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Hi there

I currently work full time as a new grad 6 months into my position at a family practice FQHC. I've been hanging tough but recently have felt that the lack of support is reaching an untenable high. I'm looking for other jobs. I am currently salaried at 94k + 10k bonus and really good benefits including 20 days PTO, 10 days CME, health dental vision malpractice and 4% 401k.

 

I am going to call a startup that I interviewed with as a new grad and who had offered me a position at the time which I declined as they offer an RVU-based salary. Now that I am 1000hrs into practice as a PA I believe I have established the clinical foundation I was previously lacking to survive an RVU-based job.

 

Can anyone speak to what they've experienced as a PA who is paid on basis of RVUs? Were there any surprises you had to learn the hard way? Any resources you found helpful?

 

Thanks for your insights.

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What do you mean by lack of support? Is it lack of support/advice from your SP or lack of clinic support like no MA. If you can't ask your current SP for help, I have high doubts you would be able to at a new start-up that's RVU based. Don't forget, your RVU will only be as good as their marketing/business ability. Doesn't seem like a great time to go RVU based due to the pandemic.

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What do you mean by lack of support? Is it lack of support/advice from your SP or lack of clinic support like no MA. If you can't ask your current SP for help, I have high doubts you would be able to at a new start-up that's RVU based. Don't forget, your RVU will only be as good as their marketing/business ability. Doesn't seem like a great time to go RVU based due to the pandemic.
The lack of support comes from both front office/operations management and from the physician I work with. On the operations side, I am dealing with multiple errors in scheduling ranging from being scheduled new patients for 20 minute visits (should be 40s), spelling errors in their names or DOB that make PDMP access impossible, incorrect phone numbers so I can't call my patients, or for example I had to take 1 week of emergency leave due to a death in the family and my entire patient panel that week had their appointments cancelled without being called, notified and rescheduled. I have notified our regional administrator 4x in the last 3 weeks regarding issues including, but not limited, to these and recieved no response.

The other big issue is that I am one of only 2 providers at our clinic taking new patients (out of 5). One of the NPs is cutting down from 4 days per week in clinic, to 1, so her patients will need to be absorbed. The other PA who is also taking new patients is seeking to reduce her hours because she is also struggling under the burden. Also my SP will probably be on maternity leave in about 6 months, when our patient volumes are highest.


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2 minutes ago, DarwinStarwin said:
8 minutes ago, Cideous said:
Worst time in the entire field of medicine to start an RVU only job.  Simply the worst.

I didn't mention it but financially I am stable and can afford to take a very large pay cut. It is a mental health issue and I have been suffering immensely.

It depends on how they set up their RVU reimbursement but if they base it off of collections, now is a really rough time.  If they are strictly paying you directly based on volume and the volume is good you should be ok but MANY clinics now are having their volumes decimated.  The things you are describing as wrong are also mostly administrative.  Every practice has this in one way or another (except maybe hospital based, they seem to hire better people and have more oversight), but just be careful you're not trading one headache for another.

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Yeah, personally I consider the RVU system to be way too easy to abuse and manipulate, plus I feel like being salaried allows me to make better and more appropriate clinical decisions. But that’s a different discussion, for another time.

Right now, my organization has had everyone salaried see a 30% pay cut. Meanwhile, the RVU-based clinicians are being paid 70% of whatever their average monthly collections were during 2019. And we’re pretty lucky, compared to some other health systems in our area .

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Yeah, personally I consider the RVU system to be way too easy to abuse and manipulate, plus I feel like being salaried allows me to make better and more appropriate clinical decisions. But that’s a different discussion, for another time.
Right now, my organization has had everyone salaried see a 30% pay cut. Meanwhile, the RVU-based clinicians are being paid 70% of whatever their average monthly collections were during 2019. And we’re pretty lucky, compared to some other health systems in our area .


Thanks for that insight. I am more interested in the aspects you're mentioning regarding clinical practice and decision making. I like to imagine I'd practice in line with how I do now, but maybe having the coding-lens on for each visit would end up changing my practice style. I do have to be very thrifty at this point given we take uninsured folks on a sliding scale. I think i would miss the great resources I have including in house referrals to therapy and psychiatry, and a community health worker. I also think because the other clinic (the one I'm looking at... rvu basis) doesn't take uninsured patients, I might have fewer psych crisis patients in the first place, where those referral resources are so strongly dedicated.
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It’s great when things are going well for the practice. I’m at a base salary with RVU-based bonus. It has since been suspended from March until who knows when, at their discretion. Plus an additional large cut to my salary. Like alluded above, not the best time to start with one. I’d imagine that could last for at least another year or two. That being said, when things are going well, it’s not uncommon to see large sums that double/triple your current bonus. 

