10 highest-paid physician specialties in 2026

Physician pay is up again in 2026, and for the first time in a few years, doctors mostly feel all right about it. The average physician now earns about $386,000 in total compensation, a roughly 3% gain over the prior year, according to Medscape's 2026 Physician Compensation Report, which surveyed 5,916 full-time U.S. physicians between September and December 2025. More than half, 53%, said they feel fairly paid, up from 48% a year earlier and the highest reading in three years.

The headline number, though, is close to meaningless for any individual physician, and the deeper you go, the more interesting the picture gets. There are two major trends are happening at once: raises are barely outrunning inflation, and, for the first time in years, physicians are earning more while doing less measured work. That second point is the one practice leaders should be watching.

A modest raise, unevenly shared

The 3% average hides a spread of more than half a million dollars between the top and bottom of the profession. Primary care physicians averaged $298,000; specialists averaged $417,000. In Doximity's most recent report, the average neurosurgeon earned $749,140 while the average pediatric endocrinologist earned $230,426, a roughly $519,000 gap that tells you almost nothing useful about either doctor's pay.

There is, at least, a slow convergence underway.

Doximity found surgical specialists earned 87% more than primary care physicians in 2024, down from 100% two years earlier. The gap is still enormous, but it is no longer widening, and primary care compensation has now risen for four consecutive years, according to the Medical Group Management Association (MGMA).

Pay and productivity part ways

The most striking finding of the year comes from MGMA, whose 2026 data, drawn from medical groups rather than from physicians themselves, shows median total compensation climbing in 2025 even as work RVUs fell in 16 of 23 common specialties and total patient encounters fell in all 23. For the first time in several years, the productivity that has historically driven physician pay moved in the opposite direction.

Andy Swanson, chief customer success officer at MGMA, told Physicians Practice the split is less contradictory than it looks.

“While encounters are down, those patients that doctors are seeing actually have higher acuity and a little bit more complexity,” he said. “Perhaps what's going on is that we are moving lower-acuity patients to our [APPs] and non-physician providers ... and physicians are seeing the right level of care.”

Compensation, meanwhile, rose by roughly 1.5% to 3% depending on specialty, real growth, but less than the roughly 3% rise in the consumer price index over the same stretch.

Swanson is cautious about whether that can hold. “In theory, pay can't keep going up and up and up while production goes down. It's one year, so I want to be cautious,” he said. The deeper pressure is cost: “If cost continues to go up, including salaries, but reimbursement continues to stay flat or negative compared to consumer price index increases and inflation, then no, things are not sustainable.”

Any practice that ties physician compensation to productivity should understand which way its own numbers are moving before the next contract cycle.

The specialties pulling away

Orthopedics again led all specialties at $611,000, the only field averaging more than $600,000.

Cardiology posted the largest raise of any specialty at about 10%, landing at $575,000 on the strength of procedural volume, imaging and a growing cardiovascular patient population.

Radiology, at $571,000, is arguably having the strongest moment of any specialty, and the demand is reshaping even fields long insulated from it.

Tynan Kugler, a principal at PYA, said supply-and-demand pressure has reached specialties that never used to feel it. Hospital-based fields such as anesthesiology and radiology, she told Medical Economics, are “needing financial assistance for the first time in that specialty's history,” a striking marker of how far demand has outrun supply for the physicians who staff operating rooms and read scans.

Where the raises reversed

Seven specialties saw average pay decline year over year: psychiatry and allergy and immunology, both down about 3%; pulmonary medicine and oncology and hematology, down about 2%; and physical medicine and rehabilitation, nephrology and dermatology, down about 1% each. A specialty's payer mix and its exposure to Medicare's shifting fee schedule can matter as much as its procedure list in any given year.

Primary care's crosscurrents

For the primary care physicians who make up most of this audience, the 2026 picture is genuinely mixed, and, unusually, some of the news is good. Averages still sit near the bottom of the specialty table: family medicine at $288,000, internal medicine at $307,000 and pediatrics at $266,000, per Medscape. But the forces underneath are pushing up.

“Especially in primary care, we continue to see some persistent shortages, and that puts upward pressure on compensation,” Kugler said, pointing to family medicine, internal medicine and obstetrics as the fields where the squeeze is sharpest.

