SGO Financial Wellness Blog Post Series Part 1 –
Beyond Burnout: Financial Wellness and the Hidden Power of RVUs

Physician wellness conversations usually focus on burnout, staffing shortages, or the emotional weight of caring for very sick patients. Those are all real and important, but there’s another contributor to physician stress that we discuss far less often: financial wellness.

For many gynecologic oncologists, financial stress does not come from a lack of income but from a lack of transparency and control. RVUs determine recognition, resources, and negotiating power within our institutions, yet most of us received little formal training in how those numbers are generated. We spent years mastering radical pelvic surgery and complex chemotherapy regimens, but many of us learned billing somewhere between our first clinic template and our third prior authorization call of the day.

Financial wellness in medicine has two sides. One is the traditional personal finance piece: how you manage, save, and invest your income over time. The other, and the one we talk about far less in the context of wellness, is ensuring that the work you are already doing is accurately captured and valued.

My goal in this piece is simple: to make the case that understanding billing and coding is not about chasing dollars, it’s about protecting your time, your resources, and ultimately your quality of life.

I began my career in academics, fully prepared to build a busy clinical practice while doing research and teaching. After five years, I transitioned to what I jokingly describe as a bougie private practice, the polar opposite of my first job. During that transition, I committed to learning more about billing and coding to better navigate my new environment.

Ironically, billing and coding matter a bit less to me personally now that I practice in an “eat-what-you-kill” model. I was never drawn to medicine for the financial incentives—though fair compensation is certainly appreciated. What I’ve come to realize, however, is that earlier in my academic career, I underestimated the broader value of RVUs.
Accurately capturing the work I was already doing might have given me greater leverage to advocate for the resources and support to sustainably care for my patients.

Gynecologic oncologists work incredibly hard and train for years to do this job well. Quantifying that workload objectively, via RVUs or revenue generation, helps justify the support we need: more nurses, more medical assistants, and more infrastructure to care for complex patients.

As a new faculty member, I understood the basics of billing. I knew a few modifiers and occasionally prioritized completing my codes accurately and promptly. But like many of us, I went into this field because I love taking care of patients and advancing gynecologic oncology. Billing felt like an administrative task rather than a professional priority.

Over time, I realized that regardless of how I feel about money, the health system prioritizes it (regardless of what is in their mission statement). Whether you are primarily clinical or heavily involved in research, your department chair, employer, or partners will know your RVU production. The more effectively you capture RVUs for the work you are already doing, the more leverage you have when negotiating for time, resources, or compensation.

According to the most recent SGO State of the Society survey, gynecologic oncologists (GOs) spend the majority of their time on clinical activities. Over the past year, GOs reported spending an average of 67% of their time in clinical care. Only about 5% of gynecologic oncologists do not supervise trainees, which means that accurately capturing the work performed during surgical cases is particularly important to preserve trainee involvement. Our surgical training is a critical investment in the future of our specialty and subspeciality, which is unfortunately not reflected in any RVU. But, our field will not survive without gyn oncology’s time investment to future generations. Proper billing helps ensure we can give trainees this time while also maintaining reasonable productivity metrics.

We are also seeing changes in surgical workflows since the COVID-19 pandemic. Many institutions report longer OR workflow times, longer turnovers, and fewer surgical cases among gynecologic oncologists. Post-COVID workflow changes and protocols have increased case duration, with anesthesia, surgical, and turnover times increasing by nearly 10 minutes per case compared with 2019.¹ Now you have less time to complete the same expected RVU load.

If all of this has convinced you to pay closer attention to billing, here are a few practical steps:

• Take a coding course every 1–2 years (commit to the masterclass at the annual meeting and stay awake for it). Review the recording when you get home. Take notes.
• Develop a relationship with your billing and coding team. Ask questions and set up recurring meetings with them to review what they’re changing.
• Talk with colleagues about how they code and bill similar cases
• Ensure you are using bilateral modifiers correctly
• For office (E&M) billing, use time-based coding when suitable
• Use detailed language around high-risk surgeries and account for the time required to coordinate complex care on the date of service

The small details add up. See below for several resources to help you stay current.

Looking Ahead

Optimizing RVU capture helps ensure the work you are already doing is recognized and supported. But financial wellness does not end with billing. In Part 2, we will shift from capturing value to managing it; practical strategies for financial planning across your career, from early-career priorities to mid-career investment decisions and working with financial advisors. (Don’t worry, I consulted actual experts for this part.)

Financial Wellness Resources

• SGO coding resources
• SGO Wellness curriculum financial module
• AAMC Financial Wellness Resources
• The White Coat Investor (blog/book/website)
• The Physician Philosopher (blog/book)
• Facebook communities such as Women Physicians Personal Finance, PSLF-Eligible Physicians, and Physicians on FIRE

Reference

1. Datzmann T, Dörfer L, Freude G, Hannemann M, Tharmaratnam G, Stangl P, Swoboda W, Schafmeister S, Gebhard F, Kaisers UX, Huber-Lang M. Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm. Eur J Trauma Emerg Surg. 2024 Oct;50(5):2411-2420. doi: 10.1007/s00068-024-02558-z. Epub 2024 Jun 13. PMID: 38869511; PMCID: PMC11599351.

Stephanie Sullivan, MD is a gynecologist oncologist at Gynecologic Oncology of Middle Tennessee practice in Nashville, TN