Envision RVU model

[Backpack234]

I’ve been hearing that envision recently changed from a base salary to a base plus rvu model. What have your experiences been with this change?

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[Brigade4Radiant]

It’s okay if you are in a shop where you can move patients but if you are holding or the volume is low it can suck

 

[bravotwozero]

Envision has had that for a long time now, at least for the 6 years I’ve been an attending.

 

[turkeyjerky]

It’s okay if you are in a shop where you can move patients but if you are holding or the volume is low it can suck

Yeah. It’s all about shifting risk of volume fluctuations from the CMG to the pit doc. That and allowing gradual pay decreases w/o people knowing. And keeping people from complaining about inadequate coverage. And getting people to see pts in the waiting room/ambulance bay.

 

[turkeyjerky]

Envision has had that for a long time now, at least for the 6 years I’ve been an attending.

I think the difference is that now it’s more or less a national strategy rather than shop specific.

 

[GeneralVeers]

It's a scam. They were never transparent with the RVUS and actual data. It's a way for them to slip in gradual pay decreases.

 

[Groove]

If it's partial RVU incentive, that's perfectly fine. Avoid 100% RVU shops like Apollo. It's all fine and dandy when you've got great flow and a full WR but most shops don't have great flow and volume can be sporadic. That makes for very stressful shifts when you are not seeing anybody and not generating any $$$. 100% RVU shops also make for ultra competitive, malignant environments and reward cherry picking. Everyone is trying to steal patients from each other and signing up on 10 patients at once in the WR when you're 5 minutes from starting your shift to "reach quota", etc.. I'll never work for Apollo again if I can help it or any other RVU heavy shop. Talk about wild fluctuations in your paycheck every month.

 

[thegenius]

If it's partial RVU incentive, that's perfectly fine. Avoid 100% RVU shops like Apollo. It's all fine and dandy when you've got great flow and a full WR but most shops don't have great flow and volume can be sporadic. That makes for very stressful shifts when you are not seeing anybody and not generating any $$$. 100% RVU shops also make for ultra competitive, malignant environments and reward cherry picking. Everyone is trying to steal patients from each other and signing up on 10 patients at once in the WR when you're 5 minutes from starting your shift to "reach quota", etc.. I'll never work for Apollo again if I can help it or any other RVU heavy shop. Talk about wild fluctuations in your paycheck every month.

I agree with that sentiment. Under TH we had 100% RVU model and our paychecks varied greatly...and if we had slow days we had to come up with agreements with the other doc who was on to get every other patient.

Now that we dumped TH, we have a hybrid model that is 100% RVU, but 75% of it is protected from RVUs. What this amounts to is a base salary. Any RVU's over it you get credited for. So it's like 3/4 base salary, 1/4 RVU.

I used to think that an all hourly model is the best way to do it, but I've seen time and time again that some docs just won't work hard. It's sad. I think a hybrid model that incentives to see patients, on some level, is the best way to run an ER. 100% RVU leads to practicing terrible medicine, and 100% hourly jobs lead to working with a bunch of lazy docs.

 

[Groove]

I agree with that sentiment. Under TH we had 100% RVU model and our paychecks varied greatly...and if we had slow days we had to come up with agreements with the other doc who was on to get every other patient.

Now that we dumped TH, we have a hybrid model that is 100% RVU, but 85% of it is protected from RVUs. What this amounts to is a base salary. Any RVU's over it you get credited for. So it's like 3/4 base salary, 1/4 RVU.

I used to think that an all hourly model is the best way to do it, but I've seen time and time again that some docs just won't work hard. It's sad. I think a hybrid model that incentives to see patients, on some level, is the best way to run an ER. 100% RVU leads to practicing terrible medicine, and 100% hourly jobs lead to working with a bunch of lazy docs.

