Which pay model should I pick in year one, straight salary, base plus bonus, or pure production?

What each model does to your risk

Straight salary pays the same in a slow month and a brutal one. The employer absorbs the census risk, the admission flow risk, and the ramp risk, and in exchange keeps the upside when you produce above the salary line. For a first attending job that trade is usually fair: your scarcest asset in year one is not income upside, it is information about your own production, and straight salary buys you a year of that information at no cost.

Base plus bonus splits the risk. The base covers your life. The incentive layer, usually wRVU based with a threshold and a conversion factor, pays when production clears the bar. This is the model most hospitalists will spend their careers on, and its fairness lives entirely in two numbers: where the threshold sits and what the factor is. The Marit Health internist data puts the median conversion factor at $48 per wRVU and the median annual volume at 6,000 wRVUs, so a threshold set near your realistic first year volume with a factor inside the market band is an honest formula. The conversion factor question on this site runs that math in full.

Pure production pays the most on average and the least predictably. Every wRVU of your income depends on a census you do not control, assigned by a hospital whose staffing decisions are not made for your benefit. Production also converts your colleagues into competitors for the same admission flow, which is a culture cost that never appears in the survey table.

The hospitalist wrinkle: your volume is assigned

Clinic physicians build panels and can grow volume with effort. Hospitalists receive volume. Your wRVUs are a function of the census cap, the admission rotation, the shift distribution, and whether the group staffs to demand or runs lean and pays the survivors in production. That asymmetry is why the year one answer differs from the career answer. A production formula that would be generous on a mature service can pay poverty wages during a slow ramp, a service line closure, or a season when the group over hires and splits the same census more ways. Ask anyone offering production in year one to show the group's per hospitalist wRVU distribution for the last two years, and price the offer at the median of that distribution, not the mean of the survey.

How to choose, and how to move later

In year one, rank the models by what they guarantee. A straight salary at or near the market median, which Marit Health puts at $312,760 for internists, with a written conversion path to an incentive model once your volume is known, is the strongest structure. Base plus bonus is a close second when the threshold is set below your expected ramp volume and the factor is at or above $48. Pure production in year one is a bet you are placing on a census you have never worked. Take it only at a factor well above the band, with a first year floor written into the contract, because the floor is what converts the bet back into a salary while you learn.

Whatever you choose, get the model change rules in the contract: when the formula is recalculated, what data it uses, and whether the employer can change the factor or the threshold mid term. Models drift in the employer's favor when the contract lets them.