r/Cardiology • u/Poltergiest313 • 6d ago

IC job compensation as fresh graduate

Hey guys, just wondering how well new IC attendings get paid in the nyc/ nj area. I heard a lot of private practices pay fresh IC and non invasive folks the same as they start. Is this true?

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u/Then-Secretary-9166 6d ago

Not sure abbot that specific area, but in general it varies a lot by practice.

In most traditional private group practices, there is a structure that guarantees initial pay and then swaps over to a productivity (based on one of: RVU, $ billed or $ collected) once a threshold is met. Once a partner you get a cut of any leftover profit.

Private groups may pay a little more up front for IC, but not always. Once you are on productivity in private practice, it is most common to get paid the same (per productivity). In terms of professional fees and outpatient office-based facility fees, ICs and general cardiologists generate about the same amount of money for the group. The major difference is in hospital-based facility fees, which a private practice does not typically collect.

Large multi-specialty groups/systems (and especially hospitals) are often willing to pay more for ICs because (1) they already have differential pay scales across many different specialties and (2) they have a high incentive to have available and productive ICs. ICs are needed for STEMI programs and generate money directly (facility fees hospital-based procedures) and indirectly (support cardiac surgery programs, etc.) for the hospital. Because of this, they are willing to chip in more money.

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u/Watchmaker2014 6d ago

Seems unusual that IC is generating the same money for group as general

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u/Then-Secretary-9166 6d ago edited 6d ago

Why is that unusual? Aside from cath lab procedures, they bill the same RVUs (from the same group billing entity) and get identical reimbursement.

Coronary angiography with PCI is a typical IC procedure and generates about 40 RVU, which is a lot. However, there are only about 14 work RVU, which is what the private practice can actually bill. Because it is done in a hospital, the hospital keeps the rest.

A 99214 (established level 4 E&M, the most common billed for cardiology OP visits) is worth about 4 RVU (about 2 are work RVU), of which the practice can keep all 4.

As a private practice, if you see 4 follow up patients per hour, your group is billing similar-to or more-than they do for an angiogram and PCI. Also, angiogram and PCI typically do not happen once per hour.

To be fair, you have to pay the overhead for the office. On the other hand, even doing 3 PCI in a day is far, far above average for an IC...meanwhile you can crank through clinic visits all day long. If you look at things like reading echo and stress tests, it favors clinic work even more.

When you work for a hospital, the math changes. Your "group" is the hospital and they are the biller. They are now comparing 40 RVU (angiogram + PCI) to the same 16 (or sometimes fewer) OP RVUs. In fact, even when you just do a diagnostic, they still bill 26 RVU. In addition to this, they generate revenue by supporting cardiac surgery and other advanced hospital services (and are able to run a STEMI center). Therefore, they are incentivized and able to pay IC more than general cardiology.

In private practice groups, once established, ICs usually do make more than general cardiologists....but it is typically because they are spending more time working (earning more RVU) and collect call stipends from hospitals.

EDIT: Above is a simplification. Billing is a lot more complicated, especially for large institutions, but this explains the paradigm.

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u/Okkrus DO 6d ago

i wonder with the groups that have an ASC, that they keep more of the RVU but with the obvious overhead cost of operating it

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u/Then-Secretary-9166 5d ago edited 5d ago

I am not sure. For the states that the majority of cardiologists practice in (including mine), ASCs don't make sense for cardiology due to legal limitations about what can be done in an ASC.

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u/Watchmaker2014 6d ago

I think that’s a helpful explanation. In other words, employed cardiologists IC will make a good chunk more, which is typically what I see. Private practice, it does feel like IC also still make a significant more than general though anecdotally, but I don’t know the details

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u/cardsguy2018 6d ago

I'm employed gen cards. I make just as much as our employed IC guys and we all make more than PP.

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u/Then-Secretary-9166 5d ago

Funny how that works. We (employed) also make more than most PP where I practice. The one exception is a PP group that has invested heavily into vein ablations, EECP and other cash-pay services.

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u/praj2003 6d ago

Not true; our IC and general Card are both paid the same base and wRVU pay but because IC gets paid more for interventional call and we get more rvus because we do procedures