Yep, agreed. With fixed hourly, you end up getting pissed off if the other doc is lazy and not seeing anyone while you're getting slammed. With 75/25, you've got enough of a base to stabilize your monthly paycheck and yet rewarding you if you end up seeing more than the other doc. It's funny how TH sites can differ so greatly. In my neck of the woods none of the TH sites do 100% RVU. It's 75/25 with RVU bonus paid out every quarter. I had a similar compensation model with Schumacher. I think most Apollo sites are all 100% RVU though regardless of location. I've never worked for Envision.

 

[Porfirio]

Depends on the shop for RVU. So many factors are out of your control.

RVU is not good for new grads. You are slow, over order, and easy to be bullied by other docs who cherry pick.

 

[thegenius]

Depends on the shop for RVU. So many factors are out of your control.

RVU is not good for new grads. You are slow, over order, and easy to be bullied by other docs who cherry pick.

No better way than throw yourself into the fire pit.

What I've found is I order a few more tests, talk a little less to patients, and my overall care is about the same.
Care is also the same because I'm more experienced.

 

[BoardingDoc]

Now that we dumped TH, we have a hybrid model that is 100% RVU, but 75% of it is protected from RVUs. What this amounts to is a base salary. Any RVU's over it you get credited for. So it's like 3/4 base salary, 1/4 RVU.

Similar to how we operate our gig. We are entirely collections based so there is a constant incentive for everyone to work hard. Cherry picking doesn't generally happen as we're a friendly group and anyone who pulls that sort of thing will have a talking to / ultimately get sacked. When it's really slow, we just alternate who picks up the next pt.

To avoid the crazy paycheck fluctuations you mentioned, we simply calculate out based on our volume, expected minimum patients/hr, collections/patient etc what the likely floor is for a given doc to generate per shift. Your salary is then set at that number * shifts/mo * 12.

Anything you generate over that amount gets paid out as a quarterly bonus. In exceedingly rare cases, you somehow underperform the minimum expectation for a few consecutive quarters and we adjust your base salary down accordingly. That almost never happens.

 

[thegenius]

Similar to how we operate our gig. We are entirely collections based so there is a constant incentive for everyone to work hard. Cherry picking doesn't generally happen as we're a friendly group and anyone who pulls that sort of thing will have a talking to / ultimately get sacked. When it's really slow, we just alternate who picks up the next pt.

To avoid the crazy paycheck fluctuations you mentioned, we simply calculate out based on our volume, expected minimum patients/hr, collections/patient etc what the likely floor is for a given doc to generate per shift. Your salary is then set at that number * shifts/mo * 12.

Anything you generate over that amount gets paid out as a quarterly bonus. In exceedingly rare cases, you somehow underperform the minimum expectation for a few consecutive quarters and we adjust your base salary down accordingly. That almost never happens.

That is exactly how we do ours. What a coincidence. It seems to be the best model of all the suboptimal models out there. It’s like the “least bad” one, so to speak.

 

[Backpack234]

Yep, agreed. With fixed hourly, you end up getting pissed off if the other doc is lazy and not seeing anyone while you're getting slammed. With 75/25, you've got enough of a base to stabilize your monthly paycheck and yet rewarding you if you end up seeing more than the other doc. It's funny how TH sites can differ so greatly. In my neck of the woods none of the TH sites do 100% RVU. It's 75/25 with RVU bonus paid out every quarter. I had a similar compensation model with Schumacher. I think most Apollo sites are all 100% RVU though regardless of location. I've never worked for Envision.

Currently at a shop with 100% base salary. Was nice when it wasn’t busy. Now that it’s busier, having some RVU would be better.

The site I’m looking at is probably closer to 40/60 base to RVU as far as I understand.

I imagine 75/25 is the better model.

 

[GeneralVeers]

Currently at a shop with 100% base salary. Was nice when it wasn’t busy. Now that it’s busier, having some RVU would be better.

The site I’m looking at is probably closer to 40/60 base to RVU as far as I understand.

I imagine 75/25 is the better model.

If you're single coverage, salary isn't a terrible idea and protects you from slow days. Do you work with other lazy docs who don't pick up patients? That's been my experience in multiple-coverage salaried situations.

