When Your Salary Stalls: Concrete Steps to Improve Productivity-Based Pay

Your productivity-based pay is not “mysterious.” If your salary has stalled, there are specific levers you can pull—and if you do not pull them, someone else will keep that money.

I am going to walk you through those levers.

This is not a pep talk about “working harder.” You are already working hard. The problem is usually that your time, coding, and contract are misaligned with how your employer prints money from your work. Fix that alignment, and your paycheck moves.

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Step 1: Diagnose Why Your Productivity Pay Stalled

Before you change anything, you need a blunt diagnostic. No more “I think” or “it feels like.” You want numbers. On paper.

1. Get Your Core Data (Do This Within 7 Days)

Ask your practice administrator, compensation office, or HR for the following—specifically in writing:

• Last 12–24 months of:
  • Work RVUs per month
  • Collections per month (if you are on collections-based pay)
  • Payer mix by percentage (Medicare, Medicaid, commercial, self-pay)
  • No-show and cancellation rates
  • Panel size (for primary care) or procedure/surgical case volume (for proceduralists)
• Your current compensation plan document:
  • RVU rate ($ per wRVU)
  • Thresholds for bonuses
  • Any caps or clawbacks
  • Definitions of “productivity” (RVU, collections, visits, etc.)
• Benchmark data your group uses:
  • MGMA / AMGA percentile targets they reference
  • Any internal productivity targets per FTE

If they stall or hand-wave, respond with:

“To optimize my productivity under our current model, I need my wRVU data, compensation formula, and benchmarks. This is standard information and necessary for me to meet targets.”

You are not asking for a favor. You are asking for the rulebook of the game they claim you are playing.

2. Compare Yourself to Benchmarks

Once you have your data, line it up against something real. Use MGMA/AMGA if you have access through your group. If not, your partners’ numbers are your internal benchmark (you already know who is “top producer” and who is not).

Create a simple snapshot:

Metric	You (Annualized)	Group or MGMA Target
wRVUs	6,200	7,000
$/wRVU	$48	$52
Total Comp	$300,000	$340,000
Clinic Sessions/Wk	8	9
No-Show Rate	18%	10%

You are looking for:

• Are your wRVUs low relative to peers?
• Is your $/wRVU low relative to peers?
• Are you producing average RVUs but getting below-average pay?
• Are clinic sessions, OR blocks, or access points limiting volume?

Different problems. Different solutions.

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Step 2: Understand Exactly How Your Productivity Is Calculated

You cannot fix what you do not understand. I have sat with physicians who were 10 years into a job and still could not recite their formula. That is how you get underpaid.

1. Decode Your Compensation Formula

Most productivity-based models boil down to one of these:

• Pure RVU:
  Total Compensation = Base (maybe) + (wRVUs × $/wRVU) – overhead/advances
• Tiered RVU:
  • First X wRVUs at one rate, next tier at higher rate, etc.
• Collections-based:
  • You get a percentage of what comes in after overhead
• Hybrid:
  • Modest base + RVU bonus above threshold + quality or citizenship bonuses

Write out your actual formula with real numbers. Example:

“I get a base of $200,000. Then $44 per wRVU for all wRVUs above 5,000 per year, reconciled quarterly, with no cap. Last year I had 6,200 wRVUs.”

That means:
6,200 – 5,000 = 1,200 bonus RVUs × $44 = $52,800 bonus
Total comp = $252,800 (before any other incentives)

Now you can ask: is the problem the volume (6,200 is low), the rate ($44 is low), or the threshold (5,000 is high)?

2. Confirm What Does and Does Not Count

This is where physicians get silently robbed.

Ask clearly:

• Do procedures, imaging reads, inpatient consults, and follow-ups all generate RVUs?
• Do I get RVU credit for:
  • Telehealth visits?
  • Phone visits / e-visits?
  • Chronic care management?
  • After-hours call follow-ups?
• Do shared/split visits (APP + physician) count for me, the APP, or are they split?

If it does not generate CPT codes and RVUs in the system for you, it is charity from a productivity standpoint. That does not mean you never do it. But you stop pretending it pays.

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Step 3: Fix Coding and Documentation Before You Add More Work

Most physicians are leaving 5–25% of wRVUs on the table through undercoding, poor documentation, or failure to capture billable work. Fixing that is the cleanest raise you will ever get.

