2026 Physician Compensation Report

Compensation Trends

Salaries for physicians differ between specialty, region, gender, and other factors, and they don’t always increase.

Physician compensation continued its upward trajectory in 2025, though the pace of growth has moderated. Average compensation rose between 2.9% and 3.7% depending on the source, a meaningful deceleration from the 5.9% growth reported the year before. While compensation is rising on paper, physicians are feeling the effects of several consecutive years of high inflation, ongoing Medicare payment cuts, including another 2.8% cut in 2025, and increasing administrative demands that erode the real value of those gains.

Across all physicians, average total compensation now ranges from $374,000 to $485,000, depending on the methodology and whether the figure represents an average or median. Primary care physicians saw modest gains of 1.4%, reaching approximately $265,000, while specialists averaged $404,000 with an increase of just 1.0%.

Compensation by Region

Physician compensation varies significantly by region. The Midwest continues to offer the highest compensation, with the average physician earning $385,000, driven by shortages in rural and underserved areas that push salaries upward. Eastern states consistently rank lowest, largely due to higher concentrations of physicians and academic medical centers that exert downward pressure on compensation.

The variation can be striking within a single specialty. Median pay for neurosurgeons in the Midwest exceeds $959,000, while their counterparts in the East earn roughly $100,000 less. In contrast, urologists see relatively modest regional variation of less than $25,000 regardless of where they practice.

Metro Areas with the Biggest Salary Increases

This year saw a significant rebound in metro area salary growth compared to 2025, when over three-quarters of metros showed growth rates below 1%. In 2025, compensation rose in 54 of the 60 metropolitan areas examined, with about two-thirds seeing growth of at least 3%.

Austin, Texas led all metros with an 11.1% increase, followed by Kansas City at 10.0%. Several metros that appeared on last year’s lowest-paying list, like Rochester, MN, surged to the top of the highest-paying list with an 8.7% increase.

Metro Areas with High and Low Salaries

Rochester, Minnesota emerged as the highest-paying large metropolitan area in 2025, with average physician compensation of $495,532, an 8.7% annual increase. St. Louis ($484,883) held the second spot for the second consecutive year, followed by five California metros: Los Angeles, San Jose, Sacramento, San Diego, and Riverside, all clustered between $455,000 and $470,000. Charlotte and Nashville round out the top ten, both benefiting from rapid population growth and healthcare system expansion in the Southeast.

At the other end, the East Coast dominates the lowest-paying list. Durham-Chapel Hill ($324,088), New Haven ($340,251), and Boston ($360,422) anchor the bottom, driven by high concentrations of academic medical centers that exert downward pressure on average compensation. Washington, DC and Philadelphia also appear on the lowest-paying list despite being among the most expensive places to live in the country.

The gap between the highest and lowest-paying large metro areas is $171,000, roughly the cost of a medical school education. For physicians with flexibility in where they practice, geography remains one of the most powerful levers for increasing compensation.

The Big-City Premium Is a Myth. Physicians in smaller markets earn even more. Rockford, Illinois ($611,000), Springfield, Illinois ($610,000), and McAllen, Texas ($582,000) all outpay the highest large metro by 20–40%.

After adjusting for cost of living, the Midwest dominates. Rochester remains number one ($532,258 adjusted), followed by St. Louis, Oklahoma City, Omaha, and Kansas City. Boston and Washington, DC offer the lowest physician purchasing power.

Top Ten States with Highest Median Salaries for Physicians

Midwestern and Plains states dominate the top ten, with no East Coast or West Coast states making the list. North Dakota leads at $444,000 in pooled average compensation. Indiana, Wisconsin, and Missouri, all top-ten states in last year’s report, remain on the list.

*Indicates states that are new to the top ten for 2025.

States no longer in the top ten: Georgia, Connecticut, New Jersey, Florida, California, and Michigan.

Compensation by Specialty

Physician compensation varies dramatically by specialty, ranging from approximately $218,000 for some pediatric subspecialties to over $850,000 for neurosurgeons. Our pooled analysis covers 147 physician specialties, of which 119 have data from two or more independent sources.

On average, neurosurgeons, cardiovascular surgeons, and orthopedic subspecialists are the highest-paid physicians. A broad group of specialties earn between $500,000 and $650,000. Pediatrics, geriatrics, preventive medicine, and family medicine physicians all earn between $200,000 and $320,000.

