Results; separated by paragraphs for different institutes. Some redacted due to personal statements. Interesting differences.
USA Acaedemic:
The Interventional and Neuroradiologists make a little more base salary. How much more I’m not sure.
We have a bonus plan but its around 5% or less of our overall salary. The bonus system is pretty fair in my opinion.
Paid out twice a year.
70% Clinical productivity. This is 50% RVUs and 50% total cases read. The second part helps MSK and Chest as we read a lot of radiographs.
20% Admin/Education You get points for presentations/ abstracts/ papers, Journal Reviewer, Moderating etc Then there is an admin component. So many points for doing the section schedule, being a Fellowship Director, being on Department/Regional /National Committees, etc. There’s also points for the residents evaluation of you.
10% Chair Discretion.
There are heavy penalties to the Bonus if you have not peer reviewed 60 cases in the past six months.
Overall I think its fair and everyone seems pretty happy with it. In particular counting total cases bring up MSK and Chest.
Based on clinical days worked per year we have to reach AAARAD RVU median to start to receive a bonus. The bonus is then staggered according to productivity over this at a lower and a higher tier. Some sections pool their RVUs and share their bonuses equally according to the number of clinical days worked. Other sections calculate their bonuses on an individual basis and some use a hybrid model. Bonuses are of the order of 10-30% of total salary. We have tried to introduce bonuses based on education and publication in the past, but have found this more difficult to sustain. The IR section have a higher base salary than the other sections. Bonuses are consequently several times higher for the neuro who only do cross sectional and no procedures and body section who do mainly cross sectional and few procedures.
My current full time job, they use 50 percent academic RVUs (35 RVUs) which is difficult to reach during regular work day. This is equivalent about 240 plain films… who can read this number in 8 hours and do a good job
The big problem is that the value of the radiographs is underestimated. That should change or there will be no readers….
Although our department has not addressed them, our division has addressed these discrepancies.. We have separate RVU thresholds based on people that read only radiographs(lower for XR only) versus cross-sectional imaging determined by the department. We have some people in the division that read only radiographs while others that interpret radiographs and cross-sectional imaging (no modification for this). Everyone in the department has an RVU threshold, which generates an RVU based bonus. However, the threshold is not modified if the cross-sectional radiologist interprets, radiographs or performs procedures. We tend to take the pool of bonus that everyone gets and divide it evenly among ourselves. Many of the higher rvu generating modalities need the lower rvu exams as a complement and they are both necessary.
I think this does impact the trainee experience and sub specialty selection. It’s a major difference from neuro radiologists who choose to no longer read spine or skull X-rays at least at our institution.
Are RVU expectations provided to each radiologist: Yes
(Example – my expectation based on clinical FTE, factoring in admin time is ~6500). Reality is though that there is no real penalty for not meeting the expectation
How are discrepancies handled among the sections:
Each section was asked more than two years ago to provide a volume, not RVU, work standard for each day (most but not all provided this to the chair – detailed below)
Background:
The institution pushed for much of the decision on staffing based on the AAMC median RVU of ~10,000
However, the department’s staffing is based more on a staffing model than a productivity model. That is, there is an understanding that some sections (like pediatric radiology) need to be covered but will ultimately not cover their salaries based purely on RVUs.
Up until 3 years ago, we were provided data across the department on RVU numbers, which was compared by specialty rather than DR or IR. But no longer, and I think almost everyone in our department understands the system is skewed towards CT and MRI.
Do we use a lower threshold or multiplying factor to try to even out the work and bonuses across the department?
Yes – differing volume equivalents across the department
I have to really credit my colleagues in the MSK section for buying in to the concept of a 120 minimum radiographic equivalent workday. That is on each full clinical workday, individuals must read 120 radiographs or the equivalents – we do not use RVU but rather:
1 CT = 4 radiographs
1 MRI = 4 radiographs
1 US = 2 radiographs
1 CT/US guided biopsy = 20 radiographs
Other sections have their own internal standards (for example abdominal imaging uses 65 US = 1 full workday)
As far as bonuses, in some years we have received nothing and others standard across the department (everyone at 100% getting the same). No benefit for productivity – really no one has made a big deal about it (there are 3 people in the department who have been consistently at >90th percentile in productivity for years – they are largely the lone ones hurt by this).
At X we only use wRVU for a small bonus. The main thing we track is the percentile of each section from the SCARD AAARAD annual survey
Personally, I think the academic model is outdated and is in need of modernization.
As reimbursements continue to decline, research funding becomes harder to obtain, volumes increase and overhead and inefficiency increases (with ongoing consolidations), something has to give.
We use AARAD median for msk (40-42 RVUs last year) as an expectation per day per faculty member. Works out to about 30xc and 50 PF I’d say.
I will add that we always exceed that, but that’s the minimum expectation and why we are looking for another FTE!
The plain films are ever-increasing. We tend to meet 50th %ile AARAD and started leaving films on the list as these were unsustainable. Administration was forced to hire more folks.
RVUs account for 50% of bonus and 50% is for quality/safety.
Quality/safety is based on dictating more than 90% reports with KL grade in knee template. Other divisions have their markers as well.
Divisional RVUs are as imp. as personal RVUs for bonus- divided ½ way among two components.
We removed findings section and only dictate impressions. Only dictate the abnormal findings in impression- no normal stuff. The technique/indication, etc. is auto populated. I can read 40-50 films an hour if done that way. Most of our folks can do 30 films an hour.
USA Private:
Our work assignments are calculated by RVU…though there is a concerted effort to obfuscate reality.
We are now in a situation where we are getting more and more tools, without RVU / CPT codes to go along with them….so our work is increasing, but it’s not reflected in the RVU, so it’s not accompanied by adjustment of the daily assignment.