1. Do a Targeted Coding Audit (30 Charts Can Change Your Income)

Ask for a focused audit of your last 30–50 visits and procedures. Not a punitive compliance audit. A revenue optimization review. Language matters.

Tell them:

“I want to ensure my coding accurately reflects my work. Can your coding team review 30–50 recent charts and show me where I am undercoding or missing billable services?”

You want specific, actionable feedback:

• How many level 4 visits should have been level 5 with better documentation?
• Are you documenting time properly when appropriate (especially for complex visits)?
• Are you consistently including:
  • Detailed HPI
  • Relevant ROS and exam
  • Clear medical decision-making elements
• Are procedure notes complete for maximal allowable RVUs?

Then you adjust this week, not “sometime later.”

2. Standardize Your Documentation for Common Scenarios

Create templates or smart phrases that make correct documentation the default:

• For complex chronic care visits (e.g., diabetics with CKD and CHF)
• For hospital follow-ups where management is complex
• For procedures that require specific elements to support the chosen CPT code

Do not over-document garbage. Document the medical reality in a way that justifies the correct code. You are likely already doing the work.

3. Capture All Billable Services

Ask coding/ billing:

• Which of these are billable in my system, and do I get RVUs for them?
  • Transitional care management
  • Chronic care management
  • Prolonged services
  • Telehealth follow-ups
  • After-hours or weekend visits
  • Same-day add-ons

Then create a tiny checklist you and your staff use to capture them.

Impact of Coding Optimization on Annual Income

Category	Value
Current	300000
After 10% RVU Increase	330000
After 20% RVU Increase	360000

If your RVU rate is $50, a 10% RVU increase on 6,000 wRVUs is 600 extra RVUs = $30,000. Same hours. Smarter coding and capture.

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Step 4: Optimize Your Schedule for Productivity, Not Punishment

Your schedule design is either an RVU machine or a throttling device. Many groups quietly cap your productivity by how they structure your day.

1. Analyze Your Template Like a Business, Not a Martyr

Look at:

• Number of appointment slots per day
• Mix of:
  • New vs established patients
  • Procedures vs visits
  • Telehealth vs in-person
• Length of slots:
  • 15, 20, 30, or 40 minutes?
• No-show patterns:
  • Certain days, times, visit types?

The goal is not “more patients no matter what.” The goal is more high-value work per hour.

For example:

• If your 60-minute new patient visit generates 2.5 wRVUs
• But two 30-minute established visits generate 2.8–3.0 wRVUs
• And no-shows are higher in new patients

Then you may need to adjust your mix unless new patients drive downstream procedures.

2. Fix the Three Common Schedule Killers

1. Swiss Cheese Schedules
   Scattered gaps kill RVUs. Work with scheduling to:

   • Cluster patients into dense blocks
   • Use “same-day access” or “rapid access” slots for high-yield visits
   • Implement a waitlist to backfill cancellations

2. Excessive Low-RVU Visits
   If your day is dominated by brief, low-complexity visits that do not lead to procedures or significant MDM, your hourly productivity stalls.
   Solutions:

   • Push appropriate follow-ups to telehealth when reimbursed
   • Use APPs for straightforward, protocol-driven visits
   • Convert frequent refill visits to protocol + annual comprehensive visits

3. High No-Show Rates
   You cannot bill a no-show. Simple, but overlooked.
   Tactics:

   • Overbook specific chronic offenders or high-no-show slots based on data
   • Use automated text/email reminders with confirmation
   • Implement a no-show policy with fees or re-scheduling rules (if your group allows)

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Step 5: Leverage Your Team Instead of Doing Everything Yourself

Productivity-based pay punishes solo heroes. If you are doing work an MA, RN, or APP could do, you are basically donating your time.

1. Redesign Clinic Workflow Around Physician-Only Tasks

Sit down with your lead MA/RN and map the entire visit flow. Ruthlessly strip out tasks that do not require an MD/DO.

You should be spending physician minutes on:

• Medical decision-making
• Procedures
• Complex counseling
• Higher-risk decisions (admissions, changes in major meds, etc.)