The gap between the highest and lowest-paid specialties is more than $625,000, a disparity that has widened over the past several years. Surgical and procedural specialties continue to dominate the top of the earnings spectrum, driven by high gross billings to commercial payers and volume-based compensation models. Meanwhile, cognitive specialties like endocrinology, infectious disease, and rheumatology remain clustered near the bottom despite lengthy fellowship training requirements.

Specialties with the Biggest Salary Changes

Otolaryngology saw the largest increase at 36%, followed by cardiology at 18.8% and radiology at 11.3%. On the declining end, orthopedic surgery starting salaries fell 16%, neurology dropped 10%, and OB/GYN declined 4.5%.

Compensation by Gender

The gender pay gap in physician compensation widened for the third consecutive year. In 2025, the gap grew to 26%, up from 23% in 2024, with women physicians earning an average of $120,917 less than men after controlling for specialty, location, and years of experience. Over a 40-year career, this gap translates to more than $2 million in cumulative lost earnings for women.

The gap exceeds 11% in every specialty studied, with no exceptions.

Eighty-five percent of physicians report being overworked. Women physicians are disproportionately affected: 91% of women physicians report being overworked, compared to 80% of men.

Compensation by Employment Setting

Where a physician works matters almost as much as what they practice. Locum tenens physicians earn a median of $665,000, nearly 50% above hospital-employed physicians. The academic penalty is significant: academic physicians start approximately 25% below non-academic peers.

82% of physicians are now employed by hospitals or corporate entities. Solo practice recruiting has virtually disappeared at just 1% of searches.

Regardless of specialty, some employment settings consistently offer higher compensation than others. Single-specialty groups pay the most across all five of the highest-compensated specialties, with neurosurgeons in single-specialty groups earning a median of $920,000. Hospital and health system-owned practices rank second or third depending on the specialty, paying $540,000 to $870,000 across these five fields.

Physician-owned practices pay the least in every specialty examined, with a gap of $110,000 to $145,000 compared to the highest-paying setting. This may seem counterintuitive, as physician owners have historically earned more through profit-sharing. However, these figures reflect starting compensation, and physician-owned groups typically offer lower guaranteed salaries with the expectation that owners will earn additional income through practice distributions over time.

The variation between settings is remarkably consistent. In each of these five specialties, the gap between the highest-paying and lowest-paying setting is approximately $110,000 to $145,000, suggesting that setting-based compensation differentials are structural rather than specialty-specific.

Compensation Bonuses

Physicians continue to earn bonuses in both primary care roles and specialties.

Top Average Signing Bonus by Specialty

The average signing bonus was $38,215 in 2025, an increase of 21% over the previous year. Signing bonuses were offered in 74% of recruiting engagements, a record high.

Top Average Incentive Bonuses by Specialty

57% of specialists reported earning an incentive bonus. Amongst PCPs, 53% received an average incentive bonus of approximately $31,000.

Types of Bonuses Earned by Physicians

RVU-based compensation remains dominant at 65% of production bonus contracts, up from 57% the prior year. Quality-based metrics have declined to just 16%, down from a high of 64% in 2019/20.

Benefits on New Hire Offers

Most physician employment contracts include benefits beyond salary and bonuses. After several years of declining benefit offerings, 2025 saw a notable rebound. Health insurance was offered in 72% of recruiting engagements, up from 66% the prior year. Malpractice coverage (69%, up from 66%) and retirement benefits (61%, up from 56%) also recovered. CME allowances remain nearly universal at 90%.

The one exception to the upward trend is student loan repayment, which appeared in 16% of contracts, down slightly from 17%. Disability insurance held roughly steady at 65%, compared to 66% the prior year.

Despite these improvements, benefit offerings remain below their pre-pandemic highs. Health insurance, for example, was offered in 72% of contracts this year compared to over 80% five years ago. Organizations looking to differentiate their offers in a competitive market should consider the full benefits package, not just salary and signing bonuses.

CME Allowances by Practice Setting

CME allowances average $3,900–$4,100 and are offered in 90% of engagements. Relocation allowances averaged $12,619 (up 12%). Student loan repayment averages $104,200 and appears in 16% of contracts. Sixty percent of physicians have a non-compete clause.

