How does panel size drive a primary care physician's pay?

Through one chain of arithmetic: panel becomes visits, visits become wRVUs, and wRVUs above the threshold become pay. In a production based primary care contract, your income is your panel's output multiplied by a conversion factor the Marit internist data puts at a median of $48 per wRVU, with a median annual volume of 6,000 wRVUs producing $288,000 of gross production value. A panel still filling produces a fraction of that, which is why the guarantee period and the ramp, not the factor, decide what a new primary care physician actually earns in years one and two. The physicians who get hurt in primary care are rarely underpaid on rate. They are underpaid on inheritance: an empty or departing panel, a production clock that starts before the patients arrive, and a threshold set for a physician who was already full.

Part of the internal medicine hub.

The chain, link by link

Start with the panel itself, and get its size from the clinic in writing. Your contract will not use the word panel half as carefully as it should. What the contract prices is production: the wRVUs your visits, procedures, and complexity generate across the year. The Marit data gives the specialty's center of gravity, a median of 6,000 wRVUs a year at a median conversion factor of $48, for a median salary of $312,760. That is the production of a mature, full panel worked at a full schedule. Every offer should be tested against it: what volume does this panel, in this clinic, with this payer mix, actually produce in year one, year two, and at maturity?

Then the threshold. Most formulas pay a base salary against a production threshold and convert wRVUs above it at the factor. A threshold set at 6,000 wRVUs on a panel that will produce 4,200 in year one pays no production at all in year one, whatever the factor promises. The question that exposes any formula, from the contracts page: at what production level does this offer pay the median? If the answer requires the panel to be full and the schedule to be perfect, the offer pays the median in the brochure and something far below it in the deposit.

The inheritance questions that decide your first contract

Ask what panel you inherit, in numbers. How many patients are assigned on day one, whose are they, and why are they available? A panel vacated by a departing physician arrives with its complexity and its refill queue intact and starts producing immediately. A panel built from new patient demand produces slowly, and the clinic's marketing claims about unmet demand are not a ramp schedule. Ask how new patient assignment actually flows, what share of new requests the last hire received, and how long the last hire took to fill.

Ask how the ramp is priced. The protections that matter are a guarantee period long enough to reach a mature panel, a threshold that is reduced or prorated during the ramp, and quality or panel management payments that do not depend on production volume while the panel is young. Ask when quality metrics begin and what they pay, because in primary care those definitions carry real money and are often the difference between two otherwise identical offers. The wRVU conversion factor question in this bank works the factor itself, and the internal medicine contracts page puts the whole panel formula through the offer comparison.

Panel pay against the hospitalist alternative

Many internists weigh this job against hospitalist work, and the comparison has a shape worth naming. The hospitalist job pays from the first shift: the self reported hospitalist average is $314,000, earned on a block schedule with no panel to build. The panel job starts lower and aims at ownership of something durable: a patient base that produces every year, grows more efficient as it matures, and in group practice can carry equity value the hospitalist job never builds. The hospitalist to primary care question in this bank works the transition math in full. The short version: the panel job's early deficit is an investment only if the contract's ramp terms protect it. Without them, it is just a pay cut with a story attached.