Every time a practice asks physicians to take on something new (e.g., more clinic hours, call coverage, administrative responsibilities, etc.) or to help fix a problem, one topic always seems to dominate the conversation:

Compensation.

Sometimes physicians will bring it up immediately. Sometimes administrators raise it because they assume it will be the physicians’ biggest concern. Either way, if pay enters the conversation too early, the entire discussion becomes transactional and progress stalls.

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I’ll bet you’ve found yourself facing a difficult situation in your practice where you knew what you needed from your physicians, but then you thought, “Who am I to tell a physician what to do?“

It’s a fair question. I mean, I was taught from a young age that the person wearing the white coat was in charge.

But after nearly 20 years of working with medical practice leaders, I’ve learned that the ones who can get comfortable “telling physicians what to do” (just as they would “tell” any other member of their team) are the ones who are most effective. Everyone else is basically crossing their fingers and hoping things work out.

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Over the years, I’ve noticed that most physician-owned groups fall into one of four stages when it comes to partnership. Where your group sits on that spectrum can have enormous implications for your culture, your finances, and your future stability.

The Stage 1 model, which is by far the most common, is that new physicians work as employees for one or two years before automatically being offered partnership.

It’s pretty simple. There’s no additional screening to be done, criteria to be met, or decision to be made. All a new physician has to do is serve their time without making any big mistakes.

This Stage 1 model of partnership is rooted in the way things have been done in medicine over many, many years. And you could argue that it helps in today’s hiring environment, when you’d be happy to get a physician in place to help with patient access, call covered, etc. It can feel risky to add friction to the process.

But there are real downsides to staying in Stage 1 for too long.

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There are things do we all do every day without really questioning them.

Hitting the snooze button out of habit, not tiredness. Brushing your teeth before you have coffee. Driving the same route to work.

It’s a reasonable way to go through life. If you stopped to question everything, you’d never get anything done.

BUT!

Have you ever thought about how many things are on your physicians’ to-do lists only because “We’ve always done it this way”?

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A few years ago, something started bothering me.

I kept getting called in to “fix” physician compensation plans. But even when the math was solid and the incentives made sense, the same problems kept showing up: physicians were disengaged, leaders were frustrated, access was still tight, and turnover still loomed.

I started thinking that maybe compensation wasn’t “broken” after all. Maybe were asking it to do something it just can’t do.

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I’ve been sharing the unspoken assumptions that practice leaders make when they rely on WRVU-based physician compensation models to solve issues within their practices.

I’ve talked about using WRVU benchmarks to set goals and whether it’s entirely up to physicians to choose to be more productive. Today, I want to talk about the assumption that physicians want to do more so they can earn more.

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I recently shared why it’s not always safe to assume that a WRVU benchmark plucked from a survey table will make a good goal for your physicians, and how you can set smarter targets.

Let’s tackle the second of three unspoken assumptions that practices make when they put their faith in WRVU-based physician compensation models to fix access or financial issues: that it’s up to each physician to choose to generate more or less WRVUs.

I find it helpful to think about WRVUs in the same way I think about body mass index (BMI): a single number that might say something about me, but that I can only partially control. Sure, I could eat less, eat better, run further, lift heavier weights. But even if someone paid me to lower my BMI, I can’t change my genetics and I can’t change my height.

Similarly, the number of WRVUs that a physician generates over the course of a year is the result of many, many factors. Some of those factors are entirely within the physician’s control. Some are entirely outside of the physician’s control. Many others are somewhere in between.

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In my last post, I laid out three unspoken assumptions that practices make when they put their faith in WRVU-based physician compensation models to fix access or financial issues. Understanding each of these assumptions and making the appropriate adjustments will help you ensure that your physicians (and your practice) are in the best position to succeed.

Let’s talk about the first of these assumptions, that physicians should be able to match benchmark WRVU levels without too much effort.

In a typical WRVU-based compensation model, physicians get a bonus for each WRVU above a certain threshold. Put another way, the model incentivizes them to meet (and exceed) a WRVU goal.

But how do you decide where to set that goal?

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I’ve been thinking about the new year, and new year’s resolutions.

Recently, it occurred to me that relying on a WRVU-based physician compensation plan to drive volume and revenue in your practice is a lot like making a resolution to lose 50 pounds without working on a supporting nutrition or fitness plan. You’re not setting yourself up for success, to say the least.

I do understand how practices like yours end up with this kind of comp plan. Something like this:

Total compensation = [$X] in base compensation + [$Y] per WRVU above [Z] WRVUs per year

After all, WRVUs, or work relative value units, seem to show up in every productivity dashboard and every leadership meeting. That just makes sense—the more WRVUs physicians generate, the more revenue the practice brings in.

As much as this line of thinking makes sense, I’ve watched so many practices implement WRVU-based comp plans and fall short of their goals. Sometimes, that meant a waste of time and money. Other times, physicians’ trust in their practice’s leaders was irreparably damaged.

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