Vacation, PTO, and Time Off

Physicians receive a median of 22 vacation days per year, but the reality is more complicated than the numbers suggest.

Research published in JAMA Network Open found that physicians who take five or fewer vacation days per year have significantly higher burnout rates, a finding with implications for retention and workforce sustainability.

Compensation Trends Summary

Here are some key takeaways:

• Primary care physicians earned an average of $265,000 in 2025, up from $260,000 in 2024. Specialists averaged $404,000.
• Neurosurgeons, cardiovascular surgeons, and orthopedic subspecialists are the three highest-earning groups, all exceeding $800,000 in pooled median compensation.
• The biggest salary increases were in otolaryngology (+36%), cardiology (+18.8%), and radiology (+11.3%).
• The gender pay gap widened to 26%, with women earning $120,917 less than men. The gap exceeds 11% in every specialty.
• Signing bonuses averaged $38,215 (up 21%) and were offered in 74% of recruiting engagements, both record highs.
• RVU-based bonuses remain dominant at 65%. Quality-based bonuses continue to decline, now at just 16%.
• Midwest and Plains states dominate the top 10 for physician compensation. Small markets pay 20–40% above large metros.
• Locum tenens physicians earn 50% above hospital-employed peers. Academic physicians start 25% below non-academic peers.
• 82% of physicians are now employed by hospitals or corporate entities.

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Hiring Trends

Hiring trends are changing with greater frequency as the population grows and health systems and practice models evolve. Different regions also require different specialties or primary care physicians.

We’ve compiled data from medical recruiting firms and other sources to create a breakdown of hiring trends based on specialty, region, and medical setting.

Hiring Trends by Specialty

Family medicine physicians remain the most-recruited type of physician for the nineteenth consecutive year. However, 78% of physician search engagements are now for specialists. When ranked by ‘absolute demand,’ hematology/oncology is the most in-demand specialty.

Hiring Trends by Employment Setting

Hospital recruiting accounted for 34% of search engagements, up from 28% the prior year. Academic medical centers also saw increased activity at 28%, up from 22%, with 89% of academic searches focused on clinical faculty, the highest percentage in the history of the survey. Medical group recruiting declined slightly to 24%, down from 26%.

The most striking shift is at the lowest percentages of the chart. Solo practice, partnership, and concierge practice recruiting collapsed to just 1% of search engagements, down from 6% one year prior and continuing a long-term trend toward consolidation. Today, 82% of physicians are employed by a hospital, health system, or other corporate entity, up from just 26% in 2012. Corporate-owned physician practices grew 86% between 2019 and 2022, driven largely by private equity acquisitions in high-revenue specialties like gastroenterology, dermatology, and urology.

For physicians evaluating opportunities, the practical takeaway is clear: nearly all new positions are now within larger organizations. The negotiation dynamics, contract structures, and compensation models in these settings are fundamentally different from private practice, making professional contract review more important than ever.

Projected Physician Shortages

The United States faces a growing physician shortage that will intensify over the next decade. The AAMC projects a shortage of up to 86,000 physicians by 2036, while HRSA projects an even more severe shortage of up to 187,130 physicians by 2037. If communities currently underserved by the healthcare system could obtain care at the same rate as populations with better access, the nation would need approximately 202,800 more physicians today.

Several factors are converging to drive the shortage. The population aged 65 and older is projected to grow 34.1% by 2036, and people in this age group visit physicians three times more frequently than younger adults. At the same time, more than one-third of currently active physicians will reach retirement age within the next decade. Burnout is accelerating those retirements: 68% of physicians say they are considering an employment change or early retirement.

One practical consequence is longer wait times. The average time to schedule a physician appointment in major metropolitan areas has grown to 31 days, a 48% increase since 2004 and a 19% increase since 2022 alone. In some specialties, the wait is even longer: OB/GYN appointments average 41.8 days, and dermatology appointments average 36.5 days.

Hiring Trends Summary

• Physician shortages continue, and workplace volatility and burnout are on the rise.
• Nearly half of all new physician searches took place to replace a departing physician, a 16% increase since 2018.
• Family physicians are still most-recruited by volume, but by absolute demand, Hematology/Oncology leads.
• The U.S. faces a projected shortage of 86,000–187,000 physicians by 2036–2037.
• Hospital and academic recruiting have surged, while solo/partnership recruiting has nearly disappeared (1% of searches).
• Physician appointment wait times have reached 31 days on average, up 48% since 2004.
• 70% of recruiting took place in communities of 100,000 or more, not just rural areas.

