Physicians on RVU-based compensation plans often have no way of knowing whether the rate they are being paid is fair, and according to one gastroenterologist, that is often by design.
The structural disconnect of wRVUs is well documented. Provider productivity, measured by wRVUs per FTE, has increased 7% since 2023, while provider compensation rose 6% and reimbursement declined 1%, as measured by net patient revenue per provider wRVU, according to Kaufman Hall’s “Physician Flash Report.”
Overall, wRVUs grew just 1.5% in 2024, down from 5.2% in 2023 and 18.3% in 2022, with the latter driven largely by evaluation and management coding changes, according to the AMGA 2025 Medical Group Compensation and Productivity Survey. Compensation, meanwhile, grew 4.9%. According to the report, about half of that compensation growth is being funded by physicians doing more work, not by gains in reimbursement.
Rajiv Sharma, MD, a gastroenterologist and president of Phoenix-based Mirage Health, told Becker’s the per-RVU rate offered to physicians for identical work can vary drastically from one contract to the next.
“I’ve seen RVU rates range from $36 to $95 per RVU,” Dr. Sharma said. “It’s more fluctuation than anywhere else.”
That spread is not accidental, he said.
“Typically, anybody who puts you on RVUs is stealing from you,” he said. “Because if they know they can pay you $87 per RVU, but they’re paying you $36 per RVU, the difference is their profit.”
Money, he said, often gets absorbed into administrative costs rather than disclosed to the physician generating it.
The range Dr. Sharma cites is consistent with published benchmarks. Compensation per wRVU ratios have normalized across specialties, indicating that pay gains are now being driven by market pressure rather than output, according to SullivanCotter’s 2025 “Physician Compensation and Productivity Survey.”
In a news release, Matthew Bates, managing director and physician enterprise service line leader at Kaufman Hall, noted that revenue has increased because physicians are working more, but “the data also show that reimbursement is not keeping pace.”
The AMGA median compensation per ASA unit figure for anesthesiology reached $49.05 in 2025, and even within a single specialty, per-unit rates vary significantly by care model and setting. For GI, Marit Health data puts compensation per wRVU at approximately $62 to $70 depending on productivity tier, a range consistent with Dr. Sharma’s observation that the spread between floor and ceiling rates can exceed $50 per unit.
Dr. Sharma said physicians should push for two things in any RVU-based contract: a locked-in rate and real visibility into their own numbers.
“A respectable RVU rate should be $65-plus, locked in for three to five years,” he said.
He added that physicians should insist on monthly visibility into their RVU totals, direct access to billers and coders to verify them, and a contractual right to audit their RVUs at any given time.
According to a report from HealthCare Appraisers, it is common for hospitals to set a minimum wRVU threshold equal to 95% of a physician’s prior year totals, with predetermined compensation reductions for every wRVU short of that minimum and incentive compensation only for productivity exceeding prior year totals.
Beyond the base RVU rate, Dr. Sharma was critical of quality bonus structures that withhold a portion of physician pay until certain metrics, such as timely documentation and patient satisfaction scores, are hit in the following year.
He said these thresholds are frequently set at levels that are difficult or impossible to reach, functioning less as a genuine bonus opportunity and more as a mechanism for the group to hold back pay.
The shift is reflected in survey data. Seventy-five percent of organizations now include productivity and patient experience measures in physician compensation plans, and outcomes-based metrics increased 4.6% year over year, according to SullivanCotter’s 2025 survey.
Dr. Sharma described the broader structure of many physician contracts as deliberately murky.
“Right now the contracts are built in this big nebula of liabilities, which physicians get exposed to, and every liability is planned in such a way that they can leverage it to not pay the physician,” he said.
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