RVU target in academics?

[Doctorer]

Out of curiosity, what are people's RVU targets for non-80/20 research academic jobs?

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[Neuronix]

I deleted this post. The info was incorrect. The accurate numbers are in the private forum.

Rough ballparks (depends on year)
MGMA median is around 9500
AAMC (FPSC) 50th percentile is around 11000 for 1 FTE (100% clinical)

 

[Pointless]

MGMA average always comes in around 8-9k but that seems low to me for a full private practice. I think a good, reasonable load is somewhere between 10k-11k and thus, at 80%, you should be around 8k. This meshes perfectly with Neuronix's numbers above.

 

[Neuronix]

MGMA median rad onc I have at 9575 for 2019.

 

[Pointless]

Is that for academics or excluding academics?

 

[Neuronix]

Don't know. Seems like MGMA and AGMA all sit between 9k-10k a year. There is some fluctuation from year to year, assume due to low sample size.

But this is all based on stuff I find on the internet like pictures of the books and other websites. If anyone has a copy and can address detailed questions I think we'd all be grateful.

 

[radoncgrad2019]

MGMA reports private practice and academics separately I believe, but haven't looked at the books in a a few years.

 

[seper]

I was a full-time clinical assistant professor at a Midwest university from 2013-17 (fairly busy practice), and my target was 7.5K wRVU.

 

[xrthopeful]

Was 7.5 fifty percent?

 

[seper]

No, MGMA 50% wRVU has always been higher than 7.5K if I recall correctly.

Was 7.5 fifty percent?

 

[ramsesthenice]

IMO, expectations vary between institutions and specific roles. If you are very procedure heavy, your RVU expectations may be lower. If you specialize in a disease site for which you are a high volume center the expectations are probably going to be higher. RVUs aside, it usually translates to carrying 15-25 patients under treatment most of the time. If you are consistently lower than that you will probably get a talkin to by your chairman.

 

[Neuronix]

I was up over 9000 wRVUs last year with 5-10 patients on beam. I'm an SRS/SBRT factory.

Number on beam is just not a good metric for productivity anymore in my opinion.

 

[ramsesthenice]

Out of curiosity, what are people's RVU targets for non-80/20 research academic jobs?

I just got my year end review yesterday. At my institution, the target minimum is 1000 RVUs per 10% clinical effort. That is not hard at all. I am 50/50. Clinically, I average 2 HDR GYN procedures per week and carry an average of 15 patients on beam (20% SBRT, no SRS) and I hit just under 9000 for the year.

 

[Irradi8or]

I'm in a busy PP around ~12-13k wRVU. 2015 MGMA (last one I have) median was 8,445; 75th% was 10,572, and 90th% was 12,228. Would love to see 2019 numbers.

 

[Chartreuse Wombat]

Below are the WRVU numbers associated with my end of year summary. I don't know the years used and I honestly don't know what FPSC stands for. Can someone enlighten me?

Mean Median 25th 75th 95th
MGMA 9010 8324 6694 10911 14476
FPSC 11027 10907 8329 13711 16524

 

[Neuronix]

Great, we all have slightly different numbers

 

[Haybrant]

What does hitting or not hitting the target mean for you situations?

 

[Neuronix]

What does hitting or not hitting the target mean for you situations?

For me, if I'm short of the wRVU target, they will cut my base salary the following year.

If I'm at least 10% over the target, I get a $/wRVU bonus--potentially adjusted downwards if certain other metrics are not met.

 

[ramsesthenice]

What does hitting or not hitting the target mean for you situations?

Depends on how substantial your bonuses are. At some academic centers, they can be upwards of 30+% of your income so modest changes in your incentive-based income can be noticeable. In centers like mine, bonuses make up <10% of my pay (by design and I love it) so it honestly isn't a major deal to me either way. I imagine if I missed it by a lot I would get a talkin' to but its hard to imaging missing them unless your doctor/patient volume ratio is really saturated.

 

[seper]

Salaried RadOncs' pay structure is extremely institution-dependent. I literally don't know any 2 places that are the same.

 

[Chartreuse Wombat]

The joke is that once you have seen one RadOnc department's compensation model you have seen one compensation model. I have worked at three academic institutions in the last >25 years and every department is different. Some made changes while I was on faculty.

I doubt that my example is representative but basically I am guaranteed salary of X. Additional 25% of X bonus if certain benchmarks are met which included metrics of scholarly activity, teaching participation, record charting efficiency, patient satisfaction report and clinical metrics like wRVU. In my case the expectations are very reasonable. I don't rely financially on the bonus for mortgage, etc. If the bonus happens then it means a good vacation, house renovation or paying down the mortgage.