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Physician Satisfaction

Compensation is only one part of the picture. How physicians feel about their careers, how they spend their time, and whether they would make the same choices again all shape the healthcare workforce in ways that directly affect patient access and care quality. The data in this section paints a complicated portrait: physicians are working long hours, spending too much of that time on paperwork, and growing increasingly frustrated, yet the majority would still choose medicine if they had to do it over again.

How Many Hours Are Physicians Working?

The average physician works approximately 49 to 52 hours per week, though hours vary widely by specialty. Vascular surgeons work the most at 59 hours per week, followed by general surgeons (55 hours) and cardiologists (53 hours). At the other end, allergy and immunology physicians (39 hours), emergency medicine physicians (40 hours), and dermatologists (41 hours) work the fewest hours.

These figures tell only part of the story. More than 75% of physicians report spending additional time charting from home, with over 25% logging five or more hours per week on home documentation on top of their reported clinical hours. That means a cardiologist reporting 53 hours may actually be working closer to 58 or 60 when home charting is included. The average physician spends roughly 16 hours per week on paperwork and administration, but the burden falls unevenly. Physical medicine and rehabilitation specialists spend the most at 19 hours per week, followed by critical care at 18 hours and cardiology, endocrinology, and psychiatry at 16 hours each. Anesthesiologists spend the least at 9 hours per week.

These reported hours also undercount the true administrative burden. More than 75% of physicians report charting from home after their workday ends, with over 25% spending five or more hours per week on home documentation. When home charting is factored in, many physicians are working 55 to 65 hours per week in total.

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Are Physicians Happy?

Eighty-five percent of physicians report being overworked, up from 81% in 2025. The burden is not distributed equally: 91% of women physicians and 90% of primary care physicians report being overworked, compared to 80% of men and 84% of surgeons.

The consequences are showing up in career decisions. Sixty-eight percent of physicians say they are looking for an employment change or considering early retirement. Meanwhile, 77% say they would accept lower compensation in exchange for greater autonomy or work-life balance, up from 75% in 2025 and 71% in 2024. That three-year trend suggests this is not a passing frustration but a structural shift in what physicians value.

Eighty-nine percent of physicians say the physician shortage is already affecting their practice, with 21% describing the impact as “severe.” The shortage creates a cycle: overworked physicians burn out, burned-out physicians leave or retire early, and the remaining physicians absorb even heavier workloads.

Compounding the problem, Medicare reimbursement has declined 33% since 2001 after adjusting for inflation, with another 2.8% cut taking effect in 2025. Nearly 150 rural hospitals have closed in the last 15 years, and 17% of physicians have already reduced the number of Medicare and Medicaid patients they see.

Do Physicians Feel Fairly Compensated?

Only 47 to 48% of physicians feel fairly compensated for their work, the lowest percentage in a decade of surveys. Even among physicians whose income covers their living expenses, debt, and retirement savings, the sense persists that their compensation does not reflect the intensity and complexity of their work.

Compensation satisfaction varies sharply by specialty, and not always in the ways you might expect. Emergency medicine physicians report the highest satisfaction with their pay at 68%, despite earning less than many surgical specialties. Psychiatry (60%) and dermatology (58%) round out the top three, both specialties that offer relatively predictable schedules and strong work-life balance.

At the other end, nephrology (41%), endocrinology (42%), and infectious disease (42%) report the lowest satisfaction. These are specialties with high cognitive demands, complex patient populations, and compensation that has not kept pace with the workload. Notably, some of the highest-paid specialties are not the most satisfied: only 52% of orthopedic surgeons and 49% of urologists feel fairly compensated despite earning well above average, suggesting that compensation satisfaction is driven as much by workload and expectations as by the dollar amount itself.

Overall, fewer than half of all physicians feel fairly compensated, and 61% believe physicians are generally underpaid. One-third have already negotiated different compensation structures to improve their work-life balance, and another 36% say they would consider doing so.

