Most U.S. doctors are paid a base salary plus bonuses tied to how much work they do, measured in RVUs. The full package also includes signing and relocation bonuses, money and time for continuing education, malpractice coverage, retirement contributions and sometimes loan repayment. This guide explains each piece and what to compare between job offers.
How much do doctors earn?
First of all, there is no official count of every doctor’s pay. Instead, the best-known figures come from surveys, which differ in who answers and how pay is counted, so each figure below names its source and year.
| Measure | Figure | Source |
|---|---|---|
| Average pay, primary care physicians | $298,000 | Medscape Physician Compensation Report 2026 (2025 pay) |
| Average pay, specialists | $417,000 | Medscape 2026 |
| Average starting salary offered to physicians | $403,000 | AMN Healthcare, 2025 Review of Recruiting Incentives |
| Gap between men’s and women’s average pay | 26% | Doximity Physician Compensation Report (2024 and 2025 pay) |
| First-year resident (PGY-1) average salary | $68,166 | AAMC Survey of Resident/Fellow Stipends, 2025 |
Meanwhile, pay has been rising slowly while productivity has fallen. MGMA’s 2026 report on 2025 data found median physician pay up across broad specialty groups, even though work RVUs fell in 16 of 23 common specialties.
How are doctors paid? The main pay models
| Model | How it works | Common in |
|---|---|---|
| Straight salary | A fixed amount, no matter how many patients are seen. | Government, some academic jobs, first years of a new job |
| Productivity | Pay = work RVUs × a dollar rate per RVU. | Hospital-employed and large group practices |
| Base plus productivity | A guaranteed base, plus a bonus for work RVUs above a target. | The most common employed model |
| Quality or value bonus | Extra pay for meeting quality, patient-experience or cost goals. | Added to most of the models above |
| Shift-based | A rate per shift or hour. | Emergency medicine, hospital medicine, anesthesia, locum tenens |
| Partnership (private practice) | Partners share what the practice collects minus its costs. New doctors usually start as employees for a few years, then may “buy in” to become partners. | Independent groups |
| Academic | A base salary from the university, plus clinical bonuses; part of the pay may depend on teaching duties and research grants. | Medical schools and teaching hospitals |
RVUs, explained
A relative value unit (RVU) is Medicare’s scale for how much work and cost each service involves. In fact, every billing code has three parts: the doctor’s work (work RVUs, or wRVUs), practice expense and malpractice cost. Then Medicare pays the total RVUs, adjusted for local costs, times a dollar “conversion factor.” For 2026 the conversion factor is $33.40, or $33.57 for doctors in qualifying alternative payment models. CMS also cut work RVUs by 2.5% for most services that aren’t billed by time.
In contrast, employers use only the work RVUs to measure a doctor’s productivity, and pay each one at a rate written into the contract. In other words, that rate is a private number, different from Medicare’s conversion factor.
Illustrative sample (not real pay data): a contract pays a $280,000 base for up to 5,000 wRVUs a year, then $55 for each wRVU above that. So a doctor who produces 6,000 wRVUs earns $280,000 + (1,000 × $55) = $335,000. In contrast, one who produces 4,600 may owe money back if the contract has a “clawback” clause, or see a lower base the next year.
