Salary & Contract Guide
The compensation and contract knowledge you need before signing your first attending contract. Salary ranges, what RVUs actually are, red flags that cost physicians thousands, and what's actually negotiable.
Understanding Physician Compensation
Physician pay is more complex than a single salary number. Here's how it actually works.
Base Salary vs. Total Compensation
- •Base salary is your guaranteed pay. Total compensation includes base salary PLUS bonuses, benefits, retirement contributions, CME, and other perks.
- •A job listing saying '$350,000 compensation' might mean $280,000 base + $40,000 productivity bonus + $30,000 retirement. Know the breakdown.
- •Ask for the total compensation breakdown in writing before signing. The difference between base and total can be $50,000-150,000.
- •Academic positions typically have lower base salaries but include protected research time, teaching, and better benefits packages.
What RVUs Are & Why They Matter
- •RVU (Relative Value Unit) is how physicians' work is measured for billing. Every CPT code has an assigned RVU value.
- •A typical office visit (99214) generates about 1.92 wRVUs. A complex visit (99215) generates about 2.80 wRVUs. Hospital admission (99223) generates about 3.86 wRVUs.
- •Most employed physicians have an RVU target (e.g., 4,500-6,000 wRVUs/year for internal medicine). Meeting or exceeding this triggers productivity bonuses.
- •The dollar-per-RVU rate varies by specialty and region. Internal medicine typically pays $52-53/wRVU. Psychiatry and orthopedics pay highest at ~$67/wRVU. Anesthesiology pays lowest at ~$43/wRVU. Medicare conversion factor for CY 2026: $33.40/RVU (standard). Source: MGMA 2025, CMS CY 2026 PFS.
- •Ask about what happens if you don't hit your RVU target. Some contracts reduce your salary. Others just withhold the bonus. This matters enormously.
Productivity Bonuses
- •Most employed positions offer bonuses above a baseline RVU threshold. For example: base salary covers first 4,000 wRVUs, then $50/wRVU for everything above.
- •Realistic bonus range: $20,000-100,000+ per year depending on specialty and work volume.
- •Some contracts use quality metrics (patient satisfaction, readmission rates, HEDIS measures) for a portion of the bonus. Understand the formula.
- •Be cautious of contracts where a large percentage of your compensation is 'productivity-based' with no guaranteed base. You need income stability in your first year while building a patient panel.
wRVU Benchmarks by Specialty (MGMA 2025)
Median wRVU production and $/wRVU conversion rates. Use these to evaluate whether your contract's RVU targets are realistic. Source: MGMA DataDive 2025, FastRVU.
| Specialty | Median wRVU | 75th %ile | $/wRVU |
|---|---|---|---|
| Family Medicine | 5,200 | 6,400 | $52 |
| Internal Medicine | 4,800 | 6,200 | $53 |
| Hospitalist | 4,800 | 5,700 | $61 |
| Cardiology (Invasive) | 9,200 | 12,000 | $58 |
| Cardiology (Non-Invasive) | 6,500 | 8,200 | — |
| Gastroenterology | 7,200 | 9,000 | $57 |
| General Surgery | 7,200 | 9,200 | $63 |
| Orthopedic Surgery | 7,800 | 11,200 | $67 |
| Dermatology | 6,200 | 8,200 | $58 |
| Psychiatry | 4,200 | — | $67 |
| Emergency Medicine | 8,200 | 10,500 | $47 |
| Anesthesiology | 9,000 | 11,200 | $43 |
| Radiology | 9,500 | 14,500 | $45 |
| Neurology | 5,500 | — | $53 |
Additional Compensation Components
Sign-On Bonus
$10,000 - $100,000+Almost always negotiable. Higher in underserved areas and for in-demand specialties. Usually requires 2-3 year commitment — if you leave early, you repay a prorated portion. Get the repayment terms in writing.
Loan Repayment
$0 - $200,000+PSLF (Public Service Loan Forgiveness): work at a 501(c)(3) employer, make 120 qualifying payments, remaining balance forgiven tax-free. Many academic and hospital systems qualify. Employer loan repayment programs: some offer $20,000-50,000/year toward loans. NHSC (National Health Service Corps): up to $50,000 for 2 years in underserved areas.
CME Allowance
$2,000 - $5,000/yearCovers conference registration, travel, and educational materials. Some employers offer $3,000-5,000 plus 5-7 days of CME time off. This is separate from vacation and often negotiable upward.
Relocation Assistance
$5,000 - $15,000Covers moving expenses for your first attending position. Some employers offer a flat stipend, others reimburse actual costs. Ask if it's taxable income (most is) and whether there's a repayment clause if you leave early.