Finally there is precedent/possibility for an additional 5% above the 1.25X which is the Chair's discretion (no metrics).

 

[OTN]

I'm surprised there's an upward bound on bonus due to increasing wRVUs. I would think they would want to continue to promote practice growth.

 

[evilbooyaa]

How common is a capped bonus in academics? To me that makes zero sense but I guess admin gets to live for free if you hit your cap.

 

[Neuronix]

How common is a capped bonus in academics? To me that makes zero sense but I guess admin gets to live for free if you hit your cap.

The problem with unlimited $/RVUs in academics is that people start fighting for patients and not doing any research.

 

[Chartreuse Wombat]

The alternative argument is that if you incentivize only wRVU you begin to have intradepartmental competition which is not good. It has happened at a number of places and is a good way to destroy morale.

The department has a wRVU goal for the entire department; different faculty have different wRVU expectations because of the nature of their practice (%FTE and as importantly the patients treated).

Imagine a brain expert who just does SRS all day every day. They can generate 15K wRVU very easily, even with 60% clinical FTE. Another faculty member has a pediatric practice and although 100% FTE it is very hard to generate 8K wRVU given the differential value according to technique. Still another faculty member may be a physician-scientist with only 20% clinical FTE.

Our department is for the most part a socialist state. The salary distribution is very flat. After 2-3 years everyone makes the same amount +/-10%.

Any excess $$ from wRVU goes to the academic mission with intramural grants, faculty development etc at the discretion of the Chair.

The model includes non wRVU. If you are an dingus then you will get incomplete bonus even if you generate above your wRVU.

The Chair is paid the same as senior members of the faculty (although they generate only 20-25% of the departmental average wRVU).

Our model and level of compensation is very transparent. It may not work for all but it works for us.

 

[Doctorer]

The problem with unlimited $/RVUs in academics is that people start fighting for patients and not doing any research.

Something tells me not all departments care if that happens...

 

[Mandelin Rain]

I would just like to say thank you to anyone providing details on their compensation/pay structure/contract. I think that this is very important and should be done more often and openly. Too long have administrators taken advantage of docs, using a severe information asymmetry while negotiating. I think we should all try to be more transparent with our colleagues so they have an understanding if they are getting ripped off or not, and vice-versa.

 

[thecarbonionangle]

Why do academic departments pay so little compared to pp? Is the simple answer “because they can?” When chairs are making 1 million dollars in some places, theres no room to do right by your docs?

Places like Stanford, UNC cannibalize new grads among many others, sad state of our field.

 

[scarbrtj]

Why do academic departments pay so little compared to pp? Is the simple answer “because they can?” When chairs are making 1 million dollars in some places, theres no room to do right by your docs?

Places like Stanford, UNC cannibalize new grads among many others, sad state of our field.

One (easy) answer is in situations where the pp is freestanding and they're splitting up the global instead of just professional. Someone above mentioned transparency, and I think this is key. It is actually good in a department if everyone knows what everyone is making IMHO.

 

[medgator]

Something tells me not all departments care if that happens...

You know... There is something to be said about the "eat what you kill" model. It isn't as bad as it sounds or always as bad as people make it out to be (in the right situation) and really works well when partners aren't in sync with each other.

There are certain referrings that seem to gravitate to certain docs in the real world/pp. Whether you're seeing technical or not, there is something to be said about making the pie as big as possible than trying to create equality if partners/colleagues are unequal.

Some docs in my practice get fed by med oncs alone and want to work 8-4 with an hour for lunch and some of us generate ENT/pulm/GI/pcp in addition to internal med onc referrals, juggling inpatient consults at lunchtime while the linac isn't treating. Then again PP is a whole different ball game than academics and referral patterns can lead to one partner treating 50% more than the other in some cases. Hard to fit a square peg in a round hole.

Whatever you decide on pursuing, make sure it is transparent before you sign on the dotted line.

 

[OTN]

Why do academic departments pay so little compared to pp? Is the simple answer “because they can?” When chairs are making 1 million dollars in some places, theres no room to do right by your docs?

Places like Stanford, UNC cannibalize new grads among many others, sad state of our field.

Lots of reasons:

1. Salaries for academic jobs are set "by the market" - academic centers compete with one another to hire physicians, and they compete on salary, benefits, protected research time, etc. More job seekers --> more power for the employers rather than the physicians --> lower salaries.

