This analysis synthesizes 11 sources published the week ending Oct 5, 2026. Editorial analysis by the PhysEmp Editorial Team.
Two numbers from the same AMN Healthcare recruiting dataset move in opposite directions. The average signing bonus offered to physicians climbed to $49,306 from $38,215, and 87% of searches carried one, up from 74%. Over that same window, the share of contracts including a CME allowance fell to 58% from 90%, educational loan repayment slipped to 12% from 16%, and the portion of total compensation determined by quality metrics was halved, to 8% from 16%. More cash at signing, less of everything that recurs.
That pairing is the actual story inside this year’s benchmarks, and it changes how Physician Compensation & Demand data should be read. Average starting salary hit $419,000, cardiology and anesthesia posted another surge, and both facts are true without meaning that base pay broadly rose. Raises are increasingly arriving as one-time money and production upside. A percentile comparison cannot tell a candidate which of the two they were handed.
Where the raise actually comes from
Sixty-eight percent of physician contracts are now built on base salary plus a production bonus, up from 61% five years ago, and 65% of those bonuses run on RVUs — far ahead of net collections at 15%. Straight salary with no production component covers 26%, concentrated in urgent care, federally qualified health centers and academic settings, where average starting pay runs $362,000 against $452,000 outside academics. The $90,000 academic gap is partly a gap in how much of the paycheck is contingent.
MGMA’s data explains the employer logic plainly. Retired senior fellow David Gans told the association’s annual conference that productivity should be a group’s first strategic priority, and that production-linked pay reliably produces production. His benchmarks also show the spread that physicians inherit: in physician-owned practices, top-quartile primary care physicians generated more than 7,585 wRVUs while the bottom quartile produced fewer than 4,165. A near-2x range inside one specialty means the midpoint of any compensation table is a statement about volume, not about value. The negotiable terms are the conversion factor per wRVU, the target itself, whether APP-attributed work counts toward it, and how many exam rooms and support staff stand behind the number — top-quartile hospital-owned groups ran close to 0.8 APPs per physician and nearly double the wRVU output of the bottom quartile.
A signing bonus is the cheapest raise an employer can offer. It doesn’t reset base salary or compound into next year’s survey median, and it never shows up in competitor benchmarks. An $11,000 bump in average signing cash alongside a 32-point drop in CME coverage is a deliberate trade: durable compensation exchanged for recruitable compensation.
Procedural pay is outrunning procedural volume
Starting salaries rose 18.5% in gastroenterology to $654,000, 22.5% in urology to $638,000 and 20.9% in cardiology to $568,000, while orthopedics fell 12%, pediatrics fell 10.6% and internal medicine slipped 1.2%. SullivanCotter’s survey of 575 organizations and roughly 235,000 physicians shows the same tilt in total cash compensation: $608,633 for general cardiologists (up 8.7%), $787,304 for electrophysiologists (up 7.6%), $766,372 for interventional cardiologists after a 10.8% jump the prior year, with five-year gains of 23% to 25% across most cardiology subspecialties.
The productivity side did not keep pace. Cardiology wRVU growth lagged pay hikes, and median wRVUs for advanced heart failure specialists dropped nearly 4%. SullivanCotter’s Ted Tackett attributed the divergence to competition for talent rather than workload. That distinction matters at the negotiating table: when compensation outruns output, the physician holds the bargaining edge. But that premium is retention money, not earned volume — making it the first line item a finance committee revisits the moment hiring pressure cools.
A layer down, the anesthesia market shows the exact same scarcity play. CRNA median pay climbed 6.3% and certified anesthesiologist assistant compensation jumped 8.2% in a single year (up 30.2% over three), while hospital-based NP and PA wage growth cooled to roughly 2%.
Payer mix sits inside every wRVU target
A production-based contract transfers reimbursement risk to the physician, and 2027 is where that transfer gets tested. The proposed fee schedule cuts the conversion factor again and pays the less expensive service at 50% when an office visit is billed on the same day as a procedure with a global period. MGMA filed 32 pages of comments and took the fight to the Office of Management and Budget and the White House Domestic Policy Council ahead of the Nov. 1 final rule. Because Medicare operates under statutory budget neutrality, any adjustment redistributes dollars across specialties — creating immediate friction inside multispecialty groups that peg internal compensation to the schedule, as MGMA’s Anders Gilberg pointed out.