Salary Ranges by Specialty (2025-2026)
Ranges reflect employed physician compensation in the United States. Private practice, academic, and locum tenens positions may differ. Data sourced from MGMA, Doximity, and Medscape surveys.
| Specialty | Range |
|---|---|
| Internal Medicine | $250,000 - $350,000 |
| Family Medicine | $230,000 - $320,000 |
| Hospital Medicine | $280,000 - $380,000 |
| Pediatrics | $220,000 - $300,000 |
| Psychiatry | $280,000 - $400,000 |
| Emergency Medicine | $300,000 - $420,000 |
| General Surgery | $350,000 - $500,000 |
| Cardiology | $450,000 - $700,000+ |
| Gastroenterology | $400,000 - $600,000+ |
| Pulmonary & Critical Care | $350,000 - $500,000 |
| Orthopedic Surgery | $500,000 - $800,000+ |
| Dermatology | $400,000 - $600,000+ |
Salary ranges are approximate and vary by region, practice setting, and experience. Verify current data with MGMA, Doximity, or Medscape salary surveys for your specific situation.
Contract Red Flags
These are the issues that cost physicians tens or hundreds of thousands of dollars. A physician contract attorney ($500-1,500) is the best investment you'll make.
Non-compete clauses with unreasonable scope
High RiskA 2-year, 30-mile non-compete in a major city is one thing. A 2-year, 50-mile non-compete in a rural area could mean you have to leave the state if the job doesn't work out. Some states (California, North Dakota, Oklahoma) don't enforce non-competes at all. Know your state's law.
Claims-made malpractice without tail coverage
High RiskClaims-made insurance only covers you if you have active coverage when a claim is filed. When you leave, you need 'tail coverage' to protect against future claims from past events. Tail can cost $30,000-100,000+. If your contract doesn't include employer-paid tail, you're on the hook. This is a dealbreaker issue — negotiate it upfront.
No guaranteed base salary (100% productivity)
High RiskNew physicians need 6-18 months to build a patient panel. A 100% productivity-based contract means you could earn very little in your first year. Insist on a guaranteed base for at least the first 1-2 years, with productivity kicking in after that.
Termination without cause with less than 90 days notice
High RiskSome contracts allow the employer to terminate you without cause with only 30 days notice. That's not enough time to find a new position, especially with credentialing timelines. Push for 90-180 day notice requirements, applied equally to both parties.
Restrictive covenant that extends beyond waiver obligations
Medium RiskFor J-1 waiver physicians: if your non-compete extends beyond your 3-year waiver period, you could be contractually trapped even after completing your obligation. Ensure the non-compete starts after the waiver period ends, or negotiate it out entirely.
No clear RVU bonus formula in writing
Medium RiskIf they promise a productivity bonus but the formula isn't in the contract, it doesn't exist. Get the exact threshold, the per-RVU rate, and the payment schedule (quarterly vs. annual) documented in the contract.
Excessively long sign-on bonus repayment period
Medium RiskA $50,000 sign-on bonus with a 4-year repayment obligation means you owe prorated repayment if you leave before year 4. Standard is 2-3 years. Anything longer is a yellow flag. Calculate the effective 'penalty' of leaving early.
What to Negotiate (And What You Can't)
Everything is negotiable until you sign. Here's what typically has room to move and what doesn't.
Base Salary
Usually NegotiableUsually has a defined range. Push to the top of the range with data from MGMA, AMGA, or Doximity salary surveys. Know the median for your specialty in that region.
Sign-On Bonus
Usually NegotiableAlmost always negotiable. Start by asking for more than you expect. Many employers have budget for this that they don't initially offer.
Loan Repayment
Usually NegotiableAsk even if it's not listed in the initial offer. Many employers will add $20,000-50,000 in loan repayment to close a deal. Document the terms clearly.
Start Date
Usually NegotiableYou can often push your start date by 2-4 weeks. This gives you time to move, decompress after residency, and prepare for credentialing. Take the break if you can.
CME Time and Funds
Usually NegotiablePush for 5-7 days and $3,000-5,000 minimum. Some employers will go higher. This is low-cost for them and high-value for you.
Non-Compete Clause
Usually NegotiablePush for shorter duration (1 year vs. 2), smaller radius (10-15 miles vs. 30), and carve-outs (academic positions, locum tenens, telemedicine). Some employers will remove it entirely if pressed.
Tail Coverage
Usually NegotiableIf on claims-made malpractice, insist the employer covers tail. This should be a non-negotiable for you. Walk away if they refuse and it's claims-made.
Benefits Package
Rarely NegotiableUsually standardized across the organization. Health insurance, dental, vision, disability, and life insurance are typically take-it-or-leave-it. Review what's included, especially disability insurance (own-occupation vs. any-occupation).
PTO in Year 1
Rarely NegotiableUsually set by organizational policy. Standard is 3-4 weeks PTO plus holidays plus CME time. Some employers allow negotiation of additional days, but most don't.
Call Schedule
Rarely NegotiableTypically determined by group structure and coverage needs. You can ask about it and factor it into your decision, but it's rarely negotiable for a new hire.
Key Takeaways
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