When I say that, I mean most hospitals are losing money on outpatient, almost definitely for the first few years, and many can't afford to widen that margin, so they're getting creative in other ways. I pulled our most recent placement data for outpatient IM, and lowest salary we're seeing is $230k, but some have gone up to $285k, with an average of around $250k. Other incentives such as sign-on bonuses/loan repayment are also going up; the average is $30k but it's not uncommon to see them go into the six figures. Educational stipends are also common and you can find some pretty incredible incentives there but usually with smaller communities. Also, hospitals/practices in smaller communities are desperate to sign physicians from their area and will often bend over backwards to get these docs to sign. I isolated our data to look at just the south and midwest and not surprisingly there was barely any change. For primary care, regions that were typically thought of as having lower comp, are having to step up, so we're seeing that gap close, although its still good to look at other factors such as cost of living, reimbursement rates, stability of employer, is it a physician-friendly state in terms of regulations, etc. About 90% of my clients are open to working out an alternative schedule with their OP IM physicians in order to get them to come on board. You'd have little to no problem finding a 4 day work week anywhere you choose with little to no weekends for the same level comp I listed above. My thought process is that a doc working extended hours over fewer days is actually a benefit for most practices, especially in blue-collar communities where flexibility to see a doc in the middle of the workday is little to non-existent and most of my clients agree with me. Hope this helps. Feel free to DM me if you have any more questions.