Am I underpaid as a doctor if my rate looks fine on paper?

Check the arithmetic, not the feeling: divide what each clinic actually paid you last quarter by every hour it consumed, clinical and administrative. If one site's figure sits far below the others, the contract is describing a job you are not actually working.

What should I do if my clinic pays me late?

If late payment is recurrent rather than occasional, treat it as a reliability problem, not a nuisance. Document expected versus actual payment dates and amounts, then use that record to renegotiate terms. If unreliability persists after a fair attempt, consider a staged exit.

How can I compare income across clinics without building a spreadsheet empire?

Three numbers per clinic, once a month: income actually paid, clinical hours, admin hours. One division turns them into comparable pay per true hour. Everything else can stay in the clinics' own systems.

Is my clinic worth the money if it pays well but generates constant prior auth?

A high nominal rate can be outweighed by heavy prior authorization and billing friction. If one clinic produces most of your weekly prior-auth hours, its friction-adjusted pay per hour can fall below more modest, lower-friction sites, making it a target for renegotiation or reduction.

How do I track physician payment problems without getting more burned out?

Aim for the smallest stable record: one short log per clinic for payment timing, and a monthly estimate of admin hours. Let the clinic systems hold the detailed billing data; you only need enough structure to see which sites quietly drain time and delay money.

Underpaid or Just Overloaded?

Underpayment, late payment, and plain overload feel almost identical from the inside, which is why so many doctors carry a steady sense of being shortchanged without ever being able to prove it. They are three different problems, though, and each asks for a different response. Telling them apart begins with refusing the one number everyone quotes.

Am I underpaid, or is the work just heavy?

The rate on the contract describes the visit, not the hours stacked around it. A time-and-motion study in Annals of Internal Medicine found that for every hour of direct care, physicians spend close to two more on the record and desk work during the day, and another one to two after hours. Any "pay per hour" that counts only the scheduled hour is therefore a comfortable fiction, and underneath it three things are usually tangled together:

The rate itself: what the clinic pays per visit, session, or shift.
Payment reliability: how fully and how promptly the money actually arrives.
Friction cost: hours spent on prior auth, documentation, inbox, and fixing billing.

Pulled apart, they stop hiding each other. A clinic that pays well but unreliably can drain you more than a modest one that pays on time, and a fair rate becomes a poor trade the moment every session drags unpaid admin behind it.

Why the headline rate lies

Three quick figures expose the gap between the money offered and the money kept:

Nominal pay per hour = contracted income ÷ scheduled clinical hours.
Realized pay per hour = income actually paid ÷ total clinical hours (including over-runs).
Friction-adjusted pay per hour = income actually paid ÷ (clinical hours + admin, prior-auth, and documentation hours for that site).

And the friction is not a rounding error. The AMA's 2024 survey found practices handle about 39 prior-authorization requests per physician each week and spend roughly 13 hours on them; when that weight lands mostly at one site, its friction-adjusted pay slides below your baseline while the contract still reads perfectly fine.

The same three clinics, side by side

Lined up, the gap is hard to miss. The figures below are an illustration, not data:

Metric	Clinic A (main)	Clinic B (satellite)	Clinic C (locum)
Nominal rate per hour	$220	$180	$160
Realized pay per hour	$215	$165	$155
Admin + prior-auth hours / week	4	9	3
Friction-adjusted pay per hour	$195	$135	$150
Payment reliability (1–5)	5 (on time)	2 (late/partial)	4 (mostly on time)

Clinic B is the trap. On paper its rate sits comfortably between the other two; in practice, once prior authorization and billing friction are counted, what it actually pays per hour drops below even the locum site. It is not "worth the money," and the contract is the last place that would have told you.

What to track, per site

You do not need a finance system, only a log honest enough to survive a renegotiation. For each clinic, across three to six months:

Open a simple log per clinic: date, expected amount, actual amount, status (on time, late, underpaid, disputed).
Once a week, estimate admin hours per site (documentation, inbox, prior auth, billing corrections).
Each month, divide income actually paid by total hours (clinical + admin) for each clinic.
Mark recurrent patterns: clinics with repeated late payments, underpayments, or disputes over at least three months.
Note the emotional load: whether unstable pay from a site is changing how you feel about your whole work.

Kept for a season, this sorts your sites into two honest piles: solid but heavy, and unstable even when the medicine is good. Money that arrives late or partial never behaves like money that arrives cleanly, and a record is what finally lets you treat it differently. It is the distinction Loguaron's monthly review is built to make.

When a clinic is no longer worth it

At some point the friction-adjusted number stops being a feeling and becomes a threshold. That is the moment to act on it rather than absorb it:

Decision rule. When friction-adjusted pay per hour at a clinic falls below roughly 70–80% of your median across sites for three consecutive months, and payment reliability scores 3 or lower on a 1–5 scale, treat that clinic as a candidate for renegotiation or exit. If payment is reliable, lead with a rate renegotiation backed by your record. If payment is unreliable, renegotiate rate and terms (timing, billing process). If that fails and the record shows ongoing loss, plan a staged exit, mindful of contracts and patient safety.

What changes the conversation is the record. "I feel underpaid" invites a shrug; "over the last four months my effective income here has been X per hour once prior auth and documentation are counted, against Y at my other sites, with Z invoices paid more than thirty days late" turns it into a shared problem with numbers attached. You are not asking for a favour; you are reporting a finding.

References

Sinsky C, Colligan L, Li L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine. 2016;165(11):753–760. acpjournals.org
American Medical Association. 2024 Prior Authorization Physician Survey. ama-assn.org
Office of the U.S. Surgeon General. Addressing Health Worker Burnout: Advisory on Building a Thriving Health Workforce. 2022. hhs.gov

Frequently asked questions

Am I underpaid as a doctor if my rate looks fine on paper?: You may be underpaid even with a decent contract if your effective pay per hour, after documentation, prior auth, and billing work, is much lower than your other sites. The only way to tell is to track true hours and friction-adjusted income per clinic over several months.
What should I do if my clinic pays me late?: If late payment is recurrent rather than occasional, treat it as a reliability problem, not a nuisance. Document expected versus actual dates and amounts, then use that record to renegotiate terms. If unreliability persists after a fair attempt, consider a staged exit.
How can I compare income across clinics without building a spreadsheet empire?: Three numbers per clinic, once a month: income actually paid, clinical hours, admin hours. One division turns them into comparable pay per true hour. Everything else can stay in the clinics' own systems.
Is my clinic worth the money if it pays well but generates constant prior auth?: A high nominal rate can be outweighed by heavy prior authorization and billing friction. If one clinic produces most of your weekly prior-auth hours, its friction-adjusted pay can fall below more modest, lower-friction sites, making it a target for renegotiation or reduction.
How do I track physician payment problems without getting more burned out?: Aim for the smallest stable record: one short log per clinic for payment timing and a monthly estimate of admin hours. Let the clinic systems hold the detailed billing data; you only need enough to see which sites quietly drain time and delay money.

Loguaron gives you a structured paper way to track pay and friction across sites, without adding screen time. The Loguaron workbook turns this analysis into six decision patterns, read from your own record. Run one week free → · See the workbook →

Related evidence: Burnout Is a System Signal →

Last reviewed: June 2026.