Compensation is at a crossroads: Drive retention with transparency and flexibility

Physician shortages are reshaping the conversation around compensation. Nearly one in four physicians is age 65 or older, according to AAMC data, with younger physicians also questioning long-term career paths.

In fact, Jessica A. Minesinger, CMOM, CMPE, FACMPE, BBCC, founder of Surgical Compensation & Consulting and an MGMA consultant, noted during her session at the MGMA Leaders Conference 2025 that 59% of physicians in Doximity and Curative’s Physician Compensation Report 2024 were considering retiring early, leaving medicine or changing jobs. Among women, that figure reached 70%.

“These shortages are translating directly into burnout, turnover, and patient access issues,” Minesinger said.

Longer wait times, especially in primary care and rural areas, are pushing physicians to the brink. The report found that four out of five physicians already feel the impact of shortages.

Compensation as culture

Minesinger emphasized that pay is rarely just about the dollar figure. Instead, dissatisfaction often stems from a lack of transparency and clarity. Physicians offered contracts based on productivity thresholds, for example, frequently face uncertainty if targets are unattainable due to staffing shortages or scheduling barriers.

“Being as transparent as you can possibly be around pay is going to benefit you in the long run,” she said.

And while overall compensation is rising, satisfaction lags. About 60% of physicians say they are not satisfied with their compensation, and many lack access to the benchmarking data administrators use to set pay.

Minesinger framed compensation as a reflection of organizational culture. “Compensation reflects workplace culture. That’s just the bottom line,” she said.

Tools for redesign

To rebuild trust, Minesinger urged organizations to simplify pay models and align them with physician motivations. She highlighted two key frameworks:

• SWOT Analysis: A practical way to identify strengths, weaknesses, opportunities and threats in existing plans, offering leaders a roadmap for change.
• SCARF Model: Rooted in neuroscience, this model focused on status, certainty, autonomy, relatedness and fairness — all domains that drive engagement when properly addressed.

Minesinger said these tools can help administrators develop strategies that balance compensation with workload management, administrative efficiency and burnout reduction.

Recruitment, retention and equity

Competition for talent is fierce, with new physicians often offered lucrative starting bonuses. Minesinger cautioned against creating wage disparities by hiring new doctors at higher rates than seasoned colleagues. Retention strategies — periodic check-ins, retention bonuses and transparent pay discussions — can be more cost-effective than constant recruitment.

The gender pay gap also demands attention.

Minesinger noted that about 75% of women physicians believe they are not paid equitably. Without maternity leave provisions or RVU proration during leave, female physicians often face compounded disadvantages.

Looking forward

Minesinger encouraged session attendees to look at compensation plans not only as financial arrangements, but as cultural commitments.

Flexibility, transparency and regular review were recurring themes.

“Physician compensation plans are a direct reflection of your organization’s culture, your commitment to recruitment and retention, and the value you place on your physicians,” she said.

As shortages deepen, she argued, practices that adopt a proactive, clear and inclusive approach to pay will have the best chance of retaining physicians — and ensuring patients can access care.