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Help! wRVU salary for new grads 1st job??

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I am a recent grad and have a job offer through a hospital that is heavily based on wRVU's. I have been researching the whole wRVU thing and still don't feel totally comfortable in understanding all the detais about it. I am a recent graduate and don't want to go into anything (i.e. sign a contract) that may come back to haunt me in the future.


 The job is with an orthopedic practice that is affiliated/part of the hospital. I would be working with an orthopedic surgeon  much like I would be if I were at an ortho practice without the hospital affiliation, roughly 2 days assisting in the OR and 3 days in clinic. Call is every 1 in 8 days, so about 4 days per month.


      The job highlight details are:


          - 3 year contract term


          - Base salary in Year 1 of the greater of $85,000 or $46.67 per wRVU


          - Year 2 & 3 salary is production based at $46.67 per wRVU


          - wRVU target for Year 1 of 1,821.30


          - $1,500 stipend for CME expenses and 5 days for CME activities


          - $500 stipend for licensing, dues, subscriptions, and memberships


          - Medical, dental, vision, 401(k) and many other standard benefits


          - 6 paid holidays per year


          - Accrued vacation, sick, and personal time


 What I don't like as a new grad, is that Year 2 & 3 of the contract there is no guaranteed base salary and it is totally on production/wRVU's. In my research, I know that there are a lot a variables to consider with wRVU production based salary. I realize that sometimes, in some systems, the PA is rendered invisible with their work and work they pergform can be placed under the Dr.'s NPI#. I don't want to get screwed here. I also know though, that if you have a fair opportunity and actually work hard, that you can be rewarded nicely with the wRVU model.


 Also the stipend of $500 for licensing and such seems a bit low to me, my state lic. alone cost me over $300 this year. I also feel that $1500 for CME is a bit low, as well as the 6 days of paid holidays. He did not give me the exact number of days for vacation/sick/personal time as of yet either, that is something I will inquire about and look at closely before signing anything. I am pretty sure that my health/dental/vision insurance is paid for by them at minimum of 85% but possibly 100%, I will find that out as well.


 This is what the hiring manager sent me as his initial highlights and he wanted me to look it over and give him my approval before he went ahead and drafted up the actual contract. What do you think? Is there anyone with any experience who could help shed some light on this deal for me? Whatever help or guidance you can give would be greatly appreciated.


Thanks

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I am a recent grad and have a job offer through a hospital that is heavily based on wRVU's. I have been researching the whole wRVU thing and still don't feel totally comfortable in understanding all the detais about it. I am a recent graduate and don't want to go into anything (i.e. sign a contract) that may come back to haunt me in the future.

 The job is with an orthopedic practice that is affiliated/part of the hospital. I would be working with an orthopedic surgeon  much like I would be if I were at an ortho practice without the hospital affiliation, roughly 2 days assisting in the OR and 3 days in clinic. Call is every 1 in 8 days, so about 4 days per month.

      The job highlight details are:

          - 3 year contract term

          - Base salary in Year 1 of the greater of $85,000 or $46.67 per wRVU

          - Year 2 & 3 salary is production based at $46.67 per wRVU

          - wRVU target for Year 1 of 1,821.30

          - $1,500 stipend for CME expenses and 5 days for CME activities

          - $500 stipend for licensing, dues, subscriptions, and memberships

          - Medical, dental, vision, 401(k) and many other standard benefits

          - 6 paid holidays per year

          - Accrued vacation, sick, and personal time

 What I don't like as a new grad, is that Year 2 & 3 of the contract there is no guaranteed base salary and it is totally on production/wRVU's. In my research, I know that there are a lot a variables to consider with wRVU production based salary. I realize that sometimes, in some systems, the PA is rendered invisible with their work and work they pergform can be placed under the Dr.'s NPI#. I don't want to get screwed here. I also know though, that if you have a fair opportunity and actually work hard, that you can be rewarded nicely with the wRVU model.

 Also the stipend of $500 for licensing and such seems a bit low to me, my state lic. alone cost me over $300 this year. I also feel that $1500 for CME is a bit low, as well as the 6 days of paid holidays. He did not give me the exact number of days for vacation/sick/personal time as of yet either, that is something I will inquire about and look at closely before signing anything. I am pretty sure that my health/dental/vision insurance is paid for by them at minimum of 85% but possibly 100%, I will find that out as well.

 This is what the hiring manager sent me as his initial highlights and he wanted me to look it over and give him my approval before he went ahead and drafted up the actual contract. What do you think? Is there anyone with any experience who could help shed some light on this deal for me? Whatever help or guidance you can give would be greatly appreciated.

Thanks

 

It depends on how they calculate the wRVUs. The rub is going to be the three days in clinic and also whether they use you properly in surgery. If the three days in clinic are all follow up that are in the global period then no wRVUs since the doc already got paid for this. On the other hand if the clinic is all joint injections and consults then it could look pretty good. Also where does the wRVU for the pre op get credited. If the doc gets the credit then not so good. 

