think many are making over $1M per annum in Tele right now. Yeh high volume but Tele is also more efficient. -
Where?
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I am in private practice. Fellowship trained and read neuro only. I read about 70-100 rvus of neuro per day. The lower end is on days when I am at the hospital reading neuro onc. While the job is busy it definitely is very manageable. Our practice is very efficient in that we have a team who does everything for us but read the studies, ie pull comparisons, get the clinician on the phone etc. I still have time to get lunch, chat with techs and surf the internet haha. My work day is usually 815ish to 430/5.
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Our profession can truly destroy our bodies-period.
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Case mix is the most important variable.
The difference between reading 6 and 10 easy cases an hour isn’t too significant. Let’s say 2 min on average = 8 min.
The difference between reading 6 and 10 hard cases an hour is extremely significant. Let’s say 6 min on average = 24 min. -
I was in a group where I worked my tail off and worked about 20-21k rvu that year. was clearing six figs a month. wasn’t worth it.
the money is there in any specialty if you want to kill yourself – just easier to do so in rads with home work stations and current locums rates etc. -
Quote from ar123
the money is there in any specialty if you want to kill yourself – just easier to do so in rads with home work stations and current locums rates etc.
This is true to some degree, though in rads I think it’s much simpler to significantly increase your output compared to many other specialties.
Not only can you often always find extra work after hours, you can also 2x or 3x your output in the same amount of time if you just stop caring. Plenty of shenanigans in lots of specialities if you want to max out pay, but rads is probably the easiest to just go way outside the norm if you want.
I’m sure some surgeons would love to operate 3x as much, but definitely more logistical challenges with OR time and patient facing specialties (30 second clinic visits might not fly, but a 30 second CT CAP report most of the time no one will know).
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Quote from Radsoxfan
Quote from ar123
the money is there in any specialty if you want to kill yourself – just easier to do so in rads with home work stations and current locums rates etc.
This is true to some degree, though in rads I think it’s much simpler to significantly increase your output compared to many other specialties.
Not only can you often always find extra work after hours, you can also 2x or 3x your output in the same amount of time if you just stop caring. Plenty of shenanigans in lots of specialities if you want to max out pay, but rads is probably the easiest to just go way outside the norm if you want.
I’m sure some surgeons would love to operate 3x as much, but definitely more logistical challenges with OR time and patient facing specialties (30 second clinic visits might not fly, but a 30 second CT CAP report most of the time no one will know).
Def true.
I guess the risk in rads is how much risk are you willing to take with your volume per day etc. I know some rads that are reading 200 cases mixed volume every day, making over a mil a year. I can’t do that outside of a call shift without missing things. -
Quote from ar123
I guess the risk in rads is how much risk are you willing to take with your volume per day etc. I know some rads that are reading 200 cases mixed volume every day, making over a mil a year. I can’t do that outside of a call shift without missing things.
Oh they miss things, lots of things. Comically bad reports. Absurd misses.
They don’t care. -
Quote from Radsoxfan
Quote from ar123
I guess the risk in rads is how much risk are you willing to take with your volume per day etc. I know some rads that are reading 200 cases mixed volume every day, making over a mil a year. I can’t do that outside of a call shift without missing things.
Oh they miss things, lots of things. Comically bad reports. Absurd misses.
They don’t care.
They’ll care when the lawsuit comes.
My wife is a med mal (defense) attorney. Has made me very paranoid about going too fast or being too greedy. -
There is also something called ethics and professionalism. Rads should realize the folks on the other side of the images are real people with real lives who trust in us to do our best. Many are having a much worse day than we are. Dont sell ur soul for money.
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Quote from Waduh Dong
There is also something called ethics and professionalism. Rads should realize the folks on the other side of the images are real people with real lives who trust in us to do our best. Many are having a much worse day than we are. Dont sell ur soul for money.
System is being corrupted by powerful interests. Free for all RVU grab bag destroys radiologist group mentality. Prep for corporate drone servitude.
New rvu system facilitates/forces high volume behavior, old private practice system limited it.
Expecting a rad to fight the system is foolish. Show me the incentive and I’ll show you the outcome. Charlie Munger -
Quote from Waduh Dong
I agree Flounce, but I am turning 47 yo next week. No way I could do the volume I see posted here by many young Rads, but then I try to remember these guys are young and hungry.I put in some years in my 30s where I cleared $750k routinely and even $900k one year just from volume. But I gained weight, my dong would not function at top level and in general I was less happy.