Career Satisfaction by Specialty

Despite widespread frustration with the healthcare system, most physicians are satisfied with their choice of specialty. Plastic surgery leads with a 4.6 out of 5 satisfaction rating, followed by dermatology (4.5) and oral and maxillofacial surgery (4.5). The top of the list is dominated by specialties that combine strong compensation with schedule control and procedural variety.

The spread is notably narrow. The highest-rated specialty scores 4.6 and even the lower end of this list sits at 4.1. Most physicians who chose a specialty are reasonably content with that choice, even when they are frustrated with the system around them.

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Would Physicians Choose the Same Specialty Again?

Those satisfaction scores translate into action. Approximately 73 to 85% of physicians say they would choose to work in medicine again, and the majority are satisfied with their specific specialty. Pain medicine, addiction medicine, cardiothoracic surgery, and geriatrics all report 100% would-choose-again rates. Among larger specialties, ophthalmology (95%), gastroenterology (93%), urology (93%), and dermatology (93%) rank highest.

The specialties least likely to choose the same path are also some of the most essential. Only 61% of internal medicine physicians would choose their specialty again, and family medicine is close behind at 66%. These are the physicians who form the backbone of primary care, and their dissatisfaction has direct implications for access and workforce sustainability.

Best Work-Life Balance

The thread connecting satisfaction, specialty choice, and career longevity is work-life balance. Allergy and immunology physicians work the fewest hours at 39 per week, followed by emergency medicine (40 hours), psychiatry (41 hours), and dermatology (41 hours). These specialties appear consistently near the top of both satisfaction and would-choose-again rankings, reinforcing that manageable hours matter as much as compensation for long-term career satisfaction.

For physicians weighing a career change or evaluating their next contract, hours worked is often a better predictor of satisfaction than salary alone.

Physician Satisfaction Summary

• Physicians work 49 to 52 hours per week on average, but 75% also chart from home. Over 25% spend five or more hours per week on home documentation.
• The average physician spends 16 hours per week on paperwork and administration, ranging from 19 hours for PM&R specialists to 9 hours for anesthesiologists.
• 85% of physicians report being overworked. 91% of women and 90% of primary care physicians report being overworked.
• 68% are considering an employment change or early retirement. 77% would accept lower pay for greater autonomy or work-life balance.
• Only 47 to 48% of physicians feel fairly compensated, the lowest in a decade. Emergency medicine (68%) reports the highest satisfaction with pay; nephrology (41%) reports the lowest.
• 89% of physicians say the physician shortage is already affecting their practice. Medicare reimbursement has declined 33% since 2001 after adjusting for inflation.
• Despite the frustration, 73 to 85% of physicians would choose medicine again. Plastic surgery (4.6/5), dermatology (4.5/5), and ophthalmology (4.4/5) report the highest career satisfaction.
• Physicians receive a median of 22 vacation days per year, but only 30% fully disconnect from work during time off. Physicians taking five or fewer vacation days have significantly higher burnout rates.

The Rise of Locum Tenens

The frustration and burnout described in the previous section are not just abstract survey results. Physicians are acting on them. Locum tenens work, once viewed as a temporary fill-in arrangement, has become a deliberate career choice for a growing share of the physician workforce. The data explains why.

Locum Tenens Hourly Rates by Specialty

Sixty-three percent of physicians are currently doing or considering locum tenens work, up from prior years. An additional 40% of physicians report supplementing t77heir income through side work including locums, moonlighting, telemedicine, and consulting.

The financial incentive is significant. Locum tenens physicians earn an average hourly rate of $200 to $225, with some specialties commanding far more. Hematology/oncology locums earn an average of $405 per hour, gastroenterology $350, and interventional radiology $315. At the other end, pediatrics locums earn $60 per hour. Full-time locum tenens physicians earn a median of $665,000 annually, nearly 50% above hospital-employed peers.

The trend is about more than money. Seventy-seven percent of physicians say they would be willing to accept lower compensation in exchange for greater autonomy or work-life balance, up from 75% in 2025 and 71% in 2024. That steady three-year climb signals a fundamental shift in how physicians think about their careers. Forty percent use a locums company to find assignments, 25% find opportunities independently, and 35% do both. Eighty-five percent report they can work with multiple staffing companies, giving them flexibility to choose assignments that fit their schedule and preferences.

