No guessing. No spin.
The Internal Medicine Rate & Negotiation Toolkit
50-state rate data, word-for-word scripts, and contract checklist: everything you need before the recruiter calls.
Get the Toolkit — $99Instant download. No subscription.
Built by a physician. No staffing agency affiliation. No referral fees.
Market Snapshot
Is your current rate above or below the median? The full 50-state breakdown is in the toolkit.
This toolkit covers outpatient internal medicine — clinic-based locum work at FQHCs, VA systems, multispecialty groups, and rural primary care sites. If you are doing inpatient hospitalist work, the Hospitalist toolkit has the rate data and negotiation scripts for that market.
What's Inside
Not "a PDF." Six specific tools:
- Rate Benchmark Database
Outpatient internal medicine rates by state and setting — urban clinic and rural/FQHC — at the 25th, 50th, 75th, and 90th percentile. Fifty states. The number you need before you call the recruiter back.
- Recruiter Call Scripts
Word-for-word. The exact sentences:
- The opening anchor when you've received a below-market offer
- The patient volume cap script — define the daily ceiling before finalizing the rate
- The subspecialty premium script — how to state that cardiology or nephrology training changes the rate tier
- The APP supervision scope script — clarify co-signature expectations and liability before committing
- The counter when they say "this is our standard clinic rate"
- Outpatient IM Leverage Points
The specific credentials and contract terms that determine your real compensation:
- Daily patient volume cap is the most important clause in any outpatient IM contract — a $155/hr rate covering 30 patients per day is a fundamentally different arrangement than $155/hr covering 18 patients
- Subspecialty training (cardiology, nephrology, endocrinology) commands a 10-20% premium at sites where your background reduces downstream referral costs
- Procedure capability (joint injections, skin biopsies, stress tests) expands your eligible assignment pool and justifies a higher rate at sites that currently refer out
- APP supervision scope is the most commonly undisclosed workload obligation — clarify how many NPs/PAs you co-sign for and whether supervision time is on top of your patient load
- Contract Red Flag Checklist
Daily patient volume not capped, APP supervision scope not disclosed, RVU productivity penalties embedded, procedure expectations undefined, charting and EMR template requirements not specified. One page, annotated. Open it while reviewing any contract.
- Agency Markup Framework
The math behind what the clinic actually pays for your coverage. Outpatient IM generates revenue through visit billing, chronic care management codes, and downstream referrals. When you know the approximate bill rate, "that's our maximum" means something different.
- Locum Tax Framework
The 1099 math: S-corp threshold, Solo 401(k) gap, and the minimum premium required to break even against a W-2 employed outpatient IM position — accounting for benefits, malpractice, and CME.
What It Looks Like on the Call
When a recruiter quotes $140/hr for an outpatient IM clinic covering 25+ patients per day, this is the sentence from Section 2:
"The market median for outpatient internal medicine in this region is $152/hr. Before we discuss rate, I need to confirm the daily patient volume — I work to a cap of 20 patients per day, and I'd want that in writing. With my nephrology background and procedure capability, I'd expect to be in the $160-170 range. Can we structure it that way?"
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.
Verify the Premise Before You Buy
Ask the recruiter what the daily patient volume expectation is and whether APP supervision is included in the scope. Write down what they say.
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 volume cap negotiation changes your effective rate on every shift.
One Honest Limitation
This toolkit covers outpatient internal medicine. If you are doing inpatient hospitalist work, the Hospitalist toolkit has the rate data and contract language for that market. If you don't know what percentile your current outpatient 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.