State of Compensation — November 2026

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Here’s a number that should change how you walk into your next contract conversation.

SullivanCotter’s 2026 survey of about 235,000 physicians found median pay rose in every specialty group this year. Median work RVUs? Up no more than 2.8% in any group, and just 0.8% in primary care. MGMA saw the same split in 2025: pay up modestly, patient visits down in all 23 core specialties.

Translation: organizations aren’t paying you more because you’re producing more. They’re paying more because replacing you is slow and expensive. Nearly 65% plan to grow their physician headcount next year, and sign-on bonuses now reach nearly 95% of physicians hired.

That’s the part nobody likes to say out loud: if you haven’t benchmarked your pay since you signed, the market has probably moved without you. The math doesn’t work for long.

Know your number before they name theirs

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Where the ceiling is

Median compensation · SalaryDr approved physician reports, Nov 2026

The national median across all specialties is $450K, and every specialty on this list clears it. The catch is underneath. Procedural fields own the top of the table, and they’re also the services Medicare’s 2.5% “efficiency adjustment” trims. MGMA says it hits urology, interventional cardiology and diagnostic radiology hardest, which are already some of the hardest specialties to recruit. So your employer has to keep your pay competitive while your RVUs shrink on paper.

If you’re on a productivity contract, that’s the clause to reread. Ask whether your RVU targets get adjusted for the new values, or whether you’re quietly being asked to do more for the same bonus. And watch anesthesiology and radiology: pay there is up 12% to 18% since 2024 (SullivanCotter), and private groups that can’t match it are consolidating.

The gap that won’t close

Average compensation · Medscape Physician Compensation Report 2026

Both groups grew about 3% in Medscape’s survey, so the gap held steady in dollars. Only half of primary care physicians say they’re fairly paid. The quieter story: primary care has the weakest RVU growth of any group, yet its pay keeps rising. That’s scarcity pricing. If you’re a PCP, your argument at the table isn’t “I produce more.” It’s “you can’t replace me quickly,” and right now the data backs you up.

Where you work, and for how long

Median compensation by practice setting (top) and years in practice (bottom) · SalaryDr approved physician reports, Nov 2026

Private practice pays $120K more at the median than hospital employment, but that number carries overhead, call and business risk a W-2 doesn’t. The more useful comparison is inside your own setting: senior attendings report $175K more than those two years out. Meanwhile MGMA found most physician pay trailed inflation in 2025, so a “standard” 2% raise is a pay cut in real dollars. If that’s what you’ve been getting, it’s worth asking why. Each figure mixes every specialty, so compare within yours.

Who got the biggest raises

Median total cash compensation, 2025 → 2026 · SullivanCotter

Chronic-care fields are winning: SullivanCotter flags infectious disease, cardiology, endocrinology and hem/onc for sustained multi-year gains, as demand for long-term disease management outruns supply. Recruiting packages have grown with it. Nearly 95% of hires got a sign-on bonus, and 49% of organizations now offer student loan repayment. If your offer has neither, ask. The one soft spot is new hires’ base: MGMA found guaranteed starting pay for nonsurgical specialists fell 6.77% in 2025, so first offers deserve the most scrutiny.

The part that doesn’t show up on a W-2

Doximity Physician Compensation Report 2026

Here’s the pattern worth naming: burnout is often what finally gets a physician to negotiate, usually on the way out the door. Use the leverage while you still want the job. A call cap, protected admin time or a lower RVU target can be easier for an employer to approve than more money, and worth more than a 3% raise if you’re running on empty.

Before your next renewal

Three moves that cost nothing and use this month’s numbers.

Walk into renewal with numbers

CMS is due to finalize the 2027 fee schedule any day now. Check what physicians in your specialty, state and setting actually report, then decide what to ask for.

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