How practice leaders can rework physician pay without losing buy-in, with Monique Delgado

Hybrid models that blend a base salary with quality and other incentives now account for more than 75% of the physician compensation structures reported to the Medical Group Management Association (MGMA), according to its 2026 Provider Compensation and Productivity Data report. Pure salary and pure productivity models continue to lose ground.

The same report found physician pay rose in 2025 while productivity fell, with patient visits down in all 23 specialties tracked. Primary care physician compensation rose 2.23%, short of the 2.7% rise in inflation.

Monique Delgado, former CEO of Integrated Medical Services (IMS) in Arizona and current market president for the west region at Vytalize Health, presented a session on building value-driven physician compensation models Sept. 28 at MGMA's 2026 Annual Conference in San Antonio. She co-presented with Eric Passon, MBA, founder and CEO of the consulting firm Ancore Health.

IMS, one of the largest physician-owned multispecialty groups in Arizona, became an independent practice group in January 2023 and joined Privia Medical Group in 2025 while remaining physician-owned. Delgado has more than 25 years of experience leading medical groups and value-based care organizations.

Before IMS, she was Arizona market president for VillageMD, regional CEO at Wellvana and chief operating officer at Equality Health.

Physicians Practice caught up with her in San Antonio, where she explained how her group used a compensation committee and contract limits on pay changes to protect trust, why administrators should bring the data and let physicians lead, and where practice leaders should look first in their own finances.

Our conversation, lightly edited for length and clarity, follows.

Your session calls physician compensation one of the most underused tools an organization has. Could you explain what you mean by that?

Monique Delgado: Physician compensation is obviously one of the key line items, if you will, in a profit and loss (P&L) statement, so it's always something you have to manage if you want your practice to be profitable and scalable. There needs to be the right emphasis on physician compensation. You need to be market competitive to make sure you retain quality physicians, and that's why I think it's very important to a practice.

A lot of physicians like having a straight salary because it's predictable. Where does a salary-only model fall short, both for the organization and for the physician?

From an organization's perspective, you always have to look at productivity, and oftentimes the salary model just doesn't align with productivity. There's just no incentive there. It also flatlines earning potential for a physician or a provider.

So having a compensation model with a productivity element, or some other means for them to earn up, if you will, is very important for the physician and also for the group. When a physician or provider has better earning potential, that increases their earning ability, but it also increases revenue for the practice itself. So it's a win-win.

Your session talks about an organization that went from salary-only pay with no incentives to a model tied to performance. What pushed them to make that change, and how did physicians react?

I just want to clarify: Some of our providers or physicians were on a salary model, but the rest were already on a productivity model. Our story, where I was previously, was really about moving from an employee type of mentality or structure with a hospital system to independent physicians owning [the group] themselves, and then making sure the business was profitable while still having the right compensation for them as individual physicians or providers. That was really the impetus for the change.

It was a big change, but we needed it to make sure we were aligning compensation and our value-based incentives for our primary care physicians, so that we were performing in our contracts and performing financially as a sustainable practice.

When pay is tied to performance, what should physicians actually be measured on, and how do you decide what counts?

For us, and I would say maybe for any organization, you have to look at what your overarching goals are. We had very specific goals we were tracking to when we created our strategic plan. We created a five-year plan, and then we had very specific goals.

We wanted to be profitable. We wanted to be high-performing in our value-based and risk-based contracts. We wanted to make sure we were competitive so we could continue to grow, and we wanted to make sure we were creating value in the organization and investing in our infrastructure. We were expanding geographically, so we needed capital to continue to do that. That's what drove our model.

So initially, it's aligning on your goals. What is it that you're trying to accomplish? Then you align the compensation incentives and metrics with those goals. For instance, we wanted to be a high-performing value-based practice, so we had incentives that aligned with quality measures and annual wellness visits. We also had a profitability gate. We had things that ultimately aligned with the goals we were trying to accomplish from a specific metric standpoint.

How do you change the way physicians get paid without hurting trust with physicians or the culture of the group as a whole?

That's such a good question, and it's so important. We had created a structure within the group that included various committees and a board. We had a compensation committee, and we invited any of the providers in the group to participate in it to make sure there was a level of trust and transparency.

Our employment agreements also had clauses that said we couldn't change compensation more than once a year, so everybody at least knew it wasn't going to change more frequently than that. And if we did change it, we had to give them a minimum of 30 days' notice.

We sought out the feedback of all the different physicians and providers within our group, and we went through a very rigorous process. It was very transparent, and it was also documented. Then we met with each and every provider to go over what their compensation looked like before and what it was going to look like in the new compensation structure, so we had time for feedback and iteration if we needed it. I think that is very important.

And again, it's making sure everybody understood the why. Why are we doing this? Anchoring back to that helps create the right culture and makes sure we're building trust.

You describe compensation as something leaders should build with physicians, not hand down to them. What does that look like in a practice?

That is, I think, one of the most critical components. As an administrator, you're in a very bad position to say, "Your comp should be X, Y or Z." The physicians have to drive the conversation.

As administration or the finance team, we're there to show them the data and what it means: "OK, you want to pay physicians X? Then this is what it does to our bottom line. This is how it impacts us overall. Here are the positives and the negatives of that." I think that's our job as administration.

But the physicians really need to lead that conversation, because ultimately they're the ones who are going to have to get buy-in from their colleagues. So they have to believe in it themselves. If they're part of that process, if they've gone through the calculations, if they believe this is a fair, equitable and market-competitive salary, then those conversations are going to extend to their colleagues.

So to me, that's what it looks like: The physicians are actively engaged, participating and creating. When you're in the sausage making of whatever is calculated, what counts and how the model works, they need to be there as part of that process. Don't bring them in after it's all baked and you're trying to feed it to them. That often goes bad.

They're there from the beginning, they're there during the sausage making, and then they're there at the end to bring everybody else along.

What's one tip you would give a practice administrator that they could put into place first thing tomorrow?

Oh, first thing tomorrow. That's a tough one. For a practice administrator, I would say go back and look at your P&L and see where you have opportunity. When you're looking at compensation, that's always a hard one.

But if you're also looking at your top-line revenue, where you have opportunities to generate more revenue and where you have opportunities to decrease expenses, then you will likely have a better conversation, or you may not need to put so much weight on physician compensation as it pertains to your entire P&L, if you will.

So that's what I would say: Be very engaged in that, really look at it and see where you have opportunities. I think that went a long way with our physicians, to say, "Here are the things we, as administration, are doing to increase top line and decrease our expenses." Then it's a partnership, and you're not just asking physicians to take less money for the hard work they're doing.

We're here at MGMA's Annual Conference in San Antonio. What's been your highlight of the show so far, or something you're looking forward to the rest of the week?

We just finished our discussion at 8:30 this morning, and we had a lot of questions. So I'm looking forward to going to the other classes and learning what the trends are. I'm always interested in what's going on nationally and seeing what others are doing, so I'm excited to learn about that.

Physicians Practice was in San Antonio at the MGMA Annual Conference, Sept. 27-30, celebrating 100 years of MGMA, attending sessions and speaking with industry leaders. Follow our coverage on our MGMA conference page.