For a growing set of physician specialties, a $500,000 offer no longer stands out. It is the going rate.
Starting salaries for gastroenterologists, urologists, radiologists, cardiologists, anesthesiologists and orthopedic surgeons all now exceed that mark. Yet several of those same specialties post some of the lowest search fill rates in the country, and recruitment leaders say the levers that close a search increasingly sit outside the salary line: schedule flexibility, administrative burden and how much of the pay is guaranteed.
Here are 10 things to know:
1. $500K is the starting line in six specialties.
The average starting salary for all physicians reached $419,000 in 2025-26, according to AMN Healthcare’s “2026 Review of Physician and Advanced Practitioner Recruiting Incentives,” released Sept. 16. Gastroenterology led at $654,000, followed by urology at $638,000, radiology at $571,000, cardiology at $568,000, anesthesiology at $525,000 and orthopedics at $507,000. Urology’s starting pay rose 22.5% from the prior year and cardiology’s rose 20.9%. Orthopedics was a notable exception, falling 12%. Offers also vary by setting: Non-academic positions averaged $452,000, compared with $362,000 in academic settings.
2. Signing bonuses are now close to universal.
Signing bonuses were offered in 87% of the physician searches AMN tracked in 2025-26, with an average of $49,306, up from $38,215 the year before. In AMN’s prior report, the highest physician signing bonus reported was $250,000. When nearly every competitor offers one, a bonus becomes a baseline expectation rather than a differentiator.
3. Established physicians already earn well above typical offers.
Ten specialties now average more than $600,000 a year, according to Doximity’s 2026 Physician Compensation Report, published Aug. 25. Neurosurgery leads at $829,161, followed by thoracic surgery at $749,707 and orthopedic surgery at $696,852. For systems trying to recruit experienced physicians away from existing practices, those averages set the bar a competing offer has to clear.
4. Higher offers are not filling searches.
Half of physician searches were still open as of Dec. 31, 2025, up from 49% in 2024 and 47% in 2023, according to the Association for Advancing Physician and Provider Recruitment’s annual benchmarking report, which draws on more than 10,000 searches. Several of the highest-paid specialties had the weakest results: Only 28.3% of urology searches were filled by the end of 2025, along with about one-third of cardiology and neurology searches, 40.1% of anesthesia searches and 40.5% of gastroenterology searches. The median physician search took 119 days to fill, and the typical physician started work 229 days after a job was posted.
Carey Goryl, CEO of AAPPR, called the findings “a clear warning sign that our physician pipeline isn’t keeping up.”
5. Demand is concentrated in the highest-paid fields, and location compounds it.
When AMN ranked specialties by job openings relative to workforce size, gastroenterology placed second and interventional cardiology third, behind hematology and oncology. Radiology, urology and anesthesiology also made the top 10. For organizations outside major metros, the candidate pool is thinner still: Only 2.3% of 2026 medical school graduates said they prefer rural practice.
6. Physicians are negotiating for more than dollars.
In CHG Healthcare’s 2025 Physician Sentiment Survey, 91% of physicians called autonomy very or extremely important to their satisfaction, but only 59% were satisfied with the autonomy they have. Across five major health systems profiled by Jordan Search Consultants, none cited salary increases as their primary recruitment lever. Leaders pointed instead to flexible scheduling, reduced administrative burden and transparent leadership communication. Separately, 63% of physicians said they would accept a pay cut for better work-life balance.
“We are evolving our employment model so that clinicians can titrate time and compensation to best fit their individual needs,” Erika Werner, MD, president of the physician organization at Boston-based Tufts Medical Center, told Becker’s in July. “Only with partnership, transparency and flexibility can we meet workforce and financial demands of 2026 and beyond.”
7. Bidding wars can make the problem worse.
Pay escalation remains very real in specialties facing acute shortages. John Deledda, MD, chief medical officer of Henry Ford Medical Group, part of Detroit-based Henry Ford Health, sees it as a symptom of systems solving the wrong problem.
“What ends up happening is organizations in the same geography start competing against each other, offering higher and higher rates, and physicians jump from system to system chasing compensation,” Dr. Deledda told Becker’s. “Competing organizations are not sitting down locally and saying, ‘The cost of healthcare in our geography is getting out of hand — we need to do something about this together.'”
8. Guaranteed pay matters more than upside to younger physicians.
National average base salary growth slowed to 2% to 4% in 2026, down from 5% to 6% in prior years, according to Resolve’s 2026 Physician Compensation Report. Employers are leaning instead on sign-on bonuses, retention incentives and RVU-based productivity thresholds. That structure can clash with what early-career physicians want.
“Often younger physicians don’t want to be at risk relative to production or the amount of volume they can generate,” said Mark Ryberg, physician workforce practice leader at SullivanCotter. “They’re prioritizing security in the form of base salaries.”
9. The headline number can hide the fine print.
A large salary figure tells a candidate little about how the pay is calculated. Rajiv Sharma, MD, a gastroenterologist and president of Phoenix-based Mirage Health, said the per-RVU rate offered for identical work can vary drastically from one contract to the next.
“I’ve seen RVU rates range from $36 to $95 per RVU,” Dr. Sharma said. “It’s more fluctuation than anywhere else.”
“A respectable RVU rate should be $65-plus, locked in for three to five years,” he said.
10. Reimbursement pressure sits behind every offer.
Health systems paid a median of $315,358 per employed physician in Q4 2025 to cover the gap between compensation and the revenue physicians generate, up 4% since 2023, according to Kaufman Hall. Medicare rates are moving the other way. CMS’ proposed 2027 physician fee schedule would cut the conversion factor 1.68% for most physicians, with specialty-level reductions of 7% for orthopedic surgery, about 3% for gastroenterology, about 2% for urology and 2% for neurosurgery.
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