 

[xaelia]

At some Kaiser sites – 100% salary and no RVU – each patient arriving is assigned the next doc in a round-robin queue sort of thing. In theory, everyone averages out to the same amount of work and cherry-picking is mostly eliminated.

 

[Dr Mantis Toboggan]

At some Kaiser sites – 100% salary and no RVU – each patient arriving is assigned the next doc in a round-robin queue sort of thing. In theory, everyone averages out to the same amount of work and cherry-picking is mostly eliminated.

Plus they’ll drop patients if they abuse the ED too much I heard?

 

[xaelia]

Plus they’ll drop patients if they abuse the ED too much I heard?

Maybe. In Oregon, a certain number of their public health plan patients are assigned to each of the healthcare systems, and those folks (Medicaid, effectively) tend to be the high utilizers.

 

[Dr Mantis Toboggan]

Maybe. In Oregon, a certain number of their public health plan patients are assigned to each of the healthcare systems, and those folks (Medicaid, effectively) tend to be the high utilizers.

Yeah I imagine they can’t toss them very easily.

 

[thegenius]

At some Kaiser sites – 100% salary and no RVU – each patient arriving is assigned the next doc in a round-robin queue sort of thing. In theory, everyone averages out to the same amount of work and cherry-picking is mostly eliminated.

its like this at the Kaiser I work at.
prior to this there were a handful of docs seeing less than 1/2 the normal pt/hr average.

 

[GeneralVeers]

its like this at the Kaiser I work at.
prior to this there were a handful of docs seeing less than 1/2 the normal pt/hr average.

That could be awful though. The last 2 hours or so of my shift I don't want to pick up an abdominal pain, drunk, or the weak/dizzy old person.

 

[xaelia]

That could be awful though. The last 2 hours or so of my shift I don't want to pick up an abdominal pain, drunk, or the weak/dizzy old person.

There was also at least 1.5h at the end of our shift for "tidying up", so there was (sometimes) enough time to get results and scans back – plus a culture of "follow-up CT" for signout etc.

 

[Apollyon]

Maybe. In Oregon, a certain number of their public health plan patients are assigned to each of the healthcare systems, and those folks (Medicaid, effectively) tend to be the high utilizers.

That's what it's like in Hawai'i, too. The private insurers have to take a certain percentage of Medicaid. When one of the MA folks got Kaiser, it was like hitting the jackpot.

 

[thegenius]

That could be awful though. The last 2 hours or so of my shift I don't want to pick up an abdominal pain, drunk, or the weak/dizzy old person.

They have a 2-3 hour lockout. So the shift might be 10 hrs long, but you don't see patients for the last 2.5 hours. And you are paid for that time too.

 

[xaelia]

They have a 2-3 hour lockout. So the shift might be 10 hrs long, but you don't see patients for the last 2.5 hours. And you are paid for that time too.

Yeah. We had a 3pph cap for 6 hours, then 2 patient cap for hour 7, then 2 hours tidy-up. Critically ill patients would break the cap. When I worked there, we were routinely murdered for 6 hours, though – you'd show up and get assigned 3 patients in the first ten minutes, frequently another critically ill patient would show up and need to be seen. Some places, the complexity, clerical, and cognitive load from 3pph isn't bad – it was for us.

It's been nice since COVID hit, though!

 

[GeneralVeers]

They have a 2-3 hour lockout. So the shift might be 10 hrs long, but you don't see patients for the last 2.5 hours. And you are paid for that time too.

Doesn't sound too bad then. If I'm salaried, I'm out the door at the stroke of my end of shift time.

 

[xaelia]

Doesn't sound too bad then. If I'm salaried, I'm out the door at the stroke of my end of shift time.

It was mostly sustainable.

The goal while I was there was to staff to 1.6pph average over 9 hours, but KP works hard to redirect low-complexity patients to primary care/urgent care, so the casemix tended to have a fair bit of complexity and care coordination burden.

I don't know how other KP regions worked things in their Eds specifically.

