Family Medicine Contracts and Income

Most offers pay in two phases: a guaranteed base for the first one to two years, then production pay built on wRVUs, panel size, and quality bonuses. The guarantee is the ramp. The second phase decides your income for every year after it.

In production, you generate work relative value units, called wRVUs, for the care you provide. The employer sets a threshold, the production you must reach before production pay starts, and a conversion factor, the dollars paid for each wRVU above it. Your panel is the raw material: a larger panel means more visits and more wRVUs. Quality and value based bonuses layer on top, paid when your panel meets defined measures of care.

The numbers: The average starting salary is $291,000. The overall average is $288,000 and the median is $305,000, so half of family medicine physicians earn more than $305,000.

A starting offer at $291,000 is $14,000 below the $305,000 median, because $305,000 minus $291,000 is $14,000. Production and bonuses must add that gap for the job to reach the middle of the specialty.

Ask what panel you are expected to carry, how fast you must build it, and what you inherit on day one, and get all three answers in the contract. A physician who inherits an established panel produces immediately. One who builds from zero can hit the production start date with a panel still half built, through no fault of their own.

The written version should state the expected panel at full ramp, the timeline for reaching it, how new patients are assigned, and what happens if the panel builds slowly. Ask about composition too: a panel heavy with complex patients takes longer per visit and scores differently on quality measures than one of mostly well child and routine visits.

The formula is simple: pay above the threshold equals the wRVUs you produce above the threshold, multiplied by the conversion factor. Many offers state none of those numbers. Do not evaluate a production offer until you have the threshold, the conversion factor, the measurement period, and what happens to your base if you fall short.

Work it against the benchmarks. Offers anchored at the overall average of $288,000 and at the median of $305,000 differ by $305,000 minus $288,000, which is $17,000 a year, or $17,000 times two, which is $34,000, over a two year guarantee. Then ask the question that exposes any threshold: at what production level does this offer pay $305,000 in total? If the answer requires more production than the expected panel can generate, it is a lower paying job wearing a higher paying costume.

A quality bonus is worth only what its definitions say it is worth. In value based arrangements, part of your pay rides on how your panel performs on the measures the employer or the payer tracks. That can reward good primary care. It can also pay you for documentation patterns and attribution rules you have never seen.

Get four things in writing: the exact metrics, named in the contract or an attached exhibit; how patients are attributed to you; the measurement period and payout timing; and what you are paid if you leave before the payout date. Until the first payout has arrived, treat the bonus as possible income, not salary.

Every protection below fails the same way: it was promised out loud and never written down. Malpractice coverage should state who pays for tail coverage if you leave, because a claims made policy ends when the job ends. The noncompete should state its distance and duration, read against a map of where else you could work.

Call duties belong in the document: how call is shared, how often you can expect it, and whether obstetrics is part of the job. OB call changes the shape of your life more than almost any other term, and it should never arrive as a surprise. The sign on bonus needs its clawback read like a loan agreement: what triggers repayment, whether repayment is prorated or all or nothing, and when the clock starts and ends.

Rural family medicine pays a genuine premium: $343,000 on average against $288,000 overall, a difference of $55,000 a year. The rural range runs from $240,287 to $465,000, so the average is a benchmark, not a promise. Rural offers often add broader scope, more call, and OB duties, and the premium partly pays for that breadth.

These sites can also stack loan help on top of salary. At approved sites in shortage areas, the National Health Service Corps pays up to $75,000 in loan repayment, tax free, for a two year full time initial term, and many federally qualified health centers also qualify as PSLF employers. The full strategy lives on the family medicine student loans page. Under Section 127, an employer can also provide up to $5,250 a year in education assistance excluded from your income, which is $10,500 over two years at the full amount. Ask whether the offer includes it, in writing.

Put both offers through the same lines, in the same order, and let the totals argue. Guaranteed base and the length of the guarantee. Production: threshold, conversion factor, and the level needed to reach your target. Panel: expected size, ramp, and what you inherit. Quality: named metrics, measurement period, and payout timing. Call, including OB if any. Tail, the noncompete, and the clawback. A blank line is a cost you cannot see yet.

Now the salary shapes. Offer shape one is a metro employed job at the average starting salary, $291,000. Offer shape two is a rural job at the rural average total compensation, $343,000. The difference is $343,000 minus $291,000, which is $52,000 a year, and $52,000 times two, or $104,000, across two years, before either job pays a bonus. If the rural job carries the heavier call and the tighter noncompete, that $52,000 a year is what those things pay, and you can decide with open eyes whether the trade is worth it.

Choose the job you would still take if the sign on bonus were removed from both offers, then sign the one whose written terms match it.

Ryan Inman is a retired financial planner who worked with about 500 physician families. He created the Financial Residency podcast (about 3 million downloads) and is no longer affiliated with it. Financial Fellowship is his sole focus. This guide is educational. Last updated October 2026.