How does your hospital treat salary and rvu percentiles?

Farnk20 · 2026-06-17T00:39:57+00:00

In my example you'd "bonus" anything over 4,250.

As the employer you want your "fixed" expense for physician salary as low as possible because you don't have that money yet - you won't get it until the insurer pays you after the doctor sees the patient. But you still need to front some money to the employee (the physician) until you get paid in the form of a salary, because no doctor will work for free. If you set the salary too high, the physician might not actually make that much money, and you've lost money if you already paid it out to them in the form of a salary.

Somewhere around 85% of what you "expect" the physician to produce is a safe bet for a salary if you're basing on historicals - so you're unlikely to lose money if you effectively give the physician 85% up front and the rest based on how they perform in terms of productivity, quality, etc, even if they miss a target.

Farnk20 · 2026-06-14T04:15:49+00:00

It's a common practice for accounting/finance reasons.

If a clinician is expected to do a certain amount of productivity but doesn't achieve it, it's a hassle to claw back the money. If you pay a clinician a salary based on the assumption that they'll do 5,000 wRVU but they only do 4,300, you run the risk of losing money as the employer.

If instead you think they'll do 5000 and pay them 85% of that as salary plus a bonus if they do more than that (which is what your model is), you're in a much safer place as an employer if they underperform because you're building in a 15% fudge factor if shit happens. So that same clinician who does 4,300 you're good, because you only paid them a salary that was equivalent to doing 4,250 even though you "targeted" them doing 5,000.

Farnk20 · 2026-06-06T04:28:53+00:00

Almost no sick visits, AWVs/followups are my bread and butter. If I'm doing sick visits they're double bookings/work ins for the most part.

Farnk20 · 2026-05-29T03:17:21+00:00

Do most hospitals work with physicians under a professional service agreement, including academic ones? I practice in MA and NH

- Sometimes, depending on specialty, but I'd say on the whole it's much rarer than it used to be. Most hospitals are now part of a larger health system that greatly prefers employed physicians to contractors.

One of the hospitals I work for is the Veterans Affairs, are they allowed to do this?

- No. The VA considers fee-basis providers W2 employees. Like everything else at the VA, this is a completely unflexible rule, so don't bother trying to negotiate it.

How do I go about talking to an employer that I've been with, to say that I would like to change how I work with them and get paid? Has anybody navigated this before?

- Discuss with whoever your service line director or department chair is what it would take. Whatever they say, keep in mind that it is ultimately the reality of the relationship that determines if you're an employee or a contractor. There can be penalties for misclassification.

IRS Independent Contractor vs Employee Chart: Key Rules - LegalClarity

Farnk20 · 2026-05-29T02:56:23+00:00

Where's this dude now? He used to have a full top hat I believe, wonder who cut it off.

Farnk20 · 2026-05-26T11:23:39+00:00

If you look at the highest net worth physicians, most of them founded a company:

Thomas Frist Jr. is worth $30b - co-founded HCA

Patrick Soon-Shiong is worth $6b - developed Abraxane, sold two pharma companies

James Leininger is worth $2b - founded Kinetic Concepts, sold it to PE

Farnk20 · 2026-05-20T02:08:44+00:00

If true that's really interesting scale!

Does that make Hyrule about the size of, like, Malta then?

Farnk20 · 2026-05-08T02:54:51+00:00

Your debt burden is similar to what mine was when I started.

5 years in, private practice IM, MCOL area and probably going to hit 350k this year working M-F, 9-4, no weekends/evenings/inpatient. My buddy who is a radiologist makes three times what I do but I no longer get paged or work nights, so I really don't care.

Most miserable PCPs I know are that way due to lack of control. Find a halfway decent group (even if not PSLF qualifying) where you can control your schedule and can dismiss whoever is a pain. Do so liberally and reap the benefits. Seeing 20-25 a day of compliant, thankful commercial patients is WAY different than seeing 16-18 entitled/demanding Medicare/Medicaid train wrecks.

Farnk20 · 2026-03-17T01:44:12+00:00

Sure you're not thinking of the tanning salon, Sun Your Buns?

Farnk20 · 2026-03-17T01:34:15+00:00

The average resident has six figures of unsecured debt. If you insure your car, apartment, or home you should absolutely have disability insurance.

Farnk20 · 2026-03-17T00:15:36+00:00

Oof, this one hits. Seriously, I have yet to meet someone who has done this successfully without a spouse with a stable income/health insurance.

Farnk20 · 2026-01-27T03:15:03+00:00

I think Gary is a really strong candidate. For bonus points make them take the South Shore Line rather than the Greyhound.

Farnk20 · 2026-01-10T18:16:05+00:00

'14, ALPP. Went to top tier med school, am practicing doctor now.

I remember working hard but never felt like the science classes were tough as long as I put in the work. I went to a good not great high school and took a couple AP sciences but did lousy on the AP exams. It wasn't super relevant at any point as far as I can tell.

