May 28, 2025
A negotiation success story for family docs who know their worth
By Andrew Dirmeyer, MD
The lunch was free, but the meeting was insulting.
My new employer invited the primary care doctors of our group to a meeting to reveal details of their compensation plan. It was a day I had eagerly anticipated. I expected an agreeable package that would end uncertainty and allow me to focus on patient care.
It was the worst meeting I have attended in my entire career. The first item on the agenda was an insult to every family doctor. The company planned to pay family physicians roughly $2 per relative value unit (RVU) less than the internists in our group. The difference wasn’t based on actions by insurance plans or other external factors. The health system’s plan would simply pocket more of the money generated by family medicine than it did from internists.
Their explanation was that family doctors make less money than internists.
I was so angry that I left work in the middle of the day and drove to the site where a competing medical group planned a new facility. I pictured myself practicing there. But leaving my practice wasn’t that simple.
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When I first came to this small town south of Knoxville, I worked for two other family doctors who were established in the community. A year later, we joined forces with other family doctors, internists and subspecialists to form a new medical group.
We worked on a productivity-based reimbursement model, and the compensation plan made no distinction between internists and family doctors. Why would it? Both specialties have three-year residency programs and requirements for board certification and CME.
More than a decade ago, our medical group was purchased by the community hospital, but we continued to enjoy a high degree of autonomy, and a productivity-based reimbursement plan based on RVUs. I was happy with that because I got paid the same whether I was seeing a patient who was on Medicaid, Medicare or commercial insurance. My income was based on productivity.
When our hospital ran into financial trouble, it found help from a private non-profit health care system. There’s no question this was the best outcome for the hospital and our community.
But was it good for me?
I’d spent three decades building relationships with patients, colleagues and staff. I was happy in my practice.
But things were changing. Choices were being made.
That other medical group? It was recruiting. It would be a logical choice. It’s focused on primary care, has done well with managed care and is offering good compensation.
So, why stay? If I were 10 years younger, I’d consider a move. But I’m 63. I might practice for five more years. Maybe less. I do have other things I want to do.
At the same time, I still love being a family doctor. I have found my place in the world. I enjoy my practice, my patients and my coworkers.
There were other leadership blunders in that infamous meeting. But it was the proposed pay differential that made me feel devalued. I could not come to work everyday thinking I’m worth less than someone with comparable training who is doing similar work.
So, I contacted the AAFP and asked for help. The Academy responded with some resources and talking points that I shared with my family medicine colleagues and our employer, which had based its pay discrepancy on Medical Group Management Association (MGMA) survey information.
That’s problematic given that the MGMA itself states that its data should not be used to justify compensation plans.
My family medicine colleagues stuck together, and our employer changed course. There won’t be a difference in pay between internists and family medicine doctors in our office. Some of my family medicine colleagues still plan to leave, and that’s fine. I’m staying here with my patients and staff.
If you’re an employed physician in a multispecialty setting, it’s worth asking your employer if there is a difference in the way family doctors and internists are paid. Or ask one of your internal medicine colleagues.
Exploring other practice opportunities gave us leverage, but ultimately our negotiation on this issue was successful because we were unified.