That shortage is why family medicine was the most in-demand physician specialty in AMN Healthcare's latest recruiting data, even as its pay trails the specialties.

The 2026 Medicare fee schedule also broke primary care's way, for once. The year's temporary 2.5% conversion factor increase applied broadly, while a separate efficiency adjustment cut work RVUs mainly on procedures and imaging. “Primary care hasn't been impacted as much by those efficiency adjustments, and so the two and a half percent increase is actually somewhat of a nice win,” Kugler said. Swanson agreed primary care came out “largely safe” from the adjustment, while “for non-surgical providers and surgical providers, yeah, it's going to be a big deal.”

The catch is that none of this has closed the gap. Primary care compensation has risen four years running, but it is climbing from a low base, and the shortage pressure that supports it has not translated into pay anywhere near the procedural specialties.

The gap that keeps widening

One number moved decisively in the wrong direction. Medscape put the gender pay gap at about $102,000, a 31% advantage for men, up from roughly $91,000 and 29% two years earlier. Doximity, using a method that adjusts for specialty, geography and hours, measured a $120,917 gap in 2024, which widened to 26% from 23% as men's pay rose 5.7% against women's 1.7%. Both found the gap in every specialty they measured.

What new physicians are being offered

For physicians early in their careers, the number that matters is not average pay but the starting offer. AMN Healthcare's 2025 recruiting review put the average physician starting salary at $403,000, actually down slightly from $406,000 the year before. Specialists led, with orthopedic surgery at $576,000 and gastroenterology at $552,000, while primary care trailed, at $290,000 for internal medicine, $275,000 for family medicine and $258,000 for pediatrics.

Swanson framed that dip as a plateau rather than a decline. “The significant march up in starting salary that happened beginning in COVID ... has now plateaued,” he said. “While we see some starting salary coming down slightly, we are not anticipating significant decreases.” His warning to recruiters: cutting a starting offer to chase the efficiency adjustment's math is a good way to lose the candidate, particularly in the hard-to-recruit specialties.

The reimbursement backdrop

None of this happens in a vacuum. Adjusted for inflation in practice costs, Medicare physician payment has declined 33% from 2001 to 2025, according to the AMA, the single biggest structural pressure on physician income, and one that hits primary care and Medicare-heavy practices hardest. Doximity found 17% of physicians had already cut the number of Medicare or Medicaid patients they see because of reimbursement, with another 13% saying they were likely to. And the temporary 2.5% Medicare increase that lifted 2026 expires at the end of the year, leaving 2027 to open with a cut unless Congress acts.

What it means for your practice

Here is the uncomfortable truth beneath all these numbers: most physicians do not actually know what they are worth. In Panacea Financial's 2026 “Financial Lives of Doctors” survey, 49% of physicians said understanding whether their compensation is competitive was a top career challenge, and Jillian Vestal, J.D., head of legal services at Panacea Legal, thinks even that understates it. “My guess is that there are people who don't even know that they don't know,” she told Medical Economics.

The problem, Vestal said, is that physicians fixate on the headline figure. “They see a number, but they don't know what's behind it. Is that number guaranteed? How long is it guaranteed? Are there extra incentives? ... Are they being paid for call?” Two offers with identical salaries can be worlds apart, she noted: “If you have two contracts that have the exact same number, and one doctor is required to do 10 days of call without any additional pay, and the other is going to start being paid for call on day one, those contracts aren't equal.”

That points to the practical takeaways for any physician measuring their pay against these surveys.

Know your specialty benchmark, not the national average. The $386,000 figure is useless in a negotiation; what matters is the median for your specialty, region and practice type, and even then, pay within a specialty varies more than the gap between specialties.

Know which survey you're citing. Medscape reports self-reported total compensation, Doximity a regression-adjusted mean that runs higher, MGMA a group-reported median that employers treat as fair-market value, and AMN starting offers only. Quoting the wrong one is an easy way to argue against yourself.

Negotiate the terms, not just the number. Base bands are often tight, but work-RVU conversion rates, productivity thresholds, signing bonuses and call pay are where realized income is won or lost. In a year when pay and productivity are diverging, the structure of a plan matters more than usual.

And weigh the setting. Private-practice and single-specialty-group physicians generally out-earn hospital-employed peers, particularly after partnership, a difference that has to be measured against the administrative load and financial risk of ownership.