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RVU based Salary Calculation

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Hello I was wondering if anyone has experience negotiating a salary with a similar situation to mine. I have been trying to research strategies but I am having difficulty finding any information. 

I have been at my job for almost 2 years. Started right out of PA school at a flat salary of $74,000. Quite a bit lower than the majority of my classmates but I moved to a new city and was happy to get my foot in the door in a place were PA's were few and far between. I am going to try to negotiate a salary for the upcoming year, but my day to day schedule is not straightforward. I will outline the details below:


-I work with one physician on a day to day basis (Pulmonary/ Sleep Medicine/ Critical Care), on a daily basis  we each see 6-7 patients independently who we each bill separately for. The remainder of the day includes 8-10 new patient consults who we see together- the idea is that since we are a specialty, they can see us both the first visit then see me for their follow up. We also round on 5-8 patient at Select Specialty, which is a long-term acute care facility. All of those patient and the new consults get billed under the physician. 


-One day per week, the physician is on call in the ICU and has the following day off, so I see 15-20 patients independently in the office and round on the long-term patients at Select. I bill for these visits. 


-One week per month. the physician works in the ICU and I have my own clinic that wee. I see 15-20 patients Monday-Thursday and about 8-10 on Friday. I also bill for these visits. 


-The last 4 months my RVU's have been 164, 177, 179, 277 ( the last month I have 3 full weeks of clinic time).


-On a day to day basis, I deal with all the paperwork, make phone calls, deal with authorizations, and communicate with the nurses. 


I realize based on strict RVU's, it does not look like I do much work, but prior to me being with this physician he was seeing 4-6 consults daily and the weeks he was in the ICU his practice would not run. When he was post-call, a different medical group would round on his patient, thus taking away revenue from our practice. now I see these patients. 


-We have also absorbed another physician practice as he retired shortly after I started. 


 Currently I get $74,000.

5 days paided CME $2000

3.5 weeks vacation

6% 401b Match 



I looked into AAPA and other salary tools. The data for my state suggests a 50% average salary of 90,000, 75th 98,000. For my specialty the 50th percentile was 95,000. 


I was planning to ask for a base salary of $93,00. They do offer a bonus based on RVU's which they have implemented with the other NP on staff. Her schedule is very different from mine so I havent asked her what hers looks like. 


My questions are does anyone have something similar and if so, how do you work it out?

Is this a fair number to ask for?

How can I calculate  bonus based on this information?



Side note.. My hours are awesome, the people I work with are wonderful, I work downtown in a great city so I really dont want to have to find another job! I just feel like I am being taken advantage of based on how much work I do! 


Thank you for reading all of this. 

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  • Moderator

This is the issue - and welcome to the world of the business of medicine


You are only generating about $85k per year for the practice!


At the typical formula (33-50% of receipts) you should be at less then 42K per year!




Asking for a raise can not be based on RVU - AND you really need to pay attention to your productivity!


You might be able to use the AAPA data to support you as this is what you could get if you went somewhere else, but in general I would think your request for a raise is a tough sell, and this is coming from a practice owner.



A simple question for you - where does the $$ come from to pay your salary and the overhead to support you?  The doc would need to work harder to pay you...... the wrong way




Just to give more info - last year as a practice owner working 4 days per week I generated well over twice what you did,  and if you talk to other practice owners the same theme comes up - "eat what you kill" so to speak - and my practice is an exceptionally low overhead practice with $150/m rent and one 1/2 time nurse......


If you want to get a healthy living wage you need to earn at least twice what you want....

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Thank you for the input. My whole issue is that I do not bill for all of the patients we see so my revenue is low. However, the physician I work with billing significantly more with my help. On average about 8 more consults or 99244 visits daily, which leads to about that many sleep studies to dictate. He also is able to see more patients in the hospital. Basically his RVU's have significantly increased, but there is no way to show that that is due to my help. If I was seeing 15-20 patients daily and billing for them myself I wouldnt be in this situation. I dont know what his RVU's were prior, but  I guess the only way to find out how much more he generates would be to compare then to now. 

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  • 2 weeks later...
  • Moderator

You need to be billing under your pin

No more making him look better and you look bad


If you do the work it gets billed under you


At very min if they want to get 100% and he is in the office but you do 90% of the work, you need to be credited with the RVU's



It is all a moot point if you see the patient, write the note, and bill under your PIN and YOUR RVU's are tracked....




You are a pawn, don't be duped.....

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