Every physician on a production contract gets a compensation report. It arrives on schedule, formatted and official, with your wRVU total sitting in a box near the bottom. And almost every one of us treats that number the same way: We glance at it, feel vaguely that it seems low, and file it away.
Here is the uncomfortable question I would ask every production-paid clinician. If that number were wrong, how would you know?
For most of us, the honest answer is that we would not. We are meticulous about our patients and remarkably passive about our paychecks. The employer generates the encounter data, applies the fee schedule, computes the wRVUs, applies the contract terms, and hands us the result. Every step of that pipeline happens out of our sight. A compensation report is not self-verifying. It is the other party's summary of what they owe you.
I learned this the way you would expect, by being the one person in the room who could check.
For years I kept my own production log. Nothing sophisticated, just a running record of my encounters and the codes I worked, kept on my own time on an Excel spreadsheet. It started as simple curiosity about my own numbers and became a habit. Then a discrepancy appeared between what I had done and what my comp report said I had done.
Here is the part that stays with me. When the discrepancy came to light, it turned out to affect roughly 50 providers, and plenty of them had sensed something was off. That instinct was correct. But suspicion is not proof, and proof is what gets a discrepancy fixed. A feeling that your number seems low gets you a shrug and a reassurance. A dated, code-by-code log that does not match the report gets you a correction. Because I had kept my own count, I could demonstrate what everyone else could only suspect.
I want to be clear about what this is not. It is not a claim that employers are dishonest. Compensation pipelines are long chains of software, interfaces, and human data entry, and long chains drop things. Codes get lost between the EHR and the billing system. Encounters get attributed to the wrong provider. Contracts get priced against the wrong fee-schedule year, a quiet problem ever since the 2021 evaluation and management revaluation changed the wRVU values of the most common office visits. None of this requires bad intent. It only requires that nobody on the receiving end is checking.
And mostly, nobody on the receiving end is checking, because checking has been genuinely hard. The fee schedule changes every year. The math lives in spreadsheets that do not travel well between hospital workstations and home computers. After a ten-hour day, reconciling encounter counts is nobody's idea of self-care. We built a system where the only person with an independent interest in the number being right is also the person least equipped to verify it.
The fix does not require becoming a coding expert. It requires a few minutes a day and three pieces of information you already have.
First, know your code mix, the handful of CPT codes that make up the bulk of your work. For most clinicians it is fewer than ten codes.
Second, know what those codes are worth. Each code has a work-RVU value published by CMS, and it matters which year's schedule your contract prices against. This is exactly the kind of thing worth looking up rather than assuming.
Third, know your contracted rate, your dollars per wRVU, and any thresholds or draws that sit on top of it.
Then the monthly ritual: Tally your encounters by code, multiply, and set your total next to the report's total. Close enough, file it away. Meaningfully apart, ask why, with dates and codes in hand. That is the entire practice. The point is not to catch someone. The point is that a number that gets independently checked is a number that tends to be right.
There is a wider truth here that residency never teaches: In a production contract, your count is the product. We would never let a lab report a critical value without a reference range, yet we accept our own compensation math with no reference at all. Keeping your own count is not distrust. It is the same discipline we bring to everything else in medicine: verify, document, then trust.
Fifty of my colleagues had the right instinct and no evidence. Be the one with evidence.