2. Academic jobs are, for the most part, very stable. It's not as if a new urorads center opening up down the road is going to cause the Stanford Department of Radiation Oncology to close, but the same might not be said for a private clinic who relies on prostate for business. Some value that kind of stability and would rather get paid less to enjoy it.

3. In a true private practice, the physician, along with other docs, will own stuff. In the best case, the group will own the linacs, CT scanners, PET scanners, the lab, the pharmacy, the real estate, etc, etc. As a result, the physician group sees both the professional and technical reimbursement. As long as your costs aren't higher than your revenue from all that, you'll be profitable and make money off both components of billing. Docs in academic centers usually do not own anything (edit: though there are exceptions), so don't see any part of the technical reimbursement. Now, of course, academic docs don't have to "buy in" to a practice. When I was on the interview trail I was quoted buy-ins from anywhere from $50k to $2M.

4. Although I have no data to back this up, I would guess private practice docs are busier from an wRVU standpoint than academic docs on average, which would justify at least some of the increased reimbursement. I generated 21,000 wRVUs last year, for example, and my partner wasn't too far behind.

EDIT: In our practice we are somewhat an "eat what you kill" practice, but ~30% of the money gets washed around to try to protect us all from changes in our particular specialty reimbursement, local referring patterns, etc. I think it works well to both encourage us to practice-build while at the same time decreasing substantial inequality between partners.

 

[evilbooyaa]

The problem with unlimited $/RVUs in academics is that people start fighting for patients and not doing any research.

Hmm OK I guess that makes sense. My plan would be to do just enough work to hit my cap without going over and if the department is OK with that then I guess that's OK.

 

[medgator]

Hmm OK I guess that makes sense. My plan would be to do just enough work to hit my cap without going over and if the department is OK with that then I guess that's OK.

So then do you stop seeing patients the rest of the year?

 

[xrthopeful]

Also in an academic job the reality is some of the money you generate is being used to pay for other departments. You’re signing up to work for a hospital.

 

[medgator]

Also in an academic job the reality is some of the money you generate is being used to pay for other departments. You’re signing up to work for a hospital.

Correct. Not only just other departments, other rad oncs treating less lucrative disease sites.

Many don't want to do peds before taken into account the lower reimbursement and higher emotional toll dealing with that patient population and their families and are often fine with some of their salary subsidizing the peds RO

 

[ramsesthenice]

Research costs boatloads of money. Research assistants, coordinators, non-clinical tenured faculty, faculty development, etc. these are huge expenses.

RVUs per physician tend to be lower in academics. 80-100 patients/day would not equal 8-10 FTEs at many private centers.

In academics we do often end up supporting non-profitable departments.

There are lots of reasons. High chairman compensation is probably not a major reason at most centers, just like high physician salary is not why health care is expensive.

 

[OTN]

Not to nitpick, but some private practices also do research: we have research nurses/assistants, etc. We don't have to subsidize large labs/non-clinical docs, but we also don't get grant money which would go towards that.

 

[Mandelin Rain]

Also, you gotta kick some to the dean.

Hospital tax. Dean's tax. Chairman tax. Research/Rad Bio/Physics instructor tax. It adds up.

Ergo the need for satellites generating dollars.

 

[Chartreuse Wombat]

Private practice can get grants. Not many but some do. Two groups come to mind-Dan Petereit in SD and the Wilmington NC group each have grant funding to perform research.

 

[Neuronix]

Private practice can get grants. Not many but some do. Two groups come to mind-Dan Petereit in SD and the Wilmington NC group each have grant funding to perform research.

What mechanism? I can't imagine NIH doing that. I guess I could see industry or foundations doing it in rare circumstances, especially for someone well connected.

 

[medgator]

Not to nitpick, but some private practices also do research: we have research nurses/assistants, etc. We don't have to subsidize large labs/non-clinical docs, but we also don't get grant money which would go towards that.

Haven't some of the largest RTOG enrollers been large pp groups like the one out in Arizona? In addition to the academic centers obviously. I know some of the large med onc groups and those with uson also run clinical trials and we are currently looking into running some industry sponsored clinical trials at our practice

 

[medgator]

What mechanism? I can't imagine NIH doing that. I guess I could see industry or foundations doing it in rare circumstances, especially for someone well connected.

My guess would be industry/pharma

 

[ramsesthenice]

Haven't some of the largest RTOG enrollers been large pp groups like the one out in Arizona? In addition to the academic centers obviously. I know some of the large med onc groups and those with uson also run clinical trials and we are currently looking into running some industry sponsored clinical trials at our practice

Yes. Foundation grants, co-operative groups, and industry approach (investigator-initiated) clinical investigations the same way: who has the patient volume and competence to get them the data they need in the shortest time possible. There are plenty of established private groups that are larger than mid-tier academic programs and do these kinds of studies. In the grand scheme of things, these are relatively cheap. Co-operative trials can cost you money but foundation and industry trials are usually pretty well-funded. It just depends on what they want you to bring to the table.