Although your bonus hinges on it, we actually never get a bonus….so we only get more and more work—and it’s barely compatible with life.
I just learned we have gotten that "Zero TE" MRI….the thing that generates the CT-like images with MRI…..a super fun toy in academics.
As I see it, twice the time to interpret, not reflected by RVU.
Also starting to get the DEXA trabecular bone analysis.
And…with rapid advances in MRI throughput, with our Zillion imaging centers, that disproportionately affects the MSK division—which shoulders the burden of the XRs almost exclusively in our practice.
Private practice, large. Everyone paid the same regardless of RVU production for a days work. we work on an in-house developed FTE system where we define what a full days work is equal to on a time basis (45 MRI=200 plain films=55 CTs ….or something close to that) and so as you read a variety of cases and do procedures your FTE is calculated real time. We ask that people hit a minimum 1.0 FTE for a 9 hour shift, but most of us read substantially more than a 1.0 FTE during that 9 hour shift. We recognize that some work best at a slower rate and some work best at a faster rate. Work more days you get paid more but you get paid the same for the days you work.
In short, we don’t use a RVU system in my practice.
My group is probably an outlier these days. We are a private practice (about 20 rads) in a large tertiary hospital for our system. We spend approximately 60% time on MSK and split total income after paying associate MDs (who work on high hourly rates) and billing office expenses.
The model has problems to be sure, but declining quality (as we see coming daily from elsewhere) is not one of them. It’s been sad to see the quality trend in reports that accompany outside exams.
We keep hearing of RVU based pay as a road to a toxic work place, so we are trying to be patient with the inequities of our model.
In our private practice MSK fellowship-trained radiologist only read cross-sectional studies. Plain films are all read by general radiologists who are used to reading higher volumes.
Teleradiology:
I’m a telerad, but considered part of the MSK section and read 100% MSK. Our regular and telerads have a similar contract that includes a base pay depending on years of experience. Once you hit 3 yrs you are at full base pay. Each section has a specific rvu target that depends on the makeup of studies so as an MSK rad, my target rvu is less than body and neuro (my goal is around 47 rvu/shift and body is in 70s).
For bonuses there is a point system where you get points for academic work, committees, lectures etc. The nice part is that there are also points depending on the percentage of your rvus that come from XR. So since we are heavily XR based we get our full bonus based off that alone. This also encourages other sections to help with CXR especially.
Kaiser:
I am not sure if the rules at my Kaiser institution is applicable to an academic center such as UCSD, where you are expected to spend much of your time teaching. Kaiser is essentially a private practice but now expects its doctors to teach residents and medical students.
At our Kaiser institution, we are expected to work 2 units/day 5 days per week if you are full time. One unit is 4 hours. We get audited a few times per year to see our productivity.
17.5 plain films= 1 hour
7 US= 1 hour
4 CT=1 hour ( however Ct of neck, chest, and/pelvis often seen in a cancer staging/restaging CT or trauma is only counted as 1 CT)
3.5 MRI= 1 hour
We are paid a base salary regardless. Workload for calls often exceeds 3 units/8 hour shift. No extra pay for exceeding the 2 units of work in an 8 hour shift.
It is difficult to teach and be held accountable for a targeted RVU because teaching takes a lot of time. When I have to teach the Kaiser family residents or medical students, I have to stay late to finish the 2 units worth of studies.
I think there is much burn out if an institution is acting as both an academic center and a private practice.
Non-USA:
We have a very strict ‘socialist’ approach to this problem:
EVERYONE, (I mean everyone more than 4-years on staff), earns the identical per diem rate regardless of: a) what they do – Clinical, Research, Teaching, Admin etc., b) whether you work in the hospital or private clinic, c) whether you are neuro, body, MSK, peds or intervention etc. or d) whether you have a University salary or not. That includes the University Chair of Dept, The Hospital Chief of Imaging Services, The Managing Partner of the business and any elected or appointed physician within our group. All partners are either radiologists or nuclear medicine physicians. If you have an external source of professional income e.g. a university salary, or hospital administration salary, those incomes (AND all your benefits) are subtracted from your ‘partnership income’.
There is an introductory period of 4 years as you scale up to 100%.
So within the group we have no fights or issues over income or benefits.
However there are continuous battles over ‘clinical productivity’ and protected time for non-clinical duties i.e. how much time you get for research, teaching or admin.
In future, things will change a little as we are going through our own very detailed RVU process internally that is independent of revenue, and is entirely dependent on ‘workload’.
On Tue, Dec 6, 2022 at 4:46 PM Hughes, Tudor <thughes> wrote:
Should you choose to reply to this email, please do so just to me and I will collate the answers and share with all.
I appreciate the questions may be principally USA based, but if a similar situation arises in other countries, please also let me know.
Due to the large number of radiographs in our MSK worklists, we like Chest are relatively poorly compensated with RVUs compared to cross sectional rich sections such as Neuro and Body. This reflects both in our ability to hire new faculty (need to reach an RVU threshold when a new hire may be possible), how hard we have to work to reach our RVU benchmark and how bonuses may be distributed. Also there is a feeling that this may be deterring residents from entering our subspeciality.
We were wondering if your department has already addressed these discrepancies and how they might have gone about this. Do you apply lower thresholds or use a multiplying factor to try to even out the work and bonuses throughout the Radiology department?
Tudor
Tudor Hughes
Professor of Clinical Radiology
Department of Radiology
UCSD Medical Center
Phone work 619 543 3698
Phone cell 858 230 9511
Fax 619 543 3781
Email thughes
Web site; http://bonepit.com