Beyond the salary
| Item | What to know |
|---|---|
| Signing bonus | Averaged $38,215 for physicians in AMN Healthcare’s 2025 review. However, you usually have to pay it back if you leave before a set date. |
| Relocation | Averaged $12,619 (AMN, 2025). Also check whether it is a fixed sum or reimbursed costs, and whether it is taxed. |
| CME allowance | Money for continuing medical education: conferences, courses, journals and board review. Averaged $4,073 (AMN, 2025), plus a set number of paid days off for it. |
| Licenses, DEA and board fees, society dues | Employers often pay these, sometimes from the CME allowance. So ask which. |
Insurance, retirement and loans
| Item | What to know |
|---|---|
| Malpractice insurance | “Occurrence” policies cover any event during the policy, even if the claim comes later. “Claims-made” policies only cover claims made while the policy is active, so leaving the job needs “tail” coverage. So ask who pays for the tail, because it can cost a large share of a year’s premium. |
| Retirement | 403(b), 401(k) or 457 plans, and how much the employer adds (match) and how long until it is yours (vesting). |
| Loan repayment | Public Service Loan Forgiveness (PSLF) forgives federal loans after 120 qualifying payments while working full time for a government or nonprofit employer, including most nonprofit hospitals. The National Health Service Corps and state programs repay loans in exchange for working in shortage areas. In addition, some employers add their own repayment. |
| Call pay | Pay for being on call nights and weekends. Also check how often you are on call, and whether you get call pay on top of your salary. |
| Research, teaching and presentations | Academic jobs may give protected time (days without patients) for research and teaching, pay for conference travel to present papers, and support for publication fees. In other jobs, however, these usually come out of the CME allowance. |
| Leadership stipends | Extra pay for roles such as medical director or committee chair. |
How to compare job offers
Above all, two offers with the same salary can be worth very different amounts. So here are the questions doctors most often say they wish they had asked:
- The full math. Base, the wRVU target, the rate per wRVU above it, and quality bonuses. Is the target realistic for the clinic’s patient volume, and how does it compare with others in your specialty?
- How long the guarantee lasts. Many contracts guarantee pay for one or two years, then switch to productivity. Ask what doctors in year three actually earn.
- Clawbacks. Will you owe money back if you miss the target?
- Workload. Clinic hours, patients per day, inbox and paperwork time, and call frequency.
- Support. Nurses, medical assistants, scribes, and whether you get credit (RVUs) for work done with nurse practitioners or physician assistants you supervise.
- Patient mix. The share of Medicaid, Medicare and private insurance affects what the practice collects and, in private practice, what you earn.
Contract terms to check
- Non-compete clause. How far (miles) and how long you would be barred from practicing after leaving, and which locations it covers.
- Ending the contract. Notice needed to leave “without cause”, and what you owe back when you leave (signing bonus, relocation, tail coverage).
- Path to partnership, in private practice: when, how the buy-in is calculated, and what partners actually earn.
- Cost of living and taxes. The same salary goes much further in some places.
- Time off. Vacation, CME days, and parental and sick leave.
- Turnover. Ask how many doctors left in the last few years, and talk to some of them.
In general, many doctors start looking a year or more before finishing training. Finally, ask a lawyer who works with physician contracts to review the contract before you sign.
Non-competes in 2026
The Federal Trade Commission’s nationwide ban on non-compete agreements never took effect: a federal court set it aside in August 2024, and on September 5, 2025 the FTC dropped its appeals. However, the FTC says it will still challenge harmful non-competes case by case, especially in health care. As a result, state law now decides whether a non-compete can be enforced. For example, California, Minnesota, North Dakota and Oklahoma ban most non-competes, and several other states limit them for physicians. So check your state’s current law.
What residents and fellows earn
| Year of training | Average salary (2025) |
|---|---|
| PGY-1 (first year) | $68,166 |
| PGY-2 | $70,499 |
| PGY-3 | $73,301 |
Generally, every resident at a program earns the same salary for the same year of training, whatever the specialty. In addition, some programs allow paid extra shifts (“moonlighting”). Training takes three to seven years after medical school, plus one to three for a fellowship. Our FAQ covers the steps.
Sources
- Medscape Physician Compensation Report 2026, as summarized by Advisory Board
- AMN Healthcare, 2025 Review of Physician and Advanced Practitioner Recruiting Incentives, and its August 2025 release
- Doximity Physician Compensation Report, 2025 and its 2026 edition, as summarized by Advisory Board
- AAMC, Survey of Resident/Fellow Stipends and Benefits (2025)
- MGMA, 2026 Provider Compensation and Productivity report
- CMS, Medicare Physician Fee Schedule, CY 2026 final rule (conversion factors and efficiency adjustment), as summarized by Holland & Knight
- FTC non-compete rule: Greenberg Traurig, September 2025; Becker’s timeline
- Federal Student Aid, Public Service Loan Forgiveness; HRSA National Health Service Corps loan repayment
General information, not legal, tax or financial advice. Survey figures are averages and vary widely by specialty, place and employer.