One of the reasons I started salaryDr, was to collect enough data to truly understand a key question "Are physicians underpaid?". If you ask the general public, the consensus is usually a resounding "yes", but that is why we have data. It is through this data we can begin to understand, by how much physicians are underpaid, and WHY physicians are underpaid. The numbers are sobering: despite average physician compensation reaching $374,000 in 2024, only 48% of physicians report being satisfied with their pay, the lowest in a decade. Meanwhile, Medicare reimbursement cuts have totaled 33% since 2020, and CMS is proposing another 2.5% reduction for 2026.
The message is clear: waiting for the system to reward you fairly is no longer a viable strategy. Here's how to take control of your compensation in 2026.
1. Know Your Market Value With Physician-Specific Data
Most physicians enter negotiations blind. They rely on broad industry reports that blend MD data with APPs and nurses, producing numbers that dilute the true picture of what physicians actually earn.
Before any negotiation, arm yourself with specialty-specific, geography-adjusted benchmarks. The MGMA 2025 data shows median wRVUs for primary care physicians at approximately 5,700, surgical specialists at 8,000, and nonsurgical specialists at 6,800 in hospital-owned practices. Your employer will come to the table with this data—you should too.
The critical number to know: your conversion rate ($/wRVU). This varies dramatically by geography, with rural and underserved areas paying 10-20% more than urban markets. Academic centers typically pay 10-15% less than private practice or health systems. If you don't know how your rate compares to physicians in your specialty and region, you're negotiating in the dark.
2. Renegotiate Your Contract—Or Get Out of RVU Traps
The most common compensation model—base salary plus wRVU productivity bonus—is about to get more complicated. CMS's proposed 2.5% reduction in work RVU values for 2026 will mechanically lower your measured productivity even if your clinical effort stays exactly the same.
This affects radiologists, surgical specialists, and anyone whose service mix is dominated by procedures and imaging. If your contract ties compensation directly to wRVUs without adjustment mechanisms, you could see your bonus shrink through no fault of your own.
What to negotiate:
Review your production threshold. Most contracts set bonus compensation to kick in at 60-75% of specialty median wRVUs. Compare this to MGMA benchmarks. If your threshold is set at the 75th percentile when the median is standard in your market, push back.
Negotiate your conversion factor. This is where real money lives. A difference of just $5/wRVU translates to thousands annually for a typical physician.
Build in adjustment clauses. Protect yourself against Medicare valuation changes by negotiating for annual reviews or alternative metrics that blend productivity with quality measures.
Don't ignore the base. Your guaranteed base typically covers productivity at 50-70% of specialty median. Physicians often focus exclusively on bonuses while leaving base salary on the table.
3. What to Actually Say: Negotiation Scripts That Work
Medical school doesn't teach negotiation. Here are word-for-word phrases you can adapt:
When you receive an initial offer:
Thank you, I'm genuinely excited about this opportunity and enjoyed meeting the team. Before I accept, I'd like to discuss the compensation. Based on SalaryDr benchmarks for [specialty] in [region], and the scope of this role, I was expecting something closer to [specific number]. Can we discuss how to close that gap?
When they cite budget constraints:
I understand budget realities. If base salary is fixed, I'm open to discussing other ways to get there, whether that's a higher $/wRVU rate, a signing bonus, loan repayment, or adjusting the productivity threshold for bonus eligibility.
When asking about your conversion factor:
I'd like to understand how my $/wRVU compares to market. What data are you using to set that rate, and is there flexibility based on my experience level?
When negotiating RVU thresholds:
The production threshold for bonus eligibility seems high relative to medians. Given the ramp-up period most physicians experience in year one, can we discuss either lowering that threshold or guaranteeing the bonus for the first 12 months?
When they say the offer is final:
I appreciate the transparency. Before I make a decision, can you help me understand which elements have flexibility? I want to make sure we find something that works for both sides.
The golden rule: State your number, then stop talking. Silence is a negotiation tool. Let them respond.
4. Diversify Your Income Streams
With 38% of physicians now taking on additional work outside their primary role and 54% reporting they have a side hustle, non-traditional income isn't a "nice to have" it's becoming standard practice.
Telemedicine: 75% of physicians now use telemedicine, up from just 14% in 2018. Platform rates range from $40-$200/hour depending on specialty, with full-time telemedicine positions paying $150,000-$250,000. Psychiatry, internal medicine, family practice, and dermatology see the strongest demand. I've heard from Doctors in family medicine doing telemed full time earning well over $500,000/year.
Medical Consulting: Your expertise has value beyond the clinic. Expert witness work commands $300-$500/hour. Pharmaceutical and biotech companies pay well for clinical trial consulting. Health-tech startups actively recruit physicians to advise on product development and compliance.
Locum Tenens: Beyond the higher hourly rates, locums work often includes mileage, travel, meals, and lodging benefits. It's also a way to test different practice environments before committing.
5. Target High-Growth Specialties and Geographies
Not all compensation is created equal. In 2024, endocrinologists saw 7% pay increases, the highest across specialties, while dermatologists and neurologists experienced 5% and 3% declines respectively. Gastroenterology and endocrinology remain in "absolute demand."
Geography matters too. Midwest physicians average $385,000, consistently outpacing other regions. Rural and underserved areas offer not just higher base salaries but signing bonuses and loan repayment incentives. If you have flexibility, the math is straightforward.
6. Leverage Collective Intelligence
Here's what most physicians miss: you don't have to figure this out alone.
The physician who negotiated a $40K raise didn't do it by guessing. They knew what colleagues in similar situations actually made. They understood which employers are fair and which aren't. They had access to real negotiation tactics that worked.
This information exists—but it's scattered and often hidden behind professional awkwardness about discussing money. This is one of the issues we're helping solve by offering a community for verified physicians only.
The Bottom Line
In 2026, physician compensation won't increase meaningfully through passive waiting. Medicare cuts continue. Administrative burden grows. The physicians who see real income gains will be those who actively manage their careers: knowing their market value, negotiating effectively, diversifying income streams, and learning from peers who've done it successfully. The data is clear. The strategies are available. The question is whether you'll use them.
Ready to see what physicians like you actually earn and how they negotiated to get there?
SalaryDen is the physician-only community where you can anonymously discuss real salaries, see how colleagues negotiated their contracts, read employer ratings, and get feedback on your own offers. NPI-verified. Permanently anonymous.