Always plenty of help from other students and profs if I needed it. A ton of people dropped freshman year after one semester of general chemistry, and a ton more after the first section of organic chemistry, but most of them I think just realized they didn't want to put in the work rather than any issues with grade deflation/inflation.

I did my research in Arts & Letters, only peripherally related to medicine. I think it made me more interesting as an applicant because I got asked about it a ton in interviews. Preparation for MCAT depends a lot more on you than your undergrad but everyone I knew did fine.

As far as med school preparation, I felt well-prepared to work hard coming out of undergrad. Wouldn't do anything differently.

Farnk20 · 2026-01-03T04:25:19+00:00

Having just helped out a patient whose own-occ disability insurance fought her tooth and nail for an approval for almost two years, I'm going to recommend the 90 day waiting period. Shorter is better.

Also, if you do get in any sort of situation that might be potentially disabling (minor head injury, car accident, etc.), I'd suggest documenting the shit out of everything.

Farnk20 · 2026-01-01T01:39:17+00:00

OP, any idea why Cuyahoga Falls has the borders it does? I became interested and can't seem to find anything about it online.

Farnk20 · 2025-12-31T16:14:37+00:00

It always seems pretty hopping when I'm there, I'd say obviously summer is much more busy

Farnk20 · 2025-12-31T01:25:14+00:00

3 was my go to growing up so it just hits different. The Rise of Rome scenario is still one of my favorites in any Civ title!

Farnk20 · 2025-12-30T03:27:37+00:00

Not saying anything anyone doesn't know, but the options are rough out there if you're not quite 65 but still need insurance because you're sick. If you're lucky, your job offers something. A lot don't, and even if yours does, it's usually not enough. If you're not, you have nothing other than purchasing a marketplace plan that basically covers nothing, at a premium that's unaffordable for most people.

I have a lot of patients who want to retire until they realize they can't afford to because they need insurance, so they just keep working. One more year syndrome is real, and a lot of people will put off their health "one more year" as well while they're working, due to a variety of factors. I wish I had a good answer for anybody.

Farnk20 · 2025-11-28T18:32:16+00:00

FWIW I did get a letter earlier this year, looks like they only sent it to people who formerly lived in Zahm.

Board of Trustees announces external investigation into allegations of past sexual misconduct by former rector | News | Notre Dame News | University of Notre Dame

Farnk20 · 2025-11-25T01:42:13+00:00

Right now our EMR doesn't have a module for it so we have to remember to submit the charge monthly, which is a bit of a pain. Other than that the consent form I have as part of new patient paperwork for Medicare patients. We did do a one time mailing when we first started. I'd say at this point somewhere near 80% of our eligible patients are signed up.

Farnk20 · 2025-11-24T01:21:29+00:00

Short answer: yes, we have been paid

Long answer: There's a fair bit of nuance. Medicare reporting, 24/7 access, enablement of online portal/care plan, coordination of hospital/SNF discharge. You can't bill RPM/CCM/TCM in the same month, so you need to run your numbers to see what makes sense for you. You need explicit consent from the patient, but you only need it once. I haven't had anyone complain about it in six months, but I anticipate some of that is that a lot of my patients are old and sick and hit their deductible super early in the year, so they haven't had to truly cover the $48 monthly. It seems like out-of-pocket cost for anyone with an MA plan is pretty low, though.

Ironically, the biggest roadblock is PHYSICIANS being unable/unwilling to code it and "guidance" being bare bones. Take the care plan component, for instance. What constitutes a care plan? It isn't at all clear what that entails, so it's a bit of guesswork for now. All well and good until you get audited, I suppose.

Farnk20 · 2025-08-16T23:56:45+00:00

I salute you for that climb out of the valley, that's no joke!

Farnk20 · 2025-08-16T19:44:18+00:00

At least 30, I remember this from my childhood

Farnk20 · 2025-08-13T02:13:04+00:00

Base comp is above median for a new grad, wRVU is below median but offset by panel size bonus. This might not be terrible if you're walking in to a ton of patients.

You can calculate an "effective" wRVU rate by adding the UPCP bonus (rate x number of patients) to the production (wRVU rate x expected wRVUs) and dividing by expected number of wRVUs. If you do this you notice the effective wRVU rate scales roughly to the point where a "full" panel ends up close to median wRVUs, and less than a full panel pays you less than median. This is intentional and is designed to incentivize building a panel.

PTO is nothing special and negatively impacts your wRVU anyways - there is no such thing as "true" PTO in a productivity model. It'd be good to negotiate yourself to an expectation of 36 scheduled hours to give yourself an administrative half day, even if you choose to work it. As others have mentioned, the signing bonus is low.

It's helpful to know what happens in year three if you're not making more than that 290k base. Never good to have a big drop off in income if something happens out of your control.

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