The Podcast by KevinMD Hidden financial dangers of wRVU thresholds in medical employment agreements
Jan 26, 2026
Dennis Hirsch, a health care attorney who advises on physician contracts and wRVU-based pay. He breaks down risky wRVU thresholds, the need for realistic benchmarks and ramp-up guarantees, pitfalls like billing-date crediting and clawbacks, and key negotiation priorities to protect income.
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Salaries Can Be Draws Against Production
- Most employed physician contracts incorporate WRVUs into pay via salary plus productivity bonuses.
- Many 'salaries' are actually draws that employers true-up against productivity later.
Match Pay To Expected Percentile
- Make sure pay percentile and expected productivity align in your contract.
- If they want you at the 60th percentile, your pay should reflect the 60th percentile benchmark.
Fix True-Up And Bonus Symmetry
- Clarify the true-up formula and ensure bonuses/penalties are symmetric.
- Require equivalent pay per WRVU for exceeding and missing thresholds.