| SalaryDr | STATE OF COMPENSATION · OCTOBER 2026 Your 2027 pay is being set
in Washington this fall. Five policy shifts landing before January — and what each one means for your next contract. | NEW · SALARYDR FOR IPHONE Your market value.
Now in your pocket. Live specialty and state benchmarks, reported pay ranges and physician jobs — ready when the recruiter calls. |
| | Most of the conversation about physician pay happens at the negotiating table. But a lot of what ends up in your 2027 paycheck is being decided somewhere else entirely: in a CMS rulebook, a state legislature, and your hospital’s budget meeting. In July, CMS proposed the 2027 Medicare fee schedule. The one-year 2.5% bump Congress passed for 2026 expires Dec. 31, so the conversion factor drops 1.68% for most physicians. Stack that on the −2.5% efficiency adjustment already trimming work RVUs on most procedures, and the math behind your wRVU target quietly shifts. None of this is a line item in your contract. It shows up as a tougher renewal. Here’s what’s moving the numbers, and where you have more leverage than you think. |
| | −1.68% Proposed 2027 Medicare
conversion factor |
| −2.5% Efficiency cut to
work RVUs |
| −33% Medicare pay since
2001, inflation-adj. |
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| | | | What’s moving your pay Five forces to watch before your next renewal · Oct 2026 | HEADWIND Medicare’s 2.5% bump expires The one-year boost Congress passed for 2026 ends Dec. 31. CMS’s proposed 2027 conversion factor is $32.84, down 1.68%. The final rule usually lands in early November. Who it hits: Anyone billing Medicare |
| HEADWIND Procedures are worth fewer RVUs A −2.5% “efficiency adjustment” now trims work RVUs on non-time-based services, and CMS proposes paying a same-day visit plus procedure at 50%. Who it hits: Surgeons, proceduralists, radiology |
| HEADWIND Medicaid cuts reach hospital budgets Trinity Health expects a $1.5B hit from policy changes. Hennepin Healthcare and Alameda Health System have announced layoffs tied to Medicaid losses. Who it hits: Hospital-employed, safety-net |
| TAILWIND Primary care visits get a raise CMS proposes turning the G2211 complexity add-on into a 16% bump on every office visit, or 32% inside a Shared Savings ACO. Who it hits: Primary care, E/M-heavy specialties |
| TAILWIND Noncompetes keep falling, state by state The FTC dropped its national ban, but Arkansas, Colorado, Indiana, Montana, Oregon, Texas and others restricted physician noncompetes in 2025. Who it hits: Anyone weighing a move |
The practical move: ask whether your wRVU conversion rate adjusts when CMS revalues RVUs. If it doesn’t, the same work pays less every time Washington trims a code. The long game favors you, though: with Grad PLUS gone, federal med school borrowing is capped at $200K, about half the cost of a private MD. |
| | Where the ceiling is — and who’s exposed Median compensation · self-reported SalaryDr submissions, Sept 2026 | Specialty · typical range | Median | | Orthopedic Surgery $550K–$1.1M | $795K | | | Neurosurgery $520K–$1.0M | $750K | | | Cardiothoracic Surgery $480K–$950K | $680K | | | Cardiology $380K–$850K | $550K | | | Plastic Surgery $370K–$800K | $540K | | | Anesthesiology $380K–$700K | $535K | | | Radiology $350K–$650K | $485K | | | Urology $330K–$650K | $460K | | | General Surgery $320K–$700K | $450K | | | Dermatology $320K–$600K | $445K | |
Notice who’s at the top: procedural specialties. They earn the most, and they’re also the codes the efficiency adjustment targets. A high median isn’t the same as a protected one. |
| | The gap nobody likes to talk about out loud How much more specialists earn than primary care · Doximity 2026 Surgical specialists +90.1% over primary care
up from +87.3% |
| Non-surgical specialists +38.8% over primary care
down from +41.7% |
|
| The surgical premium widened after three years of narrowing |
Policy is now pushing the other way: the G2211 change and CMS’s call to “redesign primary care” both steer Medicare dollars toward office visits. Add that internal medicine, family medicine and pediatrics are three of the four most-recruited specialties, and 2027 may be primary care’s year to negotiate. |
| | Same specialty, different employer, different money Average compensation by practice setting · Doximity 2026 Single-specialty group $481K |
| Multi-specialty group $477K |
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| Solo practice $440K −3.8% YoY |
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Your setting decides how much of the policy weather reaches you. Hospital-employed physicians sit closest to the Medicaid cuts; independents absorb Medicare cuts directly, and solo practice fell 3.8%, the most of any setting. Also worth watching: a new Senate bill to ban private-equity ownership of practices. |
| | The part that doesn’t show up on a W-2 Doximity physician surveys, 2026 | 46% considering early
retirement (was 34%) |
| 44% likely to leave clinical
practice within 2 yrs |
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76% of physicians say they’d take lower pay for more autonomy or work-life balance. That’s not a reason to accept less — it’s a reason to price your time. If you’re going to trade dollars for control, know exactly how many dollars first. |
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| | Know your number before the final rule lands CMS finalizes the 2027 fee schedule in November. Look up reported pay for your specialty, state and setting now, while you still have time to use it. Or get the SalaryDr iPhone app → |
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