 

[wareagle726]

Im averaging 70/30 base/RVU. Pretty high acuity shop with a lot of traumas. Usually put someone on the vent every night with multiple procedures(lacs, CTs, fx reductions, etc...). I have a great group of docs to work with and I don't perceive much cherry picking. From what I have seen I would much rather have this than 100% of one or the other. I definitely think I depends on the group mentality though.

 

[EctopicFetus]

Im averaging 70/30 base/RVU. Pretty high acuity shop with a lot of traumas. Usually put someone on the vent every night with multiple procedures(lacs, CTs, fx reductions, etc...). I have a great group of docs to work with and I don't perceive much cherry picking. From what I have seen I would much rather have this than 100% of one or the other. I definitely think I depends on the group mentality though.

Keep in mind envision did this for 2 purposes. To convince docs to work harder and financial engineer a win now and one later. Easier to adjust down the compensation model by 50 cents an rvu than offer a $10/hr cut.

All models have good and bad and much depends on who you work with and culture at your shop.

 

[emergentmd]

It was mostly sustainable.

The goal while I was there was to staff to 1.6pph average over 9 hours, but KP works hard to redirect low-complexity patients to primary care/urgent care, so the casemix tended to have a fair bit of complexity and care coordination burden.

1.6pph sounds like a nice relaxing lifestyle.

RVUs just allows CMGs to make docs feel they have some control over their pay but really it just allows the wizard make changes behind the curtain.

Problem is some form of RVU pay is necessary, otherwise that granny with HA, nausea, I just dont feel well is going to be sitting on the board for a long time and those healthy sore throat lay ups will be snatched up before you can blink.

I remember interviewing in a place that had an "A" and "B" doc chart rack. That would seem like a miserable job working with a slow doc watching their rack pile up while you are sitting surfing the internet.

 

[turkeyjerky]

Keep in mind envision did this for 2 purposes. To convince docs to work harder and financial engineer a win now and one later. Easier to adjust down the compensation model by 50 cents an rvu than offer a $10/hr cut.

All models have good and bad and much depends on who you work with and culture at your shop.

Exactly. I hope it's obvious, but to the residents/students lurking, there are two separate conversations going on in this tread. One is about the best payment model, which most probably believe has some mix of hourly and rvu-based payment. (If the shop is single coverage, then it really doesn't matter, although RVU-based likely leads to higher billing). Depending on the group culture, pure hourly has the potential to lead to coasting and pure RVU-based leads to sniping or cherry-picking.

The second, more important, conversation is about how envision, as well as most other cmgs and hospitals, are in the midst of a global shift in payment from straight hourly to rvu-based formulas. They will typically crouch this as a way to better match pay to productivity and reward hard work, but in reality this is in order to better allow for slow paycuts and shift any risk of volume drops to docs.

 

[VA Hopeful Dr]

Exactly. I hope it's obvious, but to the residents/students lurking, there are two separate conversations going on in this tread. One is about the best payment model, which most probably believe has some mix of hourly and rvu-based payment. (If the shop is single coverage, then it really doesn't matter, although RVU-based likely leads to higher billing). Depending on the group culture, pure hourly has the potential to lead to coasting and pure RVU-based leads to sniping or cherry-picking.

The second, more important, conversation is about how envision, as well as most other cmgs and hospitals, are in the midst of a global shift in payment from straight hourly to rvu-based formulas. They will typically crouch this as a way to better match pay to productivity and reward hard work, but in reality this is in order to better allow for slow paycuts and shift any risk of volume drops to docs.

Not to defend CMGs by any stretch, but isn't this how much of medicine works?

If the surgeon doesn't operate as much, he makes less money. If I as an FP have an empty schedule, I earn less.

 

[turkeyjerky]

Not to defend CMGs by any stretch, but isn't this how much of medicine works?

If the surgeon doesn't operate as much, he makes less money. If I as an FP have an empty schedule, I earn less.