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It’s great when things are going well for the practice. I’m at a base salary with RVU-based bonus. It has since been suspended from March until who knows when, at their discretion. Plus an additional large cut to my salary. Like alluded above, not the best time to start with one. I’d imagine that could last for at least another year or two. That being said, when things are going well, it’s not uncommon to see large sums that double/triple your current bonus. 
When things are going well, do you get your bonus quarterly? Also, which field are you in? I seem hear most of ER, surgical and orthopedic specialities utilizing an RVU based pay structure. With that being said I did see one internal med PA working both in and outpatient who was on a strict RVU structure. The job i am looking at is family practice.
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2 hours ago, DarwinStarwin said:
4 hours ago, ANESMCR said:
It’s great when things are going well for the practice. I’m at a base salary with RVU-based bonus. It has since been suspended from March until who knows when, at their discretion. Plus an additional large cut to my salary. Like alluded above, not the best time to start with one. I’d imagine that could last for at least another year or two. That being said, when things are going well, it’s not uncommon to see large sums that double/triple your current bonus. 

When things are going well, do you get your bonus quarterly? Also, which field are you in? I seem hear most of ER, surgical and orthopedic specialities utilizing an RVU based pay structure. With that being said I did see one internal med PA working both in and outpatient who was on a strict RVU structure. The job i am looking at is family practice.

Quarterly yep. I’m in outpatient GI

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My experience in EM is that the pay is primarily hourly, with some places having some sort of productivity bonus.  It's tough to do purely RVU based pay in EM since lower volume shifts, like overnight, still have to be covered.  In the 4 ED''s I've worked, only 1 had a productivity bonus, and that went away when the company was bought out by one of the big 3 national EM staffing co's.

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I'm semi retired and work every Wednesday in a local Occupational Clinic. I signed a contract 3 years ago for $65.00 an hour. Been very satisfied until a new service manager came in last January. My first encounter with her was anything but cordial. She said that I needed to get  DOT Medical Certification qualified. I said will the clinic pay for it. She said no, and then said I was not going to become certified. Then she asked about my contract and I said I was hourly. She asked if I would consider RVU pay base. I said no and explained that it wasn't my job to get patients into the clinic, it was her job. The subject was dropped until April when she approached me again and said that all the clinics she managed were going to a RVU reimbursement for their providers.  I asked if this included non provider management such as she. Well of course not. She is salaried. I said nope I have a contract. She said you will never get another raise.  I then said fine, I don't need this job and all this drama. I was hired to see patients. If 10 or 35 come in the door on any given day I will see them.  She said I don't understand and I told her that this is some bean counters way to screw the providers. I quit effective today.

And here's the rub with RVU's working in ER's, OH and Urgent Care Clinic. You are at the mercy of what comes in the door. You don't have the luxury of building a patient base that are reoccurring. My daughter in law is a PA in Tacoma, WA. She worked a 12 hour shift last Thanksgiving Day. Saw 4 patients.

This system is set up for fraud and over billing. As a example I cut my finger last winter. I needed a Tetnaus shot. I went to my local Urgent Care after hours. I didn't need sutures, I needed a Tetnaus shot which I got. I was floored when I got a bill for over $800.00. I asked for a comprehensive breakdown of the cost. The provider billed me at new patient comprehensive. I asked for my records and was stunned by the crap he had documented to get to that level. I protested the exorbitant charge and told the billing office 

1. There was no way the provider spent 1 hour with me to charge at that level. He walked in looked at my finger and walked out.  My check in time was 610 and discharge was 655. I told her I don't recognize the patient he documented seeing that day. I have no idea how he gleamed that much information in a 30 second encounter.

2. I was charged a afterhour premium charge. I said your clinic advertises its open hours as 7 am - 1000 pm. That is not after hours. I'm not paying that.

3. I was charged a surcharge for records review. I said what records were reviewed. This was the first time I had ever been i there system.

4. She then said one of the most incredible things. She said why are you making a big deal of this. Your insurance, "TriCare" is going to pay 100%. I told her we will see about that after I get done calling TriCare fraud hot line and tell them to contest these charges. I told her that I was a Physician Assistant and I knew a scam of over billing when I saw one.

5. About a week  later I received a revised bill for $180.00.

In summary how many of these clinics operate that way? How many patients just shrug their shoulders and pay the bill. Some of these providers are just driven by quantity to get paid.       

