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jbs

Straight RVU Compenstaion

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Hi All,

Does anyone have any experience with being compensated with RVU alone?  Our physician staffing firm is contemplating straight RVU compensation.

We have been hourly since the beginning, but recently there has been a lot of talk about going to RVU w/o a base salary just like our supervising ED Docs.

Any insights would be greatly appreciated.

JBS

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That would be HORRIBLE. Our group just moved from hourly to hourly plus RVU, and I hate it. I would rather earn less money. It has harmed the morale of the group. Instead of being focused on working together as a team, taking and giving... and most of all, caring for patients, the doctors especially are focused on getting more and more money. There have been days where I have been told I can come in late because a doctor has it "handed," and I come in and they're "handling" 15-18 patients ALONE. And they didn't see this many patients before - but they want to scoop up all the patients now, at the expense of patient satisfaction (how much time are they really spending with these patients) and safety (how can you safely carry 18 patients and not make terrible mistakes?). You'll try to go see a patient and they're magically in the room already picking up their 19th patient while you are sitting on your butt. And then when the ER is slow, of if one of these providers is "hogging" all of the patients, you are left seeing nothing and also making no money. I highly recommend against this model especially if it is all RVU based. You NEED an hourly wage to maintain your sanity. People will drop off like flies with the pressure of a solely RVU based pay system because they won't be able to handle the stress. 

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yup, agree with above. have done it. will never do it again.

upside: potential to make a lot of money

downsides(and there are many) :

chart hogs(as above), bad charting to see more pts, bad care to see more pts, tendency to underwork up pts to get them gone faster to see more patients...it's really as bad as you think. docs hate to talk about your patients because it keeps them from seeing more, etc. it turns a nice work environment into an assembly line mill. DO NOT DO IT.

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It's even messier than that.  Most places want a doc name on the chart so they can bill 100% for incident to rather than the 85% if an APC only sees that patient.  This creates all sorts of issues on how the RVU's are split between the APC and the doc, especially if the APC really saw the patient.  Some models include 3 different splits: 1 if the doc was only "available for consultation", 1 (with more RVU's allocated to the doc) if the APC "discussed" the patient with the doc, and a 3rd (with the doc getting most of the RVU's) if the doc did a "face-to-face" examination of the patient.  This last leads to lots of the doc saying hi from the doorway to get the most RVU's.

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23 minutes ago, ohiovolffemtp said:

It's even messier than that.  Most places want a doc name on the chart so they can bill 100% for incident to rather than the 85% if an APC only sees that patient.  This creates all sorts of issues on how the RVU's are split between the APC and the doc, especially if the APC really saw the patient.  Some models include 3 different splits: 1 if the doc was only "available for consultation", 1 (with more RVU's allocated to the doc) if the APC "discussed" the patient with the doc, and a 3rd (with the doc getting most of the RVU's) if the doc did a "face-to-face" examination of the patient.  This last leads to lots of the doc saying hi from the doorway to get the most RVU's.

yup. at a prior job the docs got 50% just to sign the chart and 75% if they say hi from the door after my 2 hr workup with procedures and consults...grrrrr.....only 1 of several reasons I quit that job. 

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In our group if the doc sees the patient even briefly and documents it, all the RVUs go to them. I have had patients where I worked my butt off for hours and at discharge the doc goes in to "say hi" and then I get squat.

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