Exactly. There is a qualitative difference between how a SDG and a CMG operate. An SDG will collect a certain amount of money and distribute it amongst the doctors as they see fit. A CMG will collect a certain amount of money, and pay the doctors as little as they can get away with.

A few years ago Envision was paying me 250/hr to sleep in a tiny hospital and see a patient every 3 hours. That money didn't come from my billing, it came from KKR. Now they want their investment returns.

 

[BoardingDoc]

Exactly. There is a qualitative difference between how a SDG and a CMG operate. An SDG will collect a certain amount of money and distribute it amongst the doctors as they see fit. A CMG will collect a certain amount of money, and pay the doctors as little as they can get away with.

A few years ago Envision was paying me 250/hr to sleep in a tiny hospital and see a patient every 3 hours. That money didn't come from my billing, it came from KKR. Now they want their investment returns.

Bingo. As I mentioned above, I'm strictly collections based. We have an artificial "base salary" that we set for everyone but that's just a number that we know that I will easily generate.

At the end of the day, I keep every single penny billed under my name, minus group costs (paying our PA salaries, etc). If it's slow, yeah, I get paid less. Covid sucked really bad when volumes were low as I took a huge paycut.

With envision, TH, USUCKS et al, it's like my model, except they do the math so that they pay me whatever percent of my collections they can get away with while keeping my salary the same (if I'm lucky) and then pocketing the rest. This incentivizes me to work harder as I'm "rvu based" but in reality they can tweak the RVU comp schedule so that my hard work just benefits them.

Long story short, CMGs suck.

 

[Janders]

RVU vs hourly vs collections vs hybrid is important, but minor league.

Show me 100% of the books, let me see every penny that comes in AND the overhead, and let me keep everything in excess of the overhead… thats major league.

(I slant towards the productivity side of the former argument, but you need a strong QA and we-are-family model… bad actors mess it up.)

 

[EctopicFetus]

RVU vs hourly vs collections vs hybrid is important, but minor league.

Show me 100% of the books, let me see every penny that comes in AND the overhead, and let me keep everything in excess of the overhead… thats major league.

(I slant towards the productivity side of the former argument, but you need a strong QA and we-are-family model… bad actors mess it up.)

agreed. open books is key. Regarding kkr losing on someone seeing a patient every 3 hours. No. They just jack up the hospital subsidy. If there is no money to be made they will be out.

 

[Kryptocoin]

I hang up the phone when I get these 100% RVU only offers. It's a phantom feast. Unless the books are open, you don't know what's being billed in your name.

CMGs are like the Littlefinger of medicine. The only way to win, is to beat him at his own game. "Sometimes when I try to understand a person's motive, I assume the worst."

 

[GatorCHOMPions]

Not to defend CMGs by any stretch, but isn't this how much of medicine works?

If the surgeon doesn't operate as much, he makes less money. If I as an FP have an empty schedule, I earn less.

I feel like EM is different in the sense in that we don’t market or advertise to get patients to come in, referrals aren’t based on our unique attributes, and patient flow can easily bottleneck if your hospital support staff is inadequate. I guess the latter can happen in a clinic practice but you can identify the 1 or 2 bad apples and fire them. It’s a lot more multifactorial in an ED or hospital system. You are not in control of your own destiny whatsoever.

 

[Birdstrike]

I feel like EM is different in the sense in that we don’t market or advertise to get patients to come in, referrals aren’t based on our unique attributes, and patient flow can easily bottleneck if your hospital support staff is inadequate. I guess the latter can happen in a clinic practice but you can identify the 1 or 2 bad apples and fire them. It’s a lot more multifactorial in an ED or hospital system. You are not in control of your own destiny whatsoever.

I agree with this 100%. I currently work in an outpatient setting and it's 100% production based and it feels very fair, because I am the main determiner of my volume and production. But in the ED, a system of pay that is 100% production based never felt completely fair. There were too many factors that affected production, that were out of my control. I think there has to be some productivity component in the ED, to incentivise efficiency. But 100% productivity never felt right working in an ED where a large part of the efficiency was out of my control. That's my 2 cents.