Practice leaders at the same conference described how that pressure plays out on the ground: an oncology group accepting only two Medicare Advantage plans to chase commercial volume, an Alaska practice unable to take new Medicare patients at all, and a San Antonio leader calling traditional Medicare her best payer. With Medicare Advantage now covering 55% of beneficiaries and commercial insurers routinely benchmarking fee schedules to CMS, panel mix quietly determines whether a wRVU quota is even attainable. Collections-based formulas add their own leak: the roughly one-point spread between physician-owned and hospital-owned adjusted collection rates drains about $10,000 per $1 million billed.
Metric assignment widens existing gaps further. Medscape’s data on nearly 6,000 physicians shows men far more often evaluated on RVUs (62% vs. 55%) and procedure counts (18% vs. 14%), while women are more often judged on quality (49% vs. 43%) — in the same year the quality share of compensation dropped to 8%. Female physician pay rose to $327,000, men averaged $429,000, and the gap widened for a third straight year to 31%, reaching 27 points in the South.
Equity audits that focus solely on base salary miss the mechanism entirely. When volume metrics fund the bonus pool while quality metrics represent just 8% of compensation, deciding who gets judged on production is itself the pay decision.
Who absorbs the coverage gap
Rural health systems are purchasing scarcity without the procedural margins to cushion it. In the MGMA, Jackson Physician Search and LocumTenens.com survey of 227 administrators and clinicians, 68% called family medicine capacity fragile or insufficient, with internal medicine at 76% and general surgery and OB/GYN at 61%. Sixty-five percent of rural clinicians said they lack adequate specialist and colleague backup, and 67% of those are at least somewhat likely to leave within two years, against 44% of those with backup. Locum tenens rated the strongest short-term bridge at 47% but was used in only 12% of openings; organizations leaned instead on physician-APP models (21%) and internal cross-coverage (18%), and only 25% of administrators ever quantified what a vacancy cost them.
Internal cross-coverage is quietly consuming paper gains. Taking extra shifts to patch local coverage yields far less net pay than posted rates suggest once higher tax brackets, 1099 payroll taxes, or income-driven student loan recalculations bite. Meanwhile, compensation consultant Jessica Minesinger points out that hospital call volume is increasingly slipped into contracts as an unpriced expectation rather than a billable duty. Rural contracts also remain the last redoubt for recurring perks urban systems have abandoned: 80.5% of rural physicians receive a CME allowance (at a $4,800 median), compared to 69% of urban physicians. Given that barely 6.7% of online job postings bother to list a CME stipend at all, the most straightforward differentiator sits ignored.
The CMS final rule arrives Nov. 1, locking in the next round of fee schedule cuts. But the immediate tension won’t be settled by regulators in Baltimore. It will be decided in hiring interviews where a candidate is handed a $49,306 check at the door, promised a production bonus tied to conversion rates that haven’t stopped falling, and handed a call schedule that nobody thought to put a price on.
Sources
Physicians’ starting salary reaches $419K: Breakdown of 14 specialties – Becker’s Hospital Review
Cardiology compensation climbs again: general cardiologists, electrophysiologists see biggest 2026 gains – Cardiovascular Business
Anesthesia pay accelerates as NP, PA compensation growth cools: 8 things to know – Becker’s ASC Review
SullivanCotter Report: NP and PA Compensation Growth Slows as Anesthesia APP Pay Accelerates – Business Wire (SullivanCotter)
Female physician pay is rising, but the gender gap is still widening: 10 things to know – Becker’s ASC Review
The New Age of Physician Contracts in 10 Numbers – Becker’s Physician Leadership
$4K CME perk missing from 93% of physician job ads – Becker’s Physician Leadership
Should You Pick an Extra Shift? It May Not Pay – Medscape
Make more money by making your doctors more productive, MGMA expert says – Medical Economics
Practice leaders describe turning away Medicare patients as pay lags behind costs – Medical Economics
New Research from MGMA, Jackson Physician Search and LocumTenens.com Gives Rural Health Leaders a Strategy for Sustaining Specialty Care – Business Wire (MGMA / Jackson Physician Search / LocumTenens.com)