A Physician's Guide to Salary Negotiation

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While ~75% of physicians are now employed by hospitals or large health systems, most are still negotiating salaries like it's 2015.

With the latest AMN Healthcare report showing a wide range of starting salaries between subspecialties, and the latest Doximity data revealing 3.6% compensation growth, physicians who understand current market dynamics and compensation structures can secure their worth.

Here's how to turn market knowledge into negotiating power.

Know Your Market Value

Physician compensation is shifting fast, and the differences between specialties are striking.

According to AMN Healthcare’s 2025 report, orthopedic surgeons are starting near $700,000, while internal medicine physicians average just over $270,000.

Geography adds another layer.

Doximity’s latest report shows Rochester, MN, St. Louis, MO, and Oklahoma City, OK leading on adjusted compensation, while physicians in Boston, DC, or Seattle may earn 15–25% less for the same work. Those adjustments can easily mean six-figure swings.

According to the latest AMN Healthcare Physician Compensation Report, starting salaries vary dramatically by specialty:

Top-Paying Specialties (2024-2025 Starting Salaries):

• Orthopedic Surgery: $686,000

• Gastroenterology: $531,000

• Urology: $496,000

• Radiology: $495,000

• Dermatology: $486,000

• Hematology/Oncology: $475,000

• Cardiology: $458,000

Primary Care Starting Salaries:

• Internal Medicine: $271,000 (up 6.7% from 2024)

• Family Medicine: $271,000 (up 6.7% from 2024)

• Pediatrics: $244,000

Other Key Market Sources:

1. HealthSalaries.com - Anonymous, physician-submitted salary data

2. Marit (marithealth.com) - Anonymous but verified physician salary sharing; Free access for verified clinicians

3. Doximity Compensation Reports - Annual comprehensive salary surveys; Metro area cost-of-living adjusted compensation

Understanding Comp Structures

While compensation for Relative Value Units (RVUs) dominate hospital employment, they’re far from the only compensation structure. Here are the most common models:

1. RVU-Based Pay

Productivity measured by work Relative Value Units (wRVUs), multiplied by a conversion factor (avg. $45–$65). Common in hospitals and health systems.

• Base + Production: guaranteed salary plus RVU bonuses above a threshold.

• Pure Production: entirely RVU-driven after an initial guarantee.

Sample RVU Benchmarks by Specialty:

• Family Medicine (hospital-owned): 4,715 annual wRVUs (50th percentile)

• Family Medicine (physician-owned): 5,945 annual wRVUs (50th percentile)

• Internal Medicine: Similar ranges, with hospitalists typically seeing 3,500-4,500 wRVUs

2. Salary-Only Models

Straight base salary with no productivity or volume incentives. These are more common in academic centers and government positions.

Simpler, but can lag behind market averages.

3. Collections-Based Models

Compensation tied directly to revenue you generate after overhead is deducted. Typical in private practices.

Incentivizes efficiency but can expose physicians to payer mix and collection risks.

4. Capitation or Value-Based Pay

Fixed payment per patient (per member, per month) with quality bonuses.

Growing in primary care and population health settings. Rewards preventive care and cost management, but requires strong systems support.

5. Hybrid Models

Many employers blend salary, RVUs, quality bonuses, and sometimes equity.

For example, a physician may receive a base salary, an RVU bonus, and an extra $10k annually for meeting patient satisfaction or quality metrics.

Understanding the different compensation structures available to you is important for weighing job opportunities, lifestyle, clinic productivity and more.

Advanced Negotiation Strategies for 2025

Phase 1: Market Research and Positioning 

Before any negotiation, compile your market intelligence:

• Pull specialty-specific data from multiple sources

• Calculate cost-of-living adjustments for your target location

• Research the organization's financial health and recent physician recruitment

Phase 2: Total Compensation Analysis 

Don't focus solely on base salary. Negotiate the complete package:

Base Compensation:

• Starting salary

• RVU conversion rates

• Bonus structures and thresholds

Sign-on Package:

• Average physician signing bonus: $31,103 (AMN Healthcare)

• Relocation allowance: $7,000-$20,000

• Student loan assistance: $15,000-$50,000 annually

• CME allowance: $2,000-$5,000

Long-term Incentives:

• Partnership track timeline

• Equity participation

• Retention bonuses

• Sabbatical opportunities

Phase 3: Leveraging Market Dynamics

Current Market Advantages:

• Physician shortage driving demand

• Competition for quality candidates

• Organizations struggling with retention

Negotiation Leverage Points:

• Multiple offers (or ability to generate them)

• Specialty-specific demand data

• Geographic flexibility

• Additional skills (telemedicine, languages, etc.)

Making the Right Choice For You

The “best” model depends on whether you prioritize stability, upside, independence, or flexibility.

Hospital Employment Advantages: Stable income with benefits, more admin support, malpractice coverage and lower business risk

Negotiation Focus:

• RVU conversion rates

• Base guarantee period

• Call schedule fairness

• Academic time (if desired)

Private Practice Employment Advantages: Partnership potential with a typically higher earning ceiling, more autonomy (for better or worse), practice ownership benefits

Negotiation Focus:

• Partnership timeline and buy-in terms

• Revenue sharing formulas

• Overhead allocation

• Payer mix and collection rates

Locum Tenens/Contract Work Advantages: Premium hourly rates ($150-$250+), geographic flexibility, no long-term commitments

Considerations:

• 1099 tax implications

• Benefit costs

• Malpractice insurance

• Irregular income flow

Action Items To Consider

Before Your Next Negotiation:

1. Review salaries, comp structures and bonuses on platforms like Health Salaries, Marit Health, and Doximity

2. Calculate your target compensation range based on job type, location

3. Research your target employer's recent physician recruitment

Week 2: 

1. Analyze total compensation beyond base salary

2. Prepare 2-3 comparable offers or market data points

3. Draft negotiation talking points for each component

4. Practice negotiation conversations with mentors

Month 1:

1. Initiate compensation discussions with confidence

2. Request 48-72 hours to review any offers

3. Counter with market-based justification

4. Negotiate non-salary benefits if base is fixed

Conclusion

The 2025 physician job market favors candidates who understand compensation structures and market dynamics.

With hospital employment dominating and RVU-based pay becoming standard (for better or worse), physicians must become better negotiators to achieve fair compensation.

Don't leave money on the table because you didn't understand your worth. Use the resources and strategies outlined here to negotiate compensation that reflects both your value and current market realities.

Remember that you’re the only person who can vouch for yourself, so equip yourself with the right knowledge prior to interviews.

Meme of the Week

Best,

M&H