How do I compare hourly pay against an RVU offer in emergency medicine?

One schedule, two formulas

Pick the schedule first, because both formulas price it and neither means anything without it. Say the job is 144 shifts a year of twelve hours, which is 1,728 clinical hours, because 144 times 12 is 1,728. Under an hourly offer at $240 an hour, that schedule pays $414,720, because 1,728 times $240 is $414,720. That number is fixed before you see a single patient, and you can budget against it on the day you sign.

Under an RVU offer, the same schedule pays whatever your volume makes it. Marit Health reports a median rate of $31 per wRVU and an average annual volume of about 11,662 wRVUs. At that volume the RVU year pays about $361,522, because 11,662 times $31 is $361,522. To match the hourly year you would need about 13,378 wRVUs, because $414,720 divided by $31 is about 13,378. Now the comparison is factual: does this department produce 13,400 wRVUs for a physician working your shifts?

That last number deserves its own check. Divide the RVU target by the clinical hours: 13,378 wRVUs over 1,728 hours is about 7.7 wRVUs per hour, sustained, all year, through slow weekday mornings and peak season surges alike. Some departments and some physicians live there comfortably. Most do not, and the offer letter will never say so. Ask the group for its own data in writing: patients per hour by shift type, the wRVU distribution of its current physicians, and where the median physician lands. A group that will not show its production numbers is telling you the answer. Run a lower case too: at ten percent below average volume, the RVU year falls to about $325,370, because 10,496 wRVUs times $31 is about $325,370, while the hourly year does not move at all.

What each formula prices without saying so

Hourly pay transfers the volume risk to the employer. A slow department, a low acuity site, a night shift where readiness is the product: the rate holds. That is why hourly is the natural formula for rural, low volume, and overnight heavy work. Its ceiling is the flip side. The busiest physician in the department earns the same as the slowest on the same shift, and the rate only moves when the contract is renegotiated.

RVU pay transfers the volume risk to you and pays you for carrying it. In a well staffed, high volume department with strong support, a fast physician can out earn any hourly rate on the table. In a thinly staffed department it pays you to run faster to stand still. It also taxes the shifts that matter most and produce least: an overnight with three very sick patients and no backup produces fewer units than a busy morning of low acuity visits, at far greater wear. The rate matters too. Marit Health reports the middle range running from $27 per wRVU at the 25th percentile to $45 per wRVU at the 75th percentile, so two RVU offers on the same volume can be very different years. Blended offers, an hourly floor with an RVU component on top, split the risk. Build the floor year, the expected year, and the bad year where volume drops, because contracts get rebid and volumes move.

The parts that are not in either formula

Whichever formula wins the year, three more lines decide the offer. First, the differential structure: how much nights, weekends, and holidays add, and how many of them the schedule assumes. Second, the benefits layer: a W2 hourly number with a retirement match, funded coverage, and paid leave attached is larger than it looks, and a 1099 RVU number with nothing attached is smaller, by the full cost of the payroll tax share, the coverage stack, and the retirement funding you now carry yourself. Third, the exit terms: tail responsibility and the restrictive covenant can outweigh a year of formula advantage in a single clause.

Keep the simplest check in view. The market medians exist because most physicians, in most departments, land near them. An offer that promises far above median production pay is usually promising far above median production, and in emergency medicine production is another word for pace. Sign the offer whose year you have already built, not the offer whose rate sounded best in the interview.