You are excited to start your career as a radiologist. And, you are interviewing hoping to find a job where you can make the most money and pay off your student debt. Well, there is much more to finding the right position than just assessing the income. Of course, you should consider the location and job profile. Just as importantly, however, you also need to figure into your calculations the workload and relative value units (RVUs) you need to complete to reach that income.
Avoid the following situation: an insurmountable daily imaging workload with a queue of patient studies that never ends. A job like this is bound to end badly. But, what is an unsafe workload for you, the radiologist? Or more accurately, when looking for a job, how many studies are too much to read daily? Let’s investigate these issues together by examining some of the markers of workload and then get to some more specifics about the appropriate RVUs for an individual radiologist.
The Lowly RVU
Before we conclude how much work is too much, we first have to define a unit of work. We call the basic measurement of work, the RVU or relative value unit. According to an excellent presentation on the history of insurance, the first “RVU” came out in 1992 (1), and a relative value unit was defined as consisting of three different components- physician work, practice expense, and malpractice. Most of the cost/workload of the RVU relates to physician work and practice expense.
So, who decides the cost of an RVU? Well, the American Medical Association defined a committee called the AMA Specialty Society Relative Value Update Committee (the RUC). It consists of an expert panel made up of an individual from the 21 major national specialty societies, two IM specialists, one primary care practitioner, one specialist, and six additional committee members. They assign explicitly what the Medicare costs are for each procedure. (1)
Why Is The Average RVUs Per Radiologist Is Important? (And Why It’s Not!)
OK. So, we have defined what makes an RVU and who creates an RVU for any given procedure. The next important question: What is the median number of RVUs per radiologist throughout the country. Well, I found a relatively recent article in Aunt Minnie that reports just that. (2) To summarize, it says that the average radiologist performed 8907 RVUs in 2016. Now that we know the average RVUs per radiologist, it’s a relatively simple step to ask what the average number of RVUs per radiologist per year is in any given practice. Usually, the business or practice manager can obtain the number for you if you ask. If you find that the number deviates significantly from the mean, perhaps, you are looking at too few or too many studies.
But wait… There’s more to the equation! Let’s say you are a neuroradiologist that reads almost exclusively high-value RVU MRIs. Perhaps, you may read them significantly quicker than a general radiologist. Then, you can probably handle more RVUs than the average radiologist. Or, let’s say you just started and have not yet picked up speed with dictating. In that case, you are likely going to read lower amounts of RVUs. Therefore, you have to put in your weighted factor to come up with how much work is reasonable.
Why Are Daily RVUs Even More Important?
Finally, we have come up with your individual optimal yearly RVU number where you should lie within a reasonable spectrum. But, it is impossible in any given practice to conform to that number precisely every day. Some days you will have more studies and others less.
To add even more variation, in some practices the radiologists may take 16 weeks of vacation, leaving only 36 weeks to complete all the work. To make the appropriate calculation of RVUs in this sort of practice, you would need to take the individual practice’s annual RVU number and divide by the number of days per year worked. In actuality, that yearly average total RVU number does not measure the amount of daily work. A more appropriate calculation would be the daily RVU number. Therefore, a practice with a seemingly ordinary yearly RVU number can have a daily RVU number that is exceedingly high.
The RVU Tipping Point
What happens when a radiologist reaches the daily RVU tipping point beyond which they are comfortable? Well, most practicing radiologists have had bad days like this at some point. (Hopefully not every day!) You cut corners; your mind drifts elsewhere; burnout ensues; eye strain develops. Not only is it a bad place for you, but it is also terrible for patient care. Let’s try to avoid that situation as much as possible.
How Much Is Too Much?
Back to the original question again. Too much work can vary widely for any individual. But at least, you now have a feel for how to calculate how much is too much. So, go forth and ask about the RVU number when you interview for a job, calculate the daily RVU value, and compare with your comfortable RVU numbers. That way, you are much more likely to find work that is appropriate for you!