 

[ramsesthenice]

I think the other thing that deserves mention (again) is that academics are not always as badly paid as it might appear at first blush. The reported data is often base salary. I know where I trained the base was very low (low $200s for assistant professors) but their bonuses were frequently high 5 to low 6 figure. Add on all of the other incentives and you are talking real compensation in the neighborhood of high 300s for 60% clinical effort as assistant professors and low-mid $400s as associates.

I'll be transparent. My base last year was $335. Bonuses totaled $35 (so we are up to $370). Our 401K is stupid high: 2:1 company match up to 15.95% so they end up kicking in the IRS max which is just shy of $33 (now we are a little over $400). I don't count it as real money but I have great health care for my entire family and the hospital pays 100% of the premium. For 50% clinical effort as a relatively new grad (starting year 3) may pay is really not that far off from what I could expect in many PP situations these days. I certainly have a lower ceiling in the long run, but I am not hurting by any stretch.

 

[Chartreuse Wombat]

What mechanism? I can't imagine NIH doing that. I guess I could see industry or foundations doing it in rare circumstances, especially for someone well connected.

Forward Thinking; Daniel Petereit, MD, FASTRO | MED MAGAZINE

Daniel Petereit, MD, a radiation oncologist with Regional Health John T. Vucurevich Cancer Care Institute in Rapid City, is one of those people who gets an idea and runs with it.

www.midwestmedicaledition.com

 

[evilbooyaa]

I think the other thing that deserves mention (again) is that academics are not always as badly paid as it might appear at first blush. The reported data is often base salary. I know where I trained the base was very low (low $200s for assistant professors) but their bonuses were frequently high 5 to low 6 figure. Add on all of the other incentives and you are talking real compensation in the neighborhood of high 300s for 60% clinical effort as assistant professors and low-mid $400s as associates.

I'll be transparent. My base last year was $335. Bonuses totaled $35 (so we are up to $370). Our 401K is stupid high: 2:1 company match up to 15.95% so they end up kicking in the IRS max which is just shy of $33 (now we are a little over $400). I don't count it as real money but I have great health care for my entire family and the hospital pays 100% of the premium. For 50% clinical effort as a relatively new grad (starting year 3) may pay is really not that far off from what I could expect in many PP situations these days. I certainly have a lower ceiling in the long run, but I am not hurting by any stretch.

That's a really good base salary especially for 50% clinical at 3 years out based on what I've heard anecdotally. I've heard of multiple base salaries lower than that (ignoring the bonus, 401k, and benefits) for 80% (or 100%) clinical, especially for a new grad.

 

[medgator]

That's a really good base salary especially for 50% clinical at 3 years out based on what I've heard anecdotally. I've heard of multiple base salaries lower than that (ignoring the bonus, 401k, and benefits) for 80% (or 100%) clinical, especially for a new grad.

Agree. Very nice considering clinical workload

 

[evilbooyaa]

So then do you stop seeing patients the rest of the year?

Ideally I'd look at my monthly RVU output and adjust how willing I was to fill up my schedule to the brim in regards to hitting my cap bonus. What's the incentive to work hard and see and treat a ton of patients if the bonus is capped? Somebody else in the department (or outside the department) can see them.

 

[ramsesthenice]

That's a really good base salary especially for 50% clinical at 3 years out based on what I've heard anecdotally. I've heard of multiple base salaries lower than that (ignoring the bonus, 401k, and benefits) for 80% (or 100%) clinical, especially for a new grad.

It’s on the high end but it’s deceptively high. There are probably plenty of people with bases closer to 250 that essentially close the gap with more generous bonuses.

Our larger system has very sticky fingers. Our chair tries to put as much into base to make sure our guaranteed pay is competitive.

 

[gmsquid]

I mean at least for me, it’s enjoying that I treat head and neck and would exceed my cap if possible. (Ours is group driven) Pound for pound at least tied for the most work (gyn and busy peds places). Part of the drive for some people in academics is just that, enjoying the service and treating as much as you can.

Ideally I'd look at my monthly RVU output and adjust how willing I was to fill up my schedule to the brim in regards to hitting my cap bonus. What's the incentive to work hard and see and treat a ton of patients if the bonus is capped? Somebody else in the department (or outside the department) can see them.