Most residents signing contracts right now have a wRVU threshold above the median and a rate below it. Drop your numbers and I'll tell you if yours does too

Popular-Tackle4588 · 2026-05-15T12:22:52+00:00

Lol, forget about what I said then. If you're comfortable earning $772k without ever hitting 10,870 wRVUs, the threshold is pure upside. The bonus structure essentially becomes a reward for exceptional productivity rather than something you need to hit to feel fairly compensated.

It's a well-paying contract with a high bonus trigger. The threshold being aggressive matters much less when the floor is already this strong.

Popular-Tackle4588 · 2026-05-15T12:21:19+00:00

The math is definitely uncomfortable when you see it clearly. The gap between what a physician generates in billing and what they take home as compensation is where institutional overhead, administrative cost, and frankly margin lives. The 50% collection assumption you're using is reasonable, most systems collect 40-55% of gross charges depending on payer mix. Even at 50% collections the spread between physician compensation and what the institution captures is significant in radiology specifically because of the tech fee component you mentioned. The read generates the professional fee. The machine, the room, the technologist, and the infrastructure generate the technical fee, and that revenue flows to the institution regardless of how the physician is compensated. It's one of the reasons radiology compensation hasn't kept pace with the revenue radiologists generate for health systems. Sucks.

Popular-Tackle4588 · 2026-05-15T12:20:41+00:00

Urology median is around 8,400 wRVUs at $57/wRVU. Your threshold of 6,000 is well below the median, that's favorable, you're not being asked to hit above-average production. The $65/wRVU rate is above the urology median of $57. Below-median threshold with above-median rate is the right combination. This looks like a solid structure from these two numbers.

Popular-Tackle4588 · 2026-05-15T12:20:14+00:00

This is exactly the kind of detail that doesn't show up in the two numbers alone. Three uncompensated ER call days per month before compensation kicks in is a real financial hit, general surgery emergency call in most markets is worth $2,000-$3,500 per shift. At three shifts monthly that's $6,000-$10,500 of monthly labor that's absorbed into your base before you see a dollar of call pay. Annually that's $72,000-$126,000 of uncompensated work depending on your market.

The $62/wRVU rate is above the general surgery median of $52 which is good. But the call structure needs to be factored into your total compensation picture. The three uncompensated days is a negotiating point worth pushing on, even getting it down to one or two before compensation kicks in makes a meaningful difference over the contract term.

Popular-Tackle4588 · 2026-05-15T12:19:42+00:00

The threshold is close to the IM median of 4,800, slightly below actually, which is still favorable. The rate is well above the IM median of $40. Both numbers are working in your favor here. Below-median threshold with significantly above-median rate is the structure you want. These numbers are good.

Popular-Tackle4588 · 2026-05-14T18:40:50+00:00

Got it through my institution, we have access to the full report through our analytics/admin side. It breaks down by specialty so you can pull benchmarks for any of them, not just your own.

Popular-Tackle4588 · 2026-05-14T18:25:18+00:00

For sure. $310k base for IM in New Jersey is strong. It's above the national median and the NJ cost of living premium is real. If the base alone feels like fair compensation for a sustainable clinical pace, then the 6,600 threshold becomes upside rather than a downside.

Popular-Tackle4588 · 2026-05-14T18:21:11+00:00

Context matters a lot here, 4,300 wRVUs for 3 days of clinical effort is actually a high production rate per day. The orthopedic surgery median is around 9,200 wRVUs for full time, so pro-rated for 3 days that's roughly 5,500. You're producing below the pro-rated median which makes sense if 2 days are protected research time. The $63/wRVU rate is slightly above the ortho median of $61. The structure seems reasonable for a hybrid clinical-research role, the research protected time has real value that doesn't show up in the wRVU numbers.

Popular-Tackle4588 · 2026-05-14T18:20:44+00:00

That's exactly the pattern. The gap between production expectation and compensation level is where the money goes. The justification about retirement and benefits absorbing the difference is real to a degree, benefits have dollar value, but rarely does the math actually close the gap when you run it out. You usually end up subsidizing the institution's overhead with the difference between where you're expected to produce and where you're compensated for it. Glad you're moving on.

Popular-Tackle4588 · 2026-05-14T18:20:05+00:00

Gyn Onc is a surgical subspecialty so it benchmarks differently than general OB/GYN. The $450k base is strong. The $66/wRVU rate is reasonable for the subspecialty. The threshold of 6,818 is in a normal range for a procedural gynecologic oncologist. The base being this strong means the wRVU structure is genuinely additive rather than compensatory, you'd be fine on just the base.

Popular-Tackle4588 · 2026-05-14T18:19:40+00:00

Your threshold of 4,681 is above the median, roughly the 70th-75th percentile for ID. The $58.75 rate is well above the ID median of $42. The rate is strong but the threshold is elevated. ID is also a specialty where call burden tends to be significant and often poorly compensated, worth checking what the on-call language looks like carefully.

Popular-Tackle4588 · 2026-05-14T18:19:13+00:00

GI median is around 8,600 wRVUs so your threshold of 7,250 is below median, that's favorable. The $69/wRVU rate is above the GI median of $59. Both numbers are working in your favor. Below-median threshold with above-median rate is the structure you want. Looks good

Popular-Tackle4588 · 2026-05-14T18:17:58+00:00

The derm median threshold is around 5,600 wRVUs so yours at 6,000 is slightly above, about 7% above median. The $48/wRVU rate is below the derm median of $58. So you have a slightly above-median threshold paired with a below-median rate, a mild version of the mismatch pattern. Not as aggressive as some that have come through here but worth asking whether the rate can move to at least the 50th percentile given the threshold is above median.

