Your paycheck has changed — here are data to prove it

The money that goes into physician paychecks comes from a changing blend of revenue streams, according to a new study by the American Medical Association (AMA).

“Physician compensation methods: Although salary-based models dominate, productivity-based models remain prominent” is an AMA Policy Research Perspective report published in March 2026. AMA Economics Director Apoorva Rama Igwe, Ph.D., analyzed data from the AMA Physician Practice Benchmark Survey and spotted changes in the sources that make up compensation for doctors.

“Overall, physician compensation models have become increasingly blended, balancing financial stability with incentives for productivity, and reflecting broader changes in employment practices and organizational structures in health care over the past decade,” Igwe wrote.

Salary is king, but it rarely stands alone

“In 2024, 70.5% of physicians received compensation from salary (up 9 percentage points since 2014),” the report notes. The figures from 2014 to 2024 showed that salary came bundled with other payment components. A majority — 60.8% — of physicians were compensated through two or more methods in 2024, compared with just 51.0% in 2014. The proportion receiving a single-method payment fell from 49.0% to 39.2% over the same period.

On average, salary accounted for 58.2 cents of every dollar a physician earned in 2024, up from 50.1 cents a decade earlier. Productivity-based pay, which typically uses relative value units (RVUs), remained the second-largest component, accounting for 28% of compensation. A full 55% of respondents indicated productivity factored into compensation.

Bonuses rounded out the picture, with 39% of physicians receiving some bonus compensation in 2024, up 9 percentage points from 2014. However, bonuses remained a relatively small slice of total income, averaging just 4.4% of overall compensation.

"Blended compensation models have become dominant," Igwe wrote, noting that the growth has been driven primarily by arrangements that pair salary with productivity pay, bonuses, or both — with salary serving as the primary component.

The report noted that due to physicians reporting multiple compensation methods, percentages did not always total 100%. Solo practitioners were excluded from the analysis because their compensation is inherently tied to practice financial performance and productivity. Respondents included 3,500 physicians per year for 2014 to 2022 and 5,000 in 2024.

The decline of pure productivity pay

One of the more notable findings for independent practice physicians is the continued retreat of pure productivity-based compensation. The percentage of physicians receiving 100% of their income through productivity metrics fell 5 percentage points over the decade, and the share of total compensation derived from productivity dropped from 32.6% in 2014 to 28% in 2024.

Compensation tied entirely to practice financial performance — revenue-sharing arrangements that link physician pay to how well the practice performs overall — also declined, dropping 4 percentage points in prevalence and falling from 11.8% to 7.0% as a share of total compensation.

The shift away from pure productivity and financial performance models reflects a broader movement in medicine toward arrangements that offer physicians more income stability without entirely eliminating performance incentives.

Owners versus employees: a widening compensation gap

For physicians weighing ownership against employment, the data revealed structural differences in how each group gets paid.

Employed physicians received 69.5% of their compensation from salary in 2024, compared with 35.0% for physician-owners. Conversely, productivity-based pay made up 40.8% of owner compensation, nearly double the 21.9% share for employees. Practice financial performance — meaning income tied directly to whether the practice is profitable — accounted for 18.2% of owner compensation versus just 2.5% for employed physicians.

Both groups saw salary shares increase from 2014 to 2024, suggesting that the trend toward blended models is not driven solely by the growing number of employed physicians.

For employed physicians: Despite working for a salary, one-fourth of their compensation still came from variable sources, including productivity metrics and practice financial performance combined. That finding challenges a common assumption that employment insulates physicians from the financial pressures of practice economics.

"It is notable that variable compensation methods (productivity and practice financial performance) make up nearly one-quarter of compensation for employed physicians and suggest that employed physicians are not entirely insulated from factors like RVUs and practice financial incentives," Igwe wrote.

The report also found that whether an employed physician works in a physician-owned practice or a hospital-owned practice made little difference in compensation structure. Both settings produced similar salary and productivity shares of roughly 68% salary. However, physicians employed directly by a hospital, rather than by a practice, had a higher salary share of approximately 76%.

Gender differences persist in pay structure

The AMA findings show that female physicians, on average, had a higher proportion of income from salary and a lower proportion from productivity-based pay than their male counterparts.

Among physician-owners, the salary share for female owner physicians was 10 percentage points higher than for male owner physicians (42.5% vs. 32.2%), whereas male owners had an 8 percentage point higher share from productivity pay (43.0% vs 35.o%). Among employed physicians, the gap was smaller but consistent: female employees had a 4 percentage point higher salary share (71.9% vs 67.6%) and a 4 percentage point lower productivity share (19.6% vs 23.6%) compared with male employees.

The report is careful to note its limitations on this point. The data reflect compensation structure, i.e., the mix of payment methods, not compensation levels in dollar terms. The analysis does not determine whether base salaries for male and female physicians are comparable, nor does it account for all potential confounding factors, including specialty selection and age distribution between male and female physicians.

“However, it does show that the compensation structure of male physicians offers a greater potential for higher earnings, particularly due to male physicians often having a larger productivity-based component in their income compared to their female counterparts,” Igwe said in the report.

Specialty matters, especially for surgeons

Across virtually all physician specialties, salary was the dominant compensation component in 2024. But surgical specialists stood apart.

Ophthalmologists and orthopedic surgeons were the only specialties where productivity pay exceeded salary as a share of total income, with productivity accounting for 57.1% and 52.6% of compensation, respectively, and salary at 35.3% and 36.0%. Other surgical subspecialists also skewed heavily toward productivity, with a 40.7% share.

By contrast, primary care specialties showed compensation structures that were much more heavily weighted toward salary. Internal medicine physicians receive 63% of their pay from salary and 28% from productivity; family medicine physicians receive 58% of their compensation from salary and 28% from productivity. Pediatricians showed a similar pattern at 67% salary and 19% productivity. Psychiatrists had the highest salary share of any specialty, at 68%.

The report attributed much of this variation to ownership rates. Specialties with the highest concentrations of physician-owners — including ophthalmology, orthopedic surgery and anesthesiology — also showed the highest shares of productivity and performance-based compensation.

Practice setting also shapes the pay mix

Where a physician practices shapes compensation structure as much as specialty or employment status.

Physicians employed by or contracting with hospitals had the highest average salary share of any practice setting — 74.7% — and the lowest productivity component, at 14.5%. Physicians in single-specialty group practices, by contrast, received 47.8% of compensation from salary and 34.8% from productivity.

Multispecialty practices fell in between, with salary averaging 58.2% and productivity at 30%. Notably, the salary share for physicians in multispecialty settings was 10 percentage points higher than for those in single-specialty practices, a gap the report says persists even within the same specialty.