Your team can handle:

• Rooming and vitals
• Protocol-based screening questions
• Vaccine administration under standing orders
• Pre-visit planning (labs, imaging, records)
• Refills that meet protocol criteria
• Patient instructions that do not require MD brainpower

Create a one-page “Division of Labor” sheet and train to it. If you are typing detailed instructions that could be templated or given verbally and documented briefly, you are wasting billable capacity.

2. Use APPs Strategically for Growth, Not Cannibalization

Done wrong, APPs cannibalize your procedures and follow-ups. Done right, they are RVU multipliers.

Good use cases:

• APP sees straightforward chronic follow-ups, you see the complex cases and procedures
• APP does pre-op or pre-procedure evaluation; you do the procedure and high-RVU decisions
• APP handles post-op checks where RVUs are low but time is consumed

Clarify with administration:

• Who gets the RVU credit?
• Are there shared-visit rules?
• Is there a team-based incentive structure?

If your APP generates 2,000–3,000 wRVUs that feed into your downstream procedures, your productivity can climb without adding more hours.

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Step 6: Target High-Yield Work, Not Just More Work

Once coding, documentation, and scheduling are aligned, then—and only then—do you selectively add or shift volume.

1. Identify Your Highest RVU Activities

Look at your reports:

• Which visit types or CPT codes generate:
  • Highest RVUs per hour?
  • Best reimbursement?
  • Downstream procedures or admissions?

Examples:

• For a gastroenterologist:
  • Clinic consult → colonoscopy/EGD → pathology → follow-up
• For a cardiologist:
  • New patient with chest pain → stress test → cath → follow-up
• For a hospitalist:
  • Higher-complexity admissions and critical care time vs quick low-complexity discharges

You want more time in those lanes.

2. Rebalance Your Practice Mix

Concrete moves:

• Negotiate for more procedure block time if your procedures are RVU-rich and you are leaving demand unmet
• Convert duplicative low-value visits into APP visits, tele-visits, or protocol-driven care
• Reserve more slots for:
  • New patients likely to need procedures
  • High-complexity follow-ups
  • Rapid-access consults from referring physicians

RVU Yield Per Hour by Visit Type

Category	Value
Brief follow-up	3
New patient	4.5
Minor procedure	6
Major procedure	10

If a major procedure is 10 RVUs in 60–90 minutes versus 3–4 RVUs per 30-minute visit, you arrange your schedule accordingly.

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Step 7: Renegotiate the Parts of the Compensation Plan That Are Actually Negotiable

Too many physicians jump to “I need a new job.” Sometimes true. Often premature. First, see if the game rules inside your current job can be adjusted.

1. Know Which Levers Are Realistic

Things that might be negotiable, especially if you are a solid producer or in a shortage specialty:

• $ per RVU rate
• Lowering the RVU threshold before bonuses kick in
• Removing or raising caps on productivity bonuses
• Credit for hospital/committee/administrative time
• Protected time vs productivity expectations
• How APP-generated RVUs are attributed

Things that are often less negotiable (but not impossible):

• Institutional adoption of an entirely new compensation model
• Changing payer contracts
• System-wide overhead percentages

Go for the achievable 10–20% improvement, not the fantasy 200%.

2. Prepare a Data-Driven Ask, Not a Complaint

You walk into the meeting with:

• Your last 12 months of:
  • wRVUs
  • Total compensation
  • Clinic sessions / OR time
• Benchmark data (MGMA/AMGA or internal)
• A specific proposal

Example framing:

“Over the last year, I produced 6,800 wRVUs, which is around 65th percentile for my specialty based on MGMA. My current effective rate is $46 per wRVU, while comparable positions are closer to $52–$55. I would like to discuss adjusting my RVU rate to $50 now, with a plan to reach $52 if I exceed 7,200 wRVUs next year.”

That is rational. Quantified. Hard to dismiss outright.

If they refuse everything, you have learned something important about your future there.

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Step 8: Decide if You Need a Structural Change, Not Just Tweaks

Sometimes the model itself is broken for you:

• Chronic lack of OR/procedure time
• Administrative bloat or overhead that eats collections
• Payer mix so bad that no volume increase helps
• Toxic culture that weaponizes “productivity” while piling on unpaid admin work

At that point, optimizing inside the system is rearranging chairs on a sinking ship.

