The Family Medicine Rate & Negotiation Toolkit

What's Inside

Not "a PDF." Six specific tools:

1. Rate Benchmark Database

   Family Medicine rates by state and setting — urban clinic and rural/critical access — at the 25th, 50th, 75th, and 90th percentile. Fifty states. Includes FQHC and IHS rate context, which differ from standard locum placements.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The IMLC leverage script — how to price geographic flexibility (42 states, one license) explicitly
   • The rural premium script for CAH and frontier settings
   • The FQHC/IHS script, where the federal contract structure requires a different framing
   • The renewal script when they try to roll your old rate forward
3. Family Medicine Leverage Points

   The specific FM credentials and coverage capabilities that justify a higher rate:

   • IMLC compact license (42 states) is the strongest FM rate lever — price geographic flexibility explicitly; a recruiter filling a hard-to-staff rural slot pays a premium for a physician who can start without a new state application
   • OB-trained FM is the single most valuable credential for rural CAH assignments requiring labor and delivery coverage — worth $40–60/hr above the standard FM rate
   • POCUS certification is now standard in competitive urban FM locum markets and a differentiator at rural sites without dedicated ultrasound support
   • Frontier and IHS settings carry federal contract structures with different leverage dynamics — productivity benchmarks and rate structures differ from standard locum placements
4. Contract Red Flag Checklist

   Productivity requirements, patient volume caps, housing and travel stipend structure, malpractice coverage, and FQHC-specific scope restrictions. One page, annotated.

5. Agency Markup Framework

   FM locum placements often carry higher percentage markups than procedural specialties. Knowing the spread between your rate and the facility payment is the strongest anchor for any counter-offer.

6. Locum Tax Framework

   The 1099 math: S-corp threshold, Solo 401(k) gap, and the minimum premium to break even against an employed W-2 FM position — the comparison most physicians are actually making.

What It Looks Like on the Call

When a recruiter quotes $178/hr for a rural South clinic assignment, this is the sentence from Section 2:

"The rural FM median for this region is $192/hr. I hold an IMLC license covering 42 states and have OB training, which cuts your credentialing timeline. I'd expect to be in the $215–230 range for a rural critical access assignment. Is there flexibility before we get into scheduling?"

You change the numbers to match your state. You say it. That is the product.

Who Built This

For years I took every rate I was offered without pushing back. Not because I was naive. I didn't have the data to know whether I should. Neither did anyone I trained with. I built this because the information existed in federal wage surveys, peer-reviewed research, and 50 years of negotiation science, and it wasn't assembled anywhere a physician could use it before calling a recruiter back.

I started with surgery. Then I built the same data model and negotiation framework for the 22 specialties with the highest locum demand. The leverage points in each toolkit come from specialty-specific research. The scripts and the data are the same framework I use myself.

The agency has this organized. Now you do too.

— General Surgery MD

Verify the Premise Before You Buy

Call three locum agencies and ask what their bill rate is for family medicine. Write down how many give you a number.

That is the problem this PDF solves.

The Research Behind It

The economic analysis in this toolkit is grounded in Nobel Prize-winning research:

• Akerlof (1970, Nobel 2001): In markets where one side has better information, the uninformed party is systematically underpriced, not because they're naive, but because the market is structured that way.
• Spence (1973, Nobel 2001): Credentials only move your rate when the agency prices them. This toolkit shows you how to make that happen.
• Nash (1950, Nobel 1994): The fair split in any negotiation assumes equal information and equal skill. Neither assumption holds on a recruiter call.

The negotiation psychology section cites 17 peer-reviewed sources. This is not a blog post formatted as a PDF.

What It Costs in Context

• Consulting an attorney to review your locum contract: $350–$500/hr.
• Hiring a negotiation consultant: $3,000–$5,000.
• This toolkit: $99. One successful push adds $8,000+ annually.

One Honest Limitation

This will not help you if you are already negotiating above the 75th percentile for your specialty and state. If you don't know what percentile your current rate is, that is the problem this solves.

About the Data

Sourced from BLS OEWS public data and CMS geographic adjustment factors, processed through a locum-adjusted model. Not derived from agency-reported data.