All moves, med school to late career · Early career · reviewed October 27, 2026 · oldest source check October 21, 2026
The decision. The first year paid on the productivity formula instead of the guaranteed base. Usually nothing new is signed.
What changes
- Pay switches from the guaranteed base to the contract's formula, often a dollar rate per work RVU above a threshold. Some contracts reconcile pay against production and allow payments above the guarantee to be taken back.Andwise clause library: compensation · checked October 21, 2026
- For 2026, CMS applied a −2.5% efficiency adjustment to work RVUs for services that are not time-based. Evaluation and management, care management, behavioral health, telehealth-list services and some maternity codes are exempt. CMS describes the adjustment as periodic without fixing an interval.CMS, CY 2026 Medicare Physician Fee Schedule final rule fact sheet; CY 2026 Physician Fee Schedule final rule, 90 FR (2025-11-05) · checked October 27, 2026
- A contract that pays a fixed rate per wRVU, counted on the 2026 values, pays less for the same procedural work than on 2025 values unless the employer restated them.Andwise: the 2026 wRVU cut; CMS, CY 2026 Medicare Physician Fee Schedule final rule fact sheet · checked October 21, 2026
- The CY 2027 proposed rule (July 16, 2026) estimates a conversion factor of $32.8409 for clinicians not in a qualifying APM, 1.7% below 2026, because a one-year 2.5% increase lapses. The conversion factor reaches a physician's pay where the contract ties its rate to Medicare's conversion factor or pays on collections.CY 2027 Physician Fee Schedule proposed rule (2026-07-16) · checked October 21, 2026
Not measured.
- No published survey measures typical guarantee lengths or wRVU thresholds. The contract's own terms are the only figures that apply.
- No source counts how many employers restated wRVU values after the 2026 change.
Who is paid for what
How each party at this decision is paid, and what its role does not include. The page states payment structures only, not intentions.
The employer
Pays the contract's formula. In PAI's 2026 survey, 41% to 53% of employed physicians reported patient-volume targets in their compensation.Physicians Advocacy Institute, 2026 Employed Physician Survey
Not part of its role Restating wRVU values after a CMS change, unless the contract requires it.
Costs that come later
What is agreed at this decision, and when its cost arrives.
- Guarantee length and the formula after it (agreed at signing)Lands at The first production yearOffer comparison: after the guarantee
- The fee-schedule year named in the contractLands at Each CMS revaluationThe 2026 wRVU cut
- Reconciliation and take-back termsLands at Year-end reconciliationwRVU statement checker
- How time off counts against the wRVU thresholdLands at Any bonus year with leaveTime off and the wRVU bonus
Dates for a calendar
Contract dates come from the terms the contract checker read, saved in this browser only; a start date places them. Rule changes come from the site's feed of dated changes. The calendar file is built on this device.
Deadlines, and who sets them
- Set in the contractThe guarantee's end date
- Set by lawThe CY 2027 fee schedule: proposed July 16, 2026; the CY 2026 final rule was published November 5, 2025CY 2026 Physician Fee Schedule final rule, 90 FR (2025-11-05); CY 2027 Physician Fee Schedule proposed rule (2026-07-16)
Tools, in the order this decision uses them
Offer comparison: after the guarantee
Last guaranteed year beside the first formula year, at the contract's rate and threshold.
wRVU statement checker
A productivity statement against the contract's terms.
Time off and the wRVU bonus
What leave does to a threshold bonus.
Compensation clause
Two versions of the clause, and the questions it raises.
Questions for a professional or the other party
The employer
- What formula applies after the guarantee, and does any base remain?
- Which fee-schedule year sets wRVU values, and are thresholds restated when CMS revalues codes?
- How often is pay reconciled, and can amounts above the guarantee be recovered?
A CPA
- If pay changes after the guarantee, how do estimated taxes and retirement contributions change?