Sorry for the rant.    

 

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On 6/23/2020 at 8:51 AM, TDIowa said:

I'm semi retired and work every Wednesday in a local Occupational Clinic. I signed a contract 3 years ago for $65.00 an hour. Been very satisfied until a new service manager came in last January. My first encounter with her was anything but cordial. She said that I needed to get  DOT Medical Certification qualified. I said will the clinic pay for it. She said no, and then said I was not going to become certified. Then she asked about my contract and I said I was hourly. She asked if I would consider RVU pay base. I said no and explained that it wasn't my job to get patients into the clinic, it was her job. The subject was dropped until April when she approached me again and said that all the clinics she managed were going to a RVU reimbursement for their providers.  I asked if this included non provider management such as she. Well of course not. She is salaried. I said nope I have a contract. She said you will never get another raise.  I then said fine, I don't need this job and all this drama. I was hired to see patients. If 10 or 35 come in the door on any given day I will see them.  She said I don't understand and I told her that this is some bean counters way to screw the providers. I quit effective today.

And here's the rub with RVU's working in ER's, OH and Urgent Care Clinic. You are at the mercy of what comes in the door. You don't have the luxury of building a patient base that are reoccurring. My daughter in law is a PA in Tacoma, WA. She worked a 12 hour shift last Thanksgiving Day. Saw 4 patients.

This system is set up for fraud and over billing. As a example I cut my finger last winter. I needed a Tetnaus shot. I went to my local Urgent Care after hours. I didn't need sutures, I needed a Tetnaus shot which I got. I was floored when I got a bill for over $800.00. I asked for a comprehensive breakdown of the cost. The provider billed me at new patient comprehensive. I asked for my records and was stunned by the crap he had documented to get to that level. I protested the exorbitant charge and told the billing office 

1. There was no way the provider spent 1 hour with me to charge at that level. He walked in looked at my finger and walked out.  My check in time was 610 and discharge was 655. I told her I don't recognize the patient he documented seeing that day. I have no idea how he gleamed that much information in a 30 second encounter.

2. I was charged a afterhour premium charge. I said your clinic advertises its open hours as 7 am - 1000 pm. That is not after hours. I'm not paying that.

3. I was charged a surcharge for records review. I said what records were reviewed. This was the first time I had ever been i there system.

4. She then said one of the most incredible things. She said why are you making a big deal of this. Your insurance, "TriCare" is going to pay 100%. I told her we will see about that after I get done calling TriCare fraud hot line and tell them to contest these charges. I told her that I was a Physician Assistant and I knew a scam of over billing when I saw one.

5. About a week  later I received a revised bill for $180.00.

In summary how many of these clinics operate that way? How many patients just shrug their shoulders and pay the bill. Some of these providers are just driven by quantity to get paid.       

Sorry for the rant.    

 

I honestly had to LOL at this post.  Welcome to Urgent Care!!!!  Medicine has become a game of seeing who will throw a fit over their bill and who will just eat it.  It's a damn disgusting travesty.

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  • 4 weeks later...

This thread has been extremely helpful. Can someone help me understand my situation? I will be a new grad starting a job with an Ortho/Plastics surgeon this fall. I have a good base salary with an RVU bonus. I am told this will be easy to reach because he is a very productive surgeon (hand/wrist ortho and does 20 surgeries a day when he does surgery). How are RVUs calculated in the OR for a PA? I will get RVUs for post-ops, right? I know I will be seeing a ton of pre and post-ops, but also doing minor procedures (biopsies, joint injections etc). This is all very new to me and I want to know what to expect. My bonus kicks in at 3,100 RVUs. 

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1 hour ago, knye42 said:

This thread has been extremely helpful. Can someone help me understand my situation? I will be a new grad starting a job with an Ortho/Plastics surgeon this fall. I have a good base salary with an RVU bonus. I am told this will be easy to reach because he is a very productive surgeon (hand/wrist ortho and does 20 surgeries a day when he does surgery). How are RVUs calculated in the OR for a PA? I will get RVUs for post-ops, right? I know I will be seeing a ton of pre and post-ops, but also doing minor procedures (biopsies, joint injections etc). This is all very new to me and I want to know what to expect. My bonus kicks in at 3,100 RVUs. 

Probably won’t get RVUs in the OR or post-op’s. You will for f/u’s, consults, new patients, office procedures. 3100 RVUs is a big number to hit before getting your bonus. I would assume you won’t have a bonus for a year or two based on that number. 

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