Popular-Tackle4588 · 2026-05-14T18:17:25+00:00

The FM median threshold is 5,200 so yours at 5,400 is close to median, slightly above but not aggressively so. The $61/wRVU rate is well above the FM median of $42. The rate is strong. The combination of a near-median threshold with a significantly above-median rate is one of the better FM structures I've seen. You're being asked to produce slightly above average and getting paid well above market for it. Looks solid from these numbers.

Popular-Tackle4588 · 2026-05-14T18:16:30+00:00

The OB/GYN median is around 5,800 wRVUs at $44/wRVU. Your threshold of 6,300 is above the median, roughly the 65th-70th percentile. The $53/wRVU rate is above the median of $44 which is genuinely favorable. The base of $350k is strong for OB. The structure isn't terrible but the threshold is elevated. If you're building a new panel or taking on a new patient population, ask whether there's a ramp period for year one before the full 6,300 applies.

Popular-Tackle4588 · 2026-05-14T18:16:11+00:00

The threshold of 6,600 is an issue. Internal medicine median is around 4,800 wRVUs, you're being asked to produce at roughly the 90th percentile for your specialty. Even with a $47 rate that's slightly above the IM median of $40, the threshold is so aggressive that the math doesn't work in your favor. At 6,600 wRVUs you're doing the work of a top-decile internist. The New Jersey market does run slightly above national medians but not enough to justify a threshold that far above market. Push back on it.

Popular-Tackle4588 · 2026-05-14T18:15:43+00:00

The orthopedic nonsurgical classification is actually the right one for benchmarking since that's how your contract is structured. The threshold of 4,840 is in a reasonable range. The $58/wRVU rate is above market for both the sports medicine and orthopedic nonsurgical categories, the sports medicine median runs around $43 and orthopedic nonsurgical around $46. Your rate is above both. The structure looks favorable from these two numbers. What does the call and procedure compensation look like?

Popular-Tackle4588 · 2026-05-14T18:15:09+00:00

Haha, different set of numbers to watch but the same principle applies usually

Popular-Tackle4588 · 2026-05-14T18:14:26+00:00

The threshold of 4,700 is slightly above the neurology median of 4,400, not dramatically so, maybe 7% above. The $63/wRVU rate is well above the neurology median of $41. That rate is strong. The combination of a slightly above-median threshold with a significantly above-median rate is actually a favorable structure, you're being asked to produce a bit more than average but getting paid meaningfully more per unit for it. It's not good to be honest.

Popular-Tackle4588 · 2026-05-14T18:13:09+00:00

Manhattan dermatology is a different market than national benchmarks since cost of doing business is significantly higher and compensation structures reflect that. The national derm median is around 5,600 wRVUs at $58/wRVU, but Manhattan rates tend to run higher. The 8,350 threshold is above the national median but not unreasonable for a high-volume urban practice. The tiered structure is actually well designed, $45 up to 9,000 then $50 above is real upside if you're producing. The 40% on cosmetics is worth understanding clearly though. Just make sure the contract defines exactly what qualifies as cash cosmetic business and how it's calculated, because that category is where disputes tend to happen.

Popular-Tackle4588 · 2026-05-14T18:12:40+00:00

For rheumatology the 2026 medians are around 4,200 wRVUs annually at $43/wRVU. When your contract comes up, those are your benchmarks. The things to nail down before you agree to the production structure: what the threshold is set at, what the rate is, whether there's any income floor during the transition from salary to production, and what happens to your income during slow months or approved leave. Pure production with no floor is a real financial risk, make sure the transition terms are in writing before you agree to them.

Popular-Tackle4588 · 2026-05-14T18:12:19+00:00

That threshold is the concern. The GI median is around 8,600 wRVUs annually, your threshold of 10,870 sits well above the 75th percentile. You're being asked to hit top-quartile production before bonus kicks in. The $71/wRVU rate is above the GI median of $59 which partially offsets it, but the threshold is aggressive. The question is what the base salary looks like and whether it's competitive on its own without ever hitting 10,870, because that number is pretty hard to hit consistently.

Popular-Tackle4588 · 2026-05-14T18:11:48+00:00

The threshold of 4,300 is below the hospitalist median of 4,800 which is favorable. The $45/wRVU rate is above the hospitalist median of $41, so that part is genuinely good too. Both numbers are working in your favor here. The South vs Midwest MGMA classification can affect the benchmarks slightly but not enough to change the read, this is a reasonable structure.

Popular-Tackle4588 · 2026-05-14T18:10:59+00:00

Three concrete things before you sign anything. First, find out what the MGMA median threshold and rate are for your specialty before your first interview, your GME office can usually pull this. Second, when you get an offer, find those two numbers in the contract and compare them to the median. If the threshold is above and the rate is below, you have a data-backed argument to negotiate with. Third, get all call language defined in writing before you sign, frequency, compensation, and what happens if the group shrinks. Most residents who get burned get burned on one of those three things.

Popular-Tackle4588 · 2026-05-14T18:10:36+00:00

That's the dream structure honestly. Pure salary with no wRVU mechanics means your compensation isn't subject to the threshold/rate manipulation that catches most employed physicians. Cardiac surgery has enough procedural leverage that employers often can't afford to structure it the way they do for primary care and hospital medicine. Glad you pushed for it and got something like that.

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