Your hospital knows the value of every procedure you perform. You probably do not. Dr. Eric Smuclovisky came back on Life of Flow to talk about why. He is an interventional radiologist, a former academic, and an independent physician-entrepreneur who opened an OBL and ASC, then watched reimbursement cuts come for the model. He calls RVUs monopoly money.
Stop Using RVUs
RVUs measure your activity. They do not tell you what your work is actually worth, and that gap is not an accident.
Watch The Episode
Stop Using RVUs, LOF #130 of Life of Flow, hosted by Dr. Lucas Ferrer and Dr. Miguel Montero-Baker.
How We Got Disconnected
Physician fees collapsed while hospital facility fees expanded. That single shift changed who controls American medicine.
There was a time hospitals competed for us. Gourmet meals. Private lounges. White tablecloth service in the physician dining room.
Then Stark Law separated doctors from hospital ownership, while leaving that ownership open to non-physicians.
RVUs measure what you do. They say nothing about what gets billed under your name.
The Dirty Little Black Book
That is what Eric calls the hospital charge list.
Hospitals set prices, then negotiate private discounts with commercial payers. Those deals are not simple multiples of Medicare.
His example: a summary of benefits showing an $80,000 charge, roughly $20,000 actually paid, and $1,000 owed by the patient.
The gaps are where the real contracts live.
You Can Ask
Under the No Surprises Act, you can request the billing associated with your own name.
Most physicians never do.
Another Route To Autonomy
Eric's answer was not to go back to employment. It was a professional service agreement: give the hospital a complete service line while keeping your independence instead of becoming a W-2 employee.
Three to five year contracts, he argues, can create real stability.
He also thinks the OBL model may be reaching the end of its ten to fifteen year cycle.
The Takeaway
The physician shortage may finally hand us leverage. Leverage only helps if you know your own numbers.
Eric said something on the show that stayed with me: "I hope none of my children become physicians."
That is not cynicism. That is a warning about the terms we accepted.
Learn what your work bills. Then negotiate from strength.