What a wRVU actually is
A work Relative Value Unit (wRVU) is the work-effort component of a CPT code, set by CMS. A 99213 office visit is 0.97 wRVUs. A complex 99215 is 2.11. A laparoscopic appendectomy is 9.42. CMS updates the values annually.
You don't need to memorize any of this. You need to understand three numbers in your contract: the conversion factor, the threshold, and the reconciliation period.
1. Conversion factor
This is dollars per wRVU. It is the single most important number in a productivity contract. Specialty matters enormously.
| Specialty | p25 | p50 | p75 |
|---|---|---|---|
| Family Medicine | $48 | $54 | $62 |
| Hospitalist | $58 | $66 | $76 |
| Cardiology (non-invasive) | $62 | $72 | $88 |
| Orthopedic Surgery | $60 | $70 | $84 |
Illustrative ranges. Real benchmark by specialty, region, and year. Not a substitute for actual market data.
If your offer's conversion factor is below specialty p50, that is a haircut, regardless of how the offer letter frames it. Hospitals will sometimes offer a high base salary paired with a below-market conversion factor, banking on the fact that you focus on the base number.
2. Threshold
The threshold is the wRVU level you must hit before the productivity bonus kicks in. Below it, you earn base only; above it, you earn base + (wRVUs above threshold × conversion factor).
The trick to look for: a threshold set above the specialty's median annual production. If most physicians in your specialty produce 5,200 wRVU/yr and the threshold is 5,800, the bonus is theoretical.
3. Reconciliation period
Reconciliation is when the hospital tallies your production and pays the bonus. Three options, listed best to worst:
- Monthly. Rare. Cash-flow friendly. Negotiate for it if you can.
- Quarterly. Standard. Reasonable.
- Annual. Common, and not in your favor. The hospital floats your bonus for up to 12 months, you get nothing if you leave mid-year, and a slow January can wipe out a great November.
The three-question test
If you remember nothing else, ask these three questions about any wRVU offer:
- Is the conversion factor at or above specialty p50 for my region?
- Is the threshold at or below specialty median annual wRVU production?
- Is reconciliation quarterly or better?
Three yeses, the structure is fair. One no, you have a real negotiation point. Two or three nos, the productivity bonus is a marketing line, not a real comp lever.
One more thing: collections-based vs. wRVU-based
Some private practices pay on collections (% of revenue you bring in) instead of wRVUs. Collections-based comp is more volatile, more dependent on your payor mix, and harder to benchmark, but can pay more in high-revenue specialties. The same three-question logic applies, just substituting “% of collections” for conversion factor.