 

[EctopicFetus]

I agree with this 100%. I currently work in an outpatient setting and it's 100% production based and it feels very fair, because I am the main determiner of my volume and production. But in the ED, a system of pay that is 100% production based never felt completely fair. There were too many factors that affected production, that were out of my control. I think there has to be some productivity component in the ED, to incentivise efficiency. But 100% productivity never felt right working in an ED where a large part of the efficiency was out of my control. That's my 2 cents.

Curious your thoughts.

lets assume a busy ED 100k visits, a common chart rack and 10 shifts a day, assume everyone works a square (aka equal schedule). Would RVU based pay be fair. (Note numbers are made up)

 

[thegenius]

Curious your thoughts.

lets assume a busy ED 100k visits, a common chart rack and 10 shifts a day, assume everyone works a square (aka equal schedule). Would RVU based pay be fair. (Note numbers are made up)

I would still go for a hybrid system, unless the schedule is created in such a way that there is never a lull week or month.

The problem with 100% RVU in this case is docs won't be clamoring for the real sick patients. While you can get high RVU's from a sick patient that gives critical care, tube, and maybe a line, it's easier to see 2 ankle sprains, cough, and dysuria in that same time. You'll make more, less medicolegal risk, not nearly as time consuming, and patients will ultimately be happier.

100% RVU is fine if everybody plays by the same rules and there is good self-policing. It can be abused extremely quickly though.

EDIT: I find it interesting that some docs are more efficient than others. That can't be penalized. That has to be rewarded. You can't run an ER and not reward efficiency

 

[namethatsmell]

Curious your thoughts.

lets assume a busy ED 100k visits, a common chart rack and 10 shifts a day, assume everyone works a square (aka equal schedule). Would RVU based pay be fair. (Note numbers are made up)

I'd still be very wary of this at any shop unless their nursing and ancillary staff were both plentiful and motivated and historically there's no/minimal boarding. So if the hospital is a unicorn like that...maybe. Otherwise, you can have 100k visits but if there's only 2 nurses or a ton of boarders you'll be spending much of your shift time trying to find a semi-quiet spot in the family/waiting/conference room to actually see a pt and then hunt down a tech/RN to do labs etc than and many patients contibuting to that 100k will elope from the WR by hour 7.

Since I have no control over all of that stuff, why would I want to take the financial risk?

I think ~80% base hourly and ~20% productivity (based on graded productivity within the group, not a cloak and dagger rvu formula) is the way to go. But I also think the base salary hourly rate needs to be adjusted based on the shift type (ie nights>swings>days and weekends>weekdays). So maybe I'm just crazy.

 

[EctopicFetus]

I would still go for a hybrid system, unless the schedule is created in such a way that there is never a lull week or month.

The problem with 100% RVU in this case is docs won't be clamoring for the real sick patients. While you can get high RVU's from a sick patient that gives critical care, tube, and maybe a line, it's easier to see 2 ankle sprains, cough, and dysuria in that same time. You'll make more, less medicolegal risk, not nearly as time consuming, and patients will ultimately be happier.

100% RVU is fine if everybody plays by the same rules and there is good self-policing. It can be abused extremely quickly though.

EDIT: I find it interesting that some docs are more efficient than others. That can't be penalized. That has to be rewarded. You can't run an ER and not reward efficiency

We all run different tests on vague complaints. Some efficiency has to do with your setup. When you have a pod efficiency is discharging someone so the room can turn over. When it is a common rack efficiency might mean something different. what is more efficient for the individual doc might be different.

Re the above that assumes that only $$ matters. If I worked in a UC i would be bored out of my mind. My struggle is either money is ripe for abuse. Re hourly I remember when i was a moonlighting resident. One of the sites I moonlit at had mostly non EM trained people. I showed up day 1 and the setup was 3-12s and as a resident i could only work the mid shift. Anyways the attending tells me literally before I sit down “I just want to let you know that I am really slow”. I was naive at the time. I probably saw 2.5 pts for every 1 she saw. As a resident i felt like i had a lot to prove. Nto so much anymore. In a busy ED you have to reward efficiency. The one flaw I see in my model above is it doesnt reward disposing patients only picking them up. NO reward for discharging questionable patients. A pod system rewards that as well.