At this age, would take $1M+ easy to get me to do a difficult job. Nights are out of the question period.
I’m about 10 years out and my efficiency and tolerance to volume seems to increase with age/experience (I’m a little older than you as I went to med school later). The fastest rads in my group are mid/late career. Newer grads not so much.
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Quote from drad123
Narrative much better than template trash. Read an ER template sometime vs hospitalists dictated paragraph of what is actually going on.
Not sure why you are conflating a level by level report with templated vs narrated reports, it can be done either way.
As is typically the case, things depend to some degree on the ordering doc’s expectations. Plenty will not accept a stream of consciousness report with all the findings compressed into a few run on sentences. It’s frankly not the standard of care for outpatient non-traumatic cervical and lumbar spine imaging.
In my experience, generally the most careless and lowest quality radiologists are the same ones that try to get away without doing a level by level eval on outpatient C and L spine cases.
Perhaps I haven’t seen a large enough sample size to fairly judge, but it has been a consistent trend so far.-
The pull of Telerad would be being able to generate a very high income.
But like Flounce says – def trade offs.
Let’s be real tho, there are not many jobs out there that give you an opportunity to make $1M+ a year. -
It sounds like I am making much less and saving much less than all you guys lol
Funny thing is, I am trying to earn even less by going further down in hours but my group is not letting me at this time, need to hire more.
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Quote from Flounce
It sounds like I am making much less and saving much less than all you guys lol
Funny thing is, I am trying to earn even less by going further down in hours but my group is not letting me at this time, need to hire more.
I respect ur approach, but I grew up right on the edge of lower middle class to almost poor so I prioritized money when I came out of training. I just wanted to build a decent portfolio and let it compound. Being almost poor was no fun when I was growing up. -
I def respect that.
I grew up upper middle class and both my parents worked hard, immigrant parents. They grew up overseas in wartime, and sought security through income. I’m grateful for what they were able to do for me and my sibilings. Since finishing training and working as a radiologist, I’ve always felt that I had enough money, and always wanted more free time. The way I see it – for myself – is that anything I make over 300K is not really contributing to my happiness, as I can always figure out a way to live and plan to retire within my physician income. What I need to live a fuller life right now and in the future is time, not more money. These are subjective choices that are different for different people.
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Quote from W24
Why idiotic? Maybe not a proven rationale but wouldn’t say idiotic.
Level by level is what 90% of rads do for C spine and L spine.
For T spine, most do not do level by level. For C/T/L spine combination, most do not do level by level.I don’t see a point leaving 4 levels of templated normals if there is isolated pathology. In that case, the normal levels get summarized.
I see those 10% reports occasionally. Usually in neuro conference.
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Depends on your audience, neurosurgeons vs noctors who might not care. Not going level by level at my fellowship or where I practice now would not fly at all. Come to think of it, I don’t think I have ever seen a Neuroradiology rad not go level by level. The only time I do that is T-spine MR or trauma CT.
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Quote from West RAD
Not going level by level at my fellowship or where I practice now would not fly at all. Come to think of it, I don’t think I have ever seen a Neuroradiology rad not go level by level. The only time I do that is T-spine MR or trauma CT.
For sure, it’s kind of amazing to see someone argue otherwise.
Reporting OP spines like that (or defending it) is instantly outing yourself as a substandard radiologist.
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Quote from stonks
Just started working for a private practice. They expect you to read 10 rvu per hour when doing outpatient neuro CT or MR cases. Is this normal? I can imagine doing this for short bursts of time, but can anyone actually sustain this pace?
If doing MSK or body, it’s 6 rvu per hour, which i find more palatable but still a stretch for me
The RVUs are not a hard rule but a guideline
“Normal”? IDK. Seems pretty busy to me; certainly busier than where I work.
Your intuition is correct. My opinion is that such a pace isn’t sustainable. I’ve worked in a place like that and couldn’t handle it. Severe negative impacts on many aspects of my life. However, have no doubt that there are rads out there that could do it.
My guess is that if you put in a few months and don’t meet the “guidelines” you’ll find that they have become “hard rules” which you’ll be on the wrong side of.
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I know a group that reads that much – 80-90 rvus a day on average (not just neurorads). But they make 1M+/year. And lot of their cases are easy and quick ones and their pacs and system is very efficient.
If you are reading a lot of difficult cases, that pace isn’t sustainable.
I think a more realistic pace for Neuro is mid 60s-70 wrvu/day in a PP with mix of outpatient/inpatient and good mix of bread and butter cases.
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