Whether you're a med student picking a specialty, a resident planning your future, or an attending negotiating your next contract — you need to know what doctors actually earn. Not what the internet says. Not what your program director hinted at. Real numbers.
This guide breaks down physician salaries by specialty, setting, and location, with the context you need to make informed decisions about your career and money.
Quick Reference: Average Physician Salaries by Specialty
| Specialty | Median Salary | Range | Training Years |
|---|---|---|---|
| Plastic Surgery | $650,000 | $380K–$1.3M | 6-8 |
| Orthopedic Surgery | $600,000 | $420K–$900K | 5-7 |
| Cardiologist | $550,000 | $380K–$800K | 6 |
| Dermatologist | $510,000 | $380K–$750K | 4 |
| Gastroenterologist | $500,000 | $380K–$700K | 6 |
| Anesthesiologist | $475,000 | $380K–$650K | 4 |
| General Surgery | $425,000 | $320K–$580K | 5 |
| OB/GYN | $355,000 | $270K–$530K | 4 |
| Emergency Medicine | $340,000 | $270K–$480K | 3-4 |
| Psychiatrist | $335,000 | $240K–$530K | 4 |
| Internist | $280,000 | $220K–$400K | 3 |
| Family Medicine | $270,000 | $220K–$380K | 3 |
| Pediatrician | $255,000 | $200K–$380K | 3 |
Source: MGMA 2026 Data, Medscape Physician Compensation Report 2026. Ranges reflect geographic variation, experience, and practice setting.
What Actually Affects Your Salary
Here's what moves the needle, and what doesn't matter as much as you think.
What Matters A LOT
1. Specialty Choice
This is the biggest lever. The difference between family medicine ($270K) and plastic surgery ($650K) is over $380K annually. That's $10M+ over a career. Pick early.
2. Practice Setting
- Academic: Usually 20-40% below market. Trade money for schedule, benefits, and mission.
- Private practice: Highest earning potential, but you need to buy in, manage a business, and carry overhead.
- Hospital-employed: Middle ground. Guaranteed salary, often with RVU bonuses. Most residents end up here.
3. Geographic Location
States with no income tax (TX, FL, WA) don't automatically mean higher take-home — but they do mean more competition for positions. Rural areas pay 10-30% premiums. The math: higher salary + lower cost of living = real wealth building.
4. RVU-Based Compensation
Most attending contracts are salary plus RVU bonus. If you're on pure RVU, you eat what you kill. Understand your contract:
- What's your base salary?
- What's the conversion rate ($/RVU)?
- What's the wRVU threshold for the bonus?
- Is there a collar (minimum guarantee regardless of production)?
Learn how to track your RVUs →
What Matters LESS Than You Think
Board certifications are nice for credibility, but the salary difference is marginal (maybe 5-10%). Experience matters more.
Fellowship is only worth it if you're passionate about the subspecialty. The opportunity cost is 1-3 years of attending salary (~$500K-$1.5M lost). Don't do it for money alone.
The Resident Salary Reality
Here's what you're actually earning during training:
| Year | Approximate Salary |
|---|---|
| PGY-1 | $64,000-$74,000 |
| PGY-2 | $66,000-$76,000 |
| PGY-3 | $68,000-$79,000 |
| PGY-4+ | $70,000-$85,000 |
| Fellow | $74,000-$95,000 |
Add $5-10K for cost-of-living adjustments in high-col areas (NYC, SF, LA).
The Hidden Costs of Residency
- Delayed retirement contributions (opportunity cost: ~$100K-300K in compound growth)
- Lost years of attending salary
- Board exam costs ($3K-10K per step)
- Interview travel ($5-15K across 4 years)
Compensation Models You Should Know
Understanding how you get paid is just as important as the number. Here's the breakdown:
1. Base Salary Only
Guaranteed income. No risk, no reward. Common in academic settings.
2. Salary + RVU Bonus
The most common model for hospital-employed physicians. Base salary (often 60-80% of total comp) + bonus once you hit RVU thresholds.
3. Pure RVU / Collections
You eat what you kill. High upside, high risk. More common in private practice.
4. Hybrid Models
Base + RVU + quality metrics + patient satisfaction. Increasingly common as health systems push value-based care.
Deep dive on compensation models →
How to Negotiate Your First Attending Salary
Don't leave money on the table. Here's what to push for:
1. Base Salary
Get it in writing. Compare to MGMA benchmarks for your specialty and region. If they're 20% below, ask why.
2. RVU Bonus Structure
- Conversion rate: Know your $/wRVU. (e.g., $50/wRVU means a 99214 [~1.5 wRVU] pays $75 per encounter)
- Bonus threshold: What RVU number triggers the bonus? Aim for reasonable.
- Collar: Minimum guarantee even if you don't hit RVU targets (critical if you're new).
3. Signing Bonus
$10K-$50K is common. Negotiate this, it's often easier than base salary.
4. Student Loan Repayment
Some employers offer $20K-$50K/year toward loans. Ask.
5. Relocation
$5K-$15K is standard. Don't foot this yourself.
6. CME Time & Budget
Don't overlook this. 5-10 days + $3K-$5K annually is reasonable.
The Bottom Line
Physician compensation is complex — but it doesn't have to be mysterious. Your specialty choice is the biggest factor (~$380K+ difference between lowest and highest paid). Your contract structure matters almost as much as the headline number.
Don't just chase the highest salary. Factor in:
- Cost of living
- Call schedules
- Work-life balance
- Career trajectory
- Location flexibility
Money matters — but so does your sanity.
Want to track your RVUs and ensure you're getting paid what you're worth?
RVU Tracker helps you log every encounter, track your productivity, and reconcile with your employer's reports.
Try RVU Tracker Free →Need to look up RVU values?
Use our free RVU Calculator → Instant lookups for any CPT code.
Questions about a specific specialty or contract term? Email us at support@rvutrackerapp.com — we read every response.