 

[EctopicFetus]

I'd still be very wary of this at any shop unless their nursing and ancillary staff were both plentiful and motivated and historically there's no/minimal boarding. So if the hospital is a unicorn like that...maybe. Otherwise, you can have 100k visits but if there's only 2 nurses or a ton of boarders you'll be spending much of your shift time trying to find a semi-quiet spot in the family/waiting/conference room to actually see a pt and then hunt down a tech/RN to do labs etc than and many patients contibuting to that 100k will elope from the WR by hour 7.

Since I have no control over all of that stuff, why would I want to take the financial risk?

I think ~80% base hourly and ~20% productivity (based on graded productivity within the group, not a cloak and dagger rvu formula) is the way to go. But I also think the base salary hourly rate needs to be adjusted based on the shift type (ie nights>swings>days and weekends>weekdays). So maybe I'm just crazy.

If you have open books and assume all the money gets paid out. So whether you get paid hourly or RVU the total paid makes no difference. What is graded productivity?

 

[BoardingDoc]

If you have open books and assume all the money gets paid out. So whether you get paid hourly or RVU the total paid makes no difference. What is graded productivity?

I feel like you and some others here have been having two different conversations. Many of the people who are responding to you (I believe) are looking at this as: what is the best situation when someone else controls the books.

You have been portraying this from the perspective of "we control the books, how do we divide up the money fairly."

 

[namethatsmell]

If you have open books and assume all the money gets paid out. So whether you get paid hourly or RVU the total paid makes no difference. What is graded productivity?

So if you had open books and everybody truly worked the same proportion of the various shifts than yeah it'd probably even out. But those are two very rare ifs. So outside of being a partner in a unicorn group at a unicorn hospital, I'd never go more than ~20% production bonus as it's too easy to get burned due to lack of site control and lack of transparency.

When I say graded productivity I basically mean a simple $/rvu above a set threshold based on historical data from the group. If every member of the groups generates a similar rvu amount than it's just a simple formula. But if you have a wide variety of docs in terms of production, then the threshold target yields no further rvu bonus for the small % of docs at the bottom if they're separated from the mean by a too much of a spread, an average $/rvu bonus for the vast majority of docs in the middle, and then an additional bonus on rvu's above a 2nd threshold for the most productive docs.

 

[namethatsmell]

I feel like you and some others here have been having two different conversations. Many of the people who are responding to you (I believe) are looking at this as: what is the best situation when someone else controls the books.

You have been portraying this from the perspective of "we control the books, how do we divide up the money fairly."

Exactly.

 

[Backpack234]

I’m glad there’s a lot of debate about this. As much as I like my flat rate gig, I’m ok with going to a CMG to get closer to family. If it’s 10-20% worse than the local amazing unicorn SDG, it’s probably 5% worse than my current gig.

I appreciate the responses in this thread. Its helped a lot!

 

[namethatsmell]

I’m glad there’s a lot of debate about this. As much as I like my flat rate gig, I’m ok with going to a CMG to get closer to family. If it’s 10-20% worse than the local amazing unicorn SDG, it’s probably 5% worse than my current gig.

I appreciate the responses in this thread. Its helped a lot!

When in doubt, prioritizing family is always the right answer.

That being said, CMGs have a knack at taking things from bad to worse and can be impressively efficient at crippling a site overnight.

Expect the worst and hope to be pleasantly surprised.

 

[RustedFox]

I’m glad there’s a lot of debate about this. As much as I like my flat rate gig, I’m ok with going to a CMG to get closer to family. If it’s 10-20% worse than the local amazing unicorn SDG, it’s probably 5% worse than my current gig.

I appreciate the responses in this thread. Its helped a lot!

PM me, amigo.
It won't let me PM you.