 

In the OR you have to make sure that you are doing cases that are being reimbursed for a first assist. If you are doing cases that are not reimbursed then you should get a portion of the wRVU since presumably you can do more cases in a given time. 

 

The other issue is how they calculate the wRVUs. Do they calculate them on whether you did the work or whether they submitted a bill/got paid for the work. All work has an assigned wRVU. Some of it is reimbursed and some isn't. The AAPA doc below gives and example of the wRVU associated for a pre op H&P. If you get the credit for the wRVU for the H&P regardless of whether its submitted then all is good. If not then its a problem. Same for surgery. You can assist on any case. Some of its reimbursed and some isn't. If you are getting wRVU credit regardless of whether its  reimbursed then it works well. 

 

Overall it really depends on how well they manage this. Find out if this is something new or is it established. Also see if you can talk to someone thats been there a while to get a sense of if this is working correctly or not. Take a look at the links below. The PAOS presentation seems to show the average wRVU for orthopedic PAs is around 3000. That would mean over $140k if you were merely average. In that sense it seems like they know what they are doing. They are giving you a low but guaranteed salary the first year. If you catch on quickly then you will make around the average for new grads or a little more. If it takes time to bring you up to speed then they don't lose much money and you get a below average salary for the first year. 

 

http://www.paos.org/sites/default/files/2012conference/PDF_handouts/Calculate_Productivity_Marriott.pdf

http://www.aapa.org/uploadedFiles/content/Your_PA_Practice/Reimbursement/Resource_Items/Calculating_PA_Productivity_2012.pdf

 

As for the rest, pretty standard. As a system they really can't negotiate on benefits. $2000 is more the average for CME but a lot of places make you use that for licensing. The real pain is when you have to renew PANRE, DEA and License in the same year. You might ask if they cover DEA separately. 

 

Overall it seems like an interesting offer by someone who has put some thought into it. If you work hard you get paid well. If you don't work hard then you don't get paid well. As usual the devil is in the details. Can they bill for what you submit and is the wRVU based on claimed wRVU, billed wRVU or collected wRVUs. These are three very different numbers. 

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Thanks Coloradopa, I appreciate your feedback. I actually have read both of the articles that you posted while I have been researching the topic. Like you said, the devil is in the details. I just think I am going to try and get at least some sort of guaranteed base salary every year. Even if I stay at the 85,000 base pay, that equals out o 1821.30 wRVU's per year. If the system is fair to PAs and the average PA reaches roughly 3000 wRVUs per year, then I should be able to easily get past the $85,000 base salary that I would be asking for as a gaurantee. I may even see if in the second year they could up the base salary 3%-4% and do the same for the 3rd year. I am just really nervous about agreeing to a contract that has 2 years based solely on production and me being a new grad not knowing much about wRVU's or how this hospital handles it all.

 

Thanks again

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any talk of rvu based means they have to give you 100% access to all records from billing      Should be in writing in the contract with penalties against them if they do not comply......

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Thanks Coloradopa, I appreciate your feedback. I actually have read both of the articles that you posted while I have been researching the topic. Like you said, the devil is in the details. I just think I am going to try and get at least some sort of guaranteed base salary every year. Even if I stay at the 85,000 base pay, that equals out o 1821.30 wRVU's per year. If the system is fair to PAs and the average PA reaches roughly 3000 wRVUs per year, then I should be able to easily get past the $85,000 base salary that I would be asking for as a gaurantee. I may even see if in the second year they could up the base salary 3%-4% and do the same for the 3rd year. I am just really nervous about agreeing to a contract that has 2 years based solely on production and me being a new grad not knowing much about wRVU's or how this hospital handles it all.

 

Thanks again

Again this really depends on how the system handles it. In general hospital systems have very little leeway in the contract. When you have hundreds of employees having individual contracts becomes a nightmare. If this is an established way of doing things then it should be OK. If this is brand new then yes I think a guarantee is in order. I would also agree with Ventanna that you have to be able to see the billing with one caveat. If they are willing to pay you wRVU on what billing you submit then you don't need to see the books because what they submit or collect is irrelevant. 

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A big concern of mine is what if something happens to my SP and I am limited with the number of surgical cases or patients I can see. He is an active guy and takes part in numerous sporting activities. What happens if, God forbid, he breaks his leg or worse his arm, and he is unable to perform surgery for 2-3 months? A senario like that and I could be in big trouble, no 1st assist cases for me for that same length of time, hence a big hit to my wRVUs. I just know that I have a big chunk of change every month that I have to throw at my student loans, I have to keep a roof over my head, and not to mention all the other bills that we all have. Worst case I could go from making a good/decent salary to not being able to make ends meet. Maybe I am thinking too much about this whole thing, but this is a big decision and I want to make sure that I have thought through any and all possible senarios. 

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