Compensation

Making sense of RVU-based pay.

A base salary tells you almost nothing about total comp once wRVUs enter the picture. Here's what to look at instead.

What a wRVU actually is

A work RVU is a standardized unit assigned to each billable service, meant to reflect the physician effort involved, independent of what any particular payer reimburses. Your production for a period is the sum of wRVUs across everything you billed. The dollar value only shows up once a conversion rate is applied on top.

The conversion rate is the real number

Two employers can offer the same $1.00 base salary framing and mean very different things depending on the conversion rate per wRVU and where your specialty's typical production lands. A modest conversion rate against high-volume production can outperform a generous-sounding rate against a role with structurally lower volume. Ask for the specific rate in writing, not just "competitive."

Guarantee period vs. steady state

Many first-attending contracts offer a guaranteed base salary for a set period (often one to two years) while you build a panel, then transition to pay based on production. Find out what happens at the end of the guarantee: does pay drop to whatever wRVUs alone generate, or is there a floor? Also ask whether unearned guarantee amounts are treated as a loan to be repaid from future bonus — that detail changes the real risk of the offer.

Benchmarking

Production targets are often set against a percentile of a national compensation survey (MGMA and similar sources are common references). Ask which survey, which percentile, and whether the number is specialty- and region-adjusted. A target set at an aggressive percentile for your specialty is a materially different job than one set at the median.