Fair isn't really the word I would use. Competitive among other specialists? Debatable. I've been out of residency since 2012. Signed a contract with a reasonable guarantee for the first 2 years then put on a base + production contract. Year 3 of my contract really, really sucked as I was still building my practice. This past year has been my best and I am still just at the national average among family docs. I'm seeing 85-105 patients a week, typically.
Yes, procedures and other ancillary things can help generate additional income but by and large in the standard FFS setting, we are a volume based business. The more butts you can move in and out, the more revenue you generate. We don't have any of the juicy procedures on our turf that make the boat and beach house payments. This automatically put us at a revenue disadvantage to the specialists because in the amount of time that it takes us to see 1 moderately complicated 4 month follow up, an orthopod has already seen 2 knees, GI has seen an IBS and a Chron's pt, Cards has seen 3 CHF-ers, Derm has seen 2 eczema and 1 funny-looking mole, and Peds has had 3 ADD f/Us. God help you if it's one of 'those days' and you've got a couple schedule busters (we all have them) or a few complicated hospital F/Us lined up. Looks like a short lunch and/or you're getting home a little late. 40 is a slow day in ortho. 40 would have me looking for another line of work.
Do I see this changing/improving in any way? Sadly, I don't. The current billing structure really hurts us, comparatively. If we could bill per problem addressed instead of a standard 213/4/5, 202/03, annual wellness then ok but we don't have that kind of lobbying power. They lob quality standards our way and advertise that as a way that compensation can improve but my finely tuned BS meter knows that's it's really only a tool to pay docs less. If it were truly an incentive system, then it would be purely a bonus based system, not one that came with penalty as well. Over the last several years, does anyone truly believe that things are vastly more complicated in a scheme to pay family docs (and all docs, for that matter) MORE money? There will never be any public outcry to pay those rich doctors more and it's certainly poor taste to complain.
DPC is a wonderful movement that has been happening and has been great for patient and doc satisfaction and cost control, but most of us are graduating with lots of dept, families and the need to make hay NOW. It's a deep sacrifice to try to make DPC work fresh out of residency.
Now, do I make BAD money? No way Jose. But I sure with I had more each month to kick in to those dang student loans....