For healthcare organizations, locum tenens demand is both a symptom and a consequence of the physician shortage. Nearly half of all recruiting searches are to replace a departing physician, a 16% increase since 2018. As more physicians explore locums and flexible arrangements, organizations that cannot offer competitive compensation, reasonable workloads, and meaningful autonomy will increasingly struggle to recruit and retain permanent staff.

Locum Tenens Summary

• 63% of physicians are doing or considering locum tenens work, up from prior years.
• Locum tenens physicians earn a median of $665,000 annually, nearly 50% above hospital-employed peers. Average hourly rates range from $60 (pediatrics) to $405 (hematology/oncology).
• 77% of physicians would accept lower compensation for greater autonomy or work-life balance, up for the third consecutive year.
• 40% of physicians supplement their income through locums, moonlighting, telemedicine, or consulting.
• 40% use a locums company, 25% find opportunities independently, and 35% do both. 85% can work with multiple staffing companies.
• Nearly half of all recruiting searches are to replace a departing physician, a 16% increase since 2018. Organizations that cannot offer competitive compensation and reasonable workloads will increasingly lose physicians to flexible alternatives.

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The Bottom Line

The physician compensation landscape in 2025 is defined by a paradox. Compensation is rising, but physicians feel worse about it than at any point in the last decade. Signing bonuses and relocation allowances are at record highs, but so is burnout. The data tells a story of a profession under pressure from every direction: rising administrative burden, declining Medicare reimbursement, widening gender pay gaps, and a shortage that is projected to reach 86,000 to 187,000 physicians within the next decade.

The physicians who are thriving in this environment share a few things in common. They understand their market value. They negotiate their contracts with professional support. They evaluate opportunities based on total compensation, not just salary. And they make deliberate choices about setting, geography, and work-life balance rather than accepting the first offer that comes along.

Whether you are a resident evaluating your first contract, a mid-career physician considering a move, or an experienced practitioner weighing locum tenens against traditional employment, the data in this report gives you the foundation to make informed decisions. What you do with that data is up to you.

Physicians Thrive offers contract review, compensation benchmarking, financial planning, disability insurance, and retirement strategies built specifically for physicians. Reach out today.

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Ready to Negotiate Your Contract?

This report presents the latest insights into compensation and hiring patterns. But data alone doesn’t negotiate your contract, protect your finances, or secure your future.

85% of physician contracts are changed following professional review.

An experienced review results in an average compensation increase of approximately $25,000, a 25x return on the cost of the review. Over a multi-year contract, that single negotiation can be worth $75,000–$150,000 or more.

Physicians Thrive is the only physician contract review provider that gives you unlimited access to both a licensed attorney and a financial planner during the review and negotiation process.

For assistance in securing a contract review specialist, exploring retirement, financial planning, discovering innovative tax-saving strategies, or safeguarding your finances with disability or life insurance, reach out to Physicians Thrive today.

Sources for This Report Include

The figures in this report are pooled averages. Your individual compensation should reflect your specialty, experience, geography, and the specific terms of your contract. Every element of a physician employment agreement is negotiable, and the physicians who negotiate with professional support consistently come out ahead.

• Medical Group Management Association (MGMA) , 2025 Compensation & Production Report, Academic Survey, Starting Salary Survey
• Doximity , 2025 Physician Compensation Report (37,000+ surveys)
• Medscape , 2025 Physician Compensation Report (7,322 physicians)
• AMN Healthcare / Merritt Hawkins , 2025 Review of Physician and Advanced Practitioner Recruiting Incentives
• Physician Side Gigs (PSG) , Physician Salary Database (6,500+ data points)
• SalaryDr , 2026 Physician Compensation Data (3,337+ verified responses)
• Marit Health , Physician Compensation and Satisfaction Data (5,700+ submissions)
• Resolve rData , Physician contract data (116 specialties)
• Bureau of Labor Statistics (BLS) , Occupational Employment and Wage Statistics
• AAMC , Physician Supply and Demand Projections, 2021 to 2036
• HRSA , Physician Workforce Projections, 2020–2035
• Today’s Hospitalist Compensation and Career Survey
• Sinsky et al. , Vacation, Work During Vacation, and Burnout (JAMA Network Open)
• American Medical Association (AMA) , Medicare payment and practice ownership data
• Indeed , Physician salary data by state
• Salary.com , Physician salary estimates (employer-reported)