Compensation Increases as Healthcare Landscape Shifts

Fred Horton, president of AMGA Consulting, expressed concern regarding the ongoing growth in productivity: "Over the past several years, provider compensation has increased, but it is important to note that approximately half of the increases during this time have been supported by ongoing increasing levels of wRVU production. In a marketplace with stagnant reimbursement rates, this is necessary to afford the increases in total cash compensation. This continued trend is worrisome, as at some point productivity will top out and, as we are all well aware, providers are looking to alternative work arrangements and adjustments to their FTE to counter increased workloads. Organizations must continue to eliminate administrative waste and fine tune their operations to ensure alignment with the focus on increased productivity."

As wRVUs continue to trend upwards, it should come as no surprise that patient visits/encounters have also shown an increase. Overall, patient visits have increased 2.0% across all specialties in the 2026 Survey. While visit volume has consistently increased over the past couple of years, primary care visits declined 2.2%, an exception to this trend.

In looking at the detailed data further, a couple of insights help to shed light on the above decreasing visits for primary care:

• Visits per year decreased at median by about 60 visits for family medicine and 90 visits for internal medicine. These changes amount to less than half a visit per day.
• Even as visit volumes declined, primary care wRVUs increased 2.0%. We further observed that wRVUs per visit rose from 1.86 to 1.94 at the median. Recent E/M and G-code changes are likely amplifying this coding shift along with challenges to specialty access, that result in primary care seeing higher acuity/complexity patients.

"At a time when patient access is at the forefront of many groups' strategies, the increase in wRVUs per visit for primary care physicians should further highlight the need for a strong care-team approach to access," commented Matthew Wells, PhD, senior director with AMGA Consulting. "To meet patient demand, medical groups need to rethink the involvement of APCs and other health care providers within their respective clinical care models."

Primary Care

Primary care total clinical compensation growth of 3.7% outpaced the 2.0% increase in wRVUs, marking the fifth straight years of compensation increases at or above 3.0%. While the visit decrease suggests that demand pressures and capacity constraints remain real challenges, medical groups continue to invest in primary care. Increases to overall productivity culminated in a modest increase of 1.7% to the compensation per wRVU ratio.

Medical Specialties

Medical specialties posted total clinical compensation growth of 4.3%, the third straight year in which compensation has increased 4.0% or more. Increases in compensation are correlated with increases in wRVU productivity at 2.0% (which corresponds to an increase in visits at 3.1%). The resulting compensation per wRVU increase of 2.6% is the largest across all major specialty groupings.

Surgical Specialties

Surgical specialties saw a 3.2% total clinical compensation growth, the smallest growth of the three major specialty groupings. The increases in compensation come with increased in wRVU productivity of 2.4%.

Advanced Practice Clinicians (APCs)

APC total clinical compensation grew 4.1% while wRVU productivity increased 3.0%, highlighting an ongoing shift of APC utilization in the marketplace. Medical groups continue to expand APC scope of practice and deploy APCs in high-need settings, in part as a mitigation strategy against physician shortages. While compensation for APCs continues to follow a relatively set range that is not tightly tied to productivity, total APC investment reflects the growing strategic importance of this workforce segment.

Kelsi O'Brien, vice president of AMGA Consulting, has this to say about the recent APC trends: "There has been a notable gap in total clinical compensation between nurse practitioners and physician assistants of like specialties in years past. We are slowly starting to see the gap close with some areas making headway faster than others (but progress all around regardless). For example, the difference in median compensation between nurse practitioners and physician assistants in medical specialties is less than $400 (compared to over $7,000 last year). This transition will make setting compensation for APCs easier in the future, especially in like settings and specialties."

Beyond the numbers, this year's survey data is best understood in the context of an ongoing workforce crisis that is reshaping how medical groups recruit, compensate, and retain providers. The AAMC projects a physician shortage of up to 86,000 by 2036,¹ driven by an aging patient population and physician workforce. Workforce shortages extend past physicians, affecting nursing, advanced practice clinicians, and administrative staff alike, compounding operational pressure for health systems.

AMGA member organizations increasingly recognize that recruitment and retention require a broader commitment: workplace culture, engagement, and staffing support, are as consequential as salary in a provider's decision to stay or leave. That challenge is made more acute from recent legislation, which projects significant reductions to Medicaid and Medicare over the coming decade. As reimbursement tightens and coverage volatility grows, medical groups must simultaneously compete for talent and absorb revenue pressure—a combination that will test the sustainability of current compensation trends in the years ahead. "The sustainability challenge must be addressed by ensuring operational support is at an optimal level and there is a focus on operational efficiency. It is extremely important that organizations don't simply leverage providers to produce at higher levels but focus on creating an operational platform that supports providers increased productivity levels, without leading to additional burnout" stated Fred Horton.