As chiropractic care continues to integrate with broader healthcare systems, the way chiropractors are compensated is evolving. One of the most common shifts, especially in larger or medically integrated clinics, is the adoption of RVUs, or Relative Value Units, as a way to measure productivity and determine pay.
If you're a new graduate entering the job market, or an experienced DC considering a new opportunity, it’s essential to understand what RVUs are, how they work, and how they can impact your income.
What Are RVUs?
Relative Value Units (RVUs) are a way of assigning standardized “value” to different healthcare services based on:
- The complexity of the service
- Time and effort required
- Resources involved
Originally developed for medical billing, RVUs are now used by many chiropractic employers to track performance, productivity, and compensation.
Common Chiropractic Services with Assigned RVUs:
ProcedureExample CPT CodeTypical RVUsSpinal adjustment (1–2 areas)98940~0.60Spinal adjustment (3–4 areas)98941~0.75New patient exam99203~1.40Re-evaluation99212~0.50Therapeutic exercise (15 min)97110~0.70
Your total weekly or monthly RVUs are calculated based on the volume and types of services you perform. This number can then be converted into compensation based on the clinic’s internal pay structure.
Why Clinics Use RVUs for Compensation
RVU-based pay systems offer several benefits for both employers and employees.
Benefits for Clinics:
- Tracks provider productivity objectively
- Encourages time management and care efficiency
- Helps compare performance across multiple providers
Benefits for Chiropractors:
- Rewards productivity, the more care you provide, the more you earn
- Often includes a base salary plus RVU bonuses, giving both security and upside
- Promotes transparency, you know exactly how your work translates to income
<Callout type="info" title="Example"> A clinic may offer a $60,000 base salary + $35 per RVU after hitting 300 RVUs/month. That means high producers can earn significantly more without needing commission-based sales. </Callout>
What Chiropractors Should Ask About RVUs
RVU-based compensation models can vary widely between clinics. If you're interviewing for a job that uses RVUs, ask these questions to understand how the system works and what’s expected.
1. How many RVUs do your current associates average per week or month?
This gives you a realistic baseline. If current providers average 150 RVUs/week, and your compensation is based on 300, that’s a red flag.
2. What is the conversion rate from RVUs to dollars?
Some clinics pay a flat rate per RVU (e.g., $30/RVU), while others use a tiered system with thresholds and bonuses.
3. Is there a guaranteed base salary?
Many positions offer a hybrid model: base pay + RVU-based incentive. This provides income stability, especially for new grads still building volume.
4. Are there performance thresholds or bonuses?
Ask if there are additional perks for exceeding certain productivity levels, such as:
- Quarterly bonuses
- CE allowances
- Increased base pay after hitting targets consistently
5. How are non-billable activities counted?
Some clinics expect time spent on team meetings, patient calls, or documentation but these may not generate RVUs. Clarify how these activities are valued in your performance evaluation.
Pros and Cons of RVU-Based Pay for Chiropractors
Pros:
- Transparent and performance-driven
- Can lead to high earning potential
- Encourages clinical efficiency
- Often avoids hard-sell commission models
Cons:
- May feel pressure to increase volume
- Can be confusing without clear benchmarks
- Requires understanding of CPT codes and documentation
Final Thoughts
RVUs are becoming a standard way to measure and reward chiropractic productivity, especially in multi-provider clinics, integrative practices, or systems aligned with medical billing standards.
Understanding how RVUs work empowers you to:
- Ask better questions during job interviews
- Set realistic goals for productivity
- Negotiate compensation that reflects your value
As always, read your employment contract carefully and seek clarification on how performance will be measured and compensated.
A well-structured RVU model can be a win-win, if you know how to navigate it.