How RVUs Are Undermining Healthcare from the Inside Out
When we reward procedures over prevention, everyone loses.
If you’ve ever worked in medicine, you’ve heard the term “RVU.” Short for Relative Value Unit, it’s a currency of sorts — a way to measure and reimburse a clinician’s productivity. In theory, it was designed to bring fairness and consistency to physician compensation. In reality, it’s one of the most corrosive forces in modern healthcare.
RVUs don’t reward quality. They reward quantity. They reward doing things to people — ordering procedures, prescribing medications, billing for complex visits. What they don’t reward is time spent with people: educating, listening, preventing disease, and fostering connection. That quiet, upstream work — the kind that prevents future illness and suffering — is worth little to nothing in the RVU economy.
The Procedure Gets Paid. The Conversation Doesn’t.
If I spend 10 minutes freezing off a wart, I earn more than if I spend 30 minutes talking someone through lifestyle changes that could prevent a heart attack. I get paid more for injecting a joint than for unraveling the web of chronic stress and trauma that’s contributing to their pain in the first place. If I see a patient for high blood pressure, the choice to prescribe a medication increases its billing potential—and this is encouraged. It’s not just misaligned — it’s backwards.
The system says: “Do more.” But what many patients need is less — less intervention, less medication, less fear-based decision-making. They need time, space, and relationships. RVUs don’t allow for that.
Productivity Metrics That Burn Providers Out
The RVU system is a machine, and providers are the cogs. Burnout isn’t a bug — it’s a feature. We are told to “hit our numbers,” to move faster, to squeeze in more patients, to code higher and document harder. Clinicians who care deeply about prevention and long-term well-being are forced to choose between doing what’s right and doing what pays.
The result? A system that incentivizes reactive care over proactive care, profits over people, and throughput over thoughtfulness.
Who Really Benefits?
Healthcare administrators may point to RVUs as an objective way to measure and reward work. But who really benefits? Large health systems rake in the profits from procedures and imaging studies, while patients are shuffled through a system that often doesn’t meet their deeper needs. Clinicians, meanwhile, are burning out in droves — and many of the best are leaving medicine altogether.
A Better Way
What if we reimagined value in healthcare? What if we paid for health outcomes, not procedures? What if time spent on relationship-building, education, prevention, and coordination of care was not just valued — but prioritized?
This isn’t just idealism. Models like value-based care, direct primary care, and integrated behavioral health show us that alternatives are possible. But to truly shift the system, we need to dismantle the RVU model and rebuild something more human.
Because healthcare should be about care. Not units. Not volume. Not profit margins. It should be about people.
And right now, the RVU system is standing in the way.
Want to stay in the loop as I unpack more about healthcare reform, burnout, and rehumanizing medicine? Subscribe and share if this resonated.