1. Compare Alternative Models Head-to-Head

Use a simple comparison table:

Factor	Current Job (RVU)	Offer A (Hybrid)	Offer B (Collections)
Base Salary	$210,000	$240,000	$0
wRVU Rate	$45	$50	N/A
Threshold	5,000	4,500	N/A
Collections Share	N/A	N/A	40% after overhead
OR/Block Access	Limited	Moderate	High
Call Pay	Included	Separate	Separate

Do the math on realistic scenarios, not recruiter fantasy. For each option, project:

• Conservative, realistic, and stretch RVU or collections estimates
• Total comp in each scenario
• Call burden and lifestyle cost

2. Use a Simple Timeline to Plan a Move

If you are leaning toward leaving, treat it like a project, not an emotional reaction.

Physician Compensation Improvement Timeline

Period	Event
Months 1-2 - Get data and audit coding	2 months
Months 3-6 - Implement schedule and workflow changes	4 months
Months 3-6 - Meet with admin for comp review	1 month
Months 7-9 - Measure RVU and income impact	3 months
Months 7-9 - Explore external offers if needed	3 months
Months 10-12 - Decide	stay with revised terms or transition

You give your current system 6–9 months of serious, documented effort. If the ceiling is still low, you use your improved productivity as leverage in the market.

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Step 9: Protect Yourself Legally and Contractually

You are in the “Financial and Legal Aspects” phase whether you like it or not. Productivity-based pay is a contractual implementation of a business model. Treat it that way.

1. Understand Key Legal Clauses That Affect Pay

When reviewing your contract (current or new), pay attention to:

• Compensation formula attachment
  Is the formula, including $/wRVU and thresholds, explicitly written or just “as per policy”?

• Unilateral change language
  Can the employer change comp structure or RVU rates unilaterally? With what notice?

• Non-compete and non-solicitation
  If you leave, can you practice nearby? For how long? With what geographic radius?

• Call pay and stipends
  Are they separate or baked into “base salary”?

• Quality and citizenship bonuses
  Are they guaranteed, discretionary, or based on opaque metrics?

If any of this is fuzzy, an hour with a physician contract attorney will usually pay for itself many times over.

2. Watch for Stark/AKS and Fair Market Value Red Flags

If someone offers a wildly above-market $/wRVU or bonus structure, understand there are legal guardrails:

• Compensation must be consistent with fair market value (FMV)
• It cannot be tied directly to referrals in a way that violates Stark or Anti-Kickback rules

Legitimate organizations use MGMA/AMGA data as a sanity check. If an offer is dramatically above 90th percentile for comp with only 50th percentile expectations for work, you need legal eyes on it quickly.

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Step 10: Build a Simple Personal RVU and Income Dashboard

You should not learn your productivity after the quarter closes. By then it is too late to adjust.

1. Track 3–5 Metrics Monthly

Set up a simple spreadsheet or note:

• wRVUs per month
• Visits / procedures per month
• Average RVUs per clinic day
• No-show rate
• Total compensation year-to-date

Monthly wRVUs and Target Line

Category	Actual wRVUs	Target wRVUs
Jan	450	500
Feb	520	500
Mar	580	500
Apr	600	500
May	610	500
Jun	640	500

If you see three consecutive months below target, you do not wait for year-end. You adjust coding, schedule, or visit mix right then.

2. Review Quarterly With Your Administrator

Do not wait for them to call you in. You initiate.

Email agenda:

• Review my RVU and compensation trends
• Identify any coding or capture issues
• Discuss access, scheduling, and block time that affect productivity
• Review where I stand vs MGMA targets used for comp

You are signaling two things:

1. You understand their business model.
2. You intend to be paid fairly within it.

That changes how you are treated.

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What You Should Do Today

Open your last month’s schedule and your last 20 notes.

• For notes: find 3–5 where you did complex work but probably undercoded or under-documented. Flag them. Then email your coder and ask for a brief review of those specific charts and how they would have coded them.
• For schedule: count how many slots were wasted by no-shows, poor clustering, or low-value visits that could have been handled by protocol or an APP.

Then send one email to your administrator:

“I would like to review my last 12 months of wRVUs, compensation calculation, and any benchmark data used for my role. I am working on optimizing my productivity under our current model and want to be sure I fully understand how it is measured.”

That one move starts the shift from “stuck salary” to “controlled, intentional income.”