2023 Insights on Physician Salaries: Trends, Equity & Compensation

Introduction: Why Physician Salaries Matter More Than Ever

Physician salaries are no longer a topic reserved for contract negotiations and late-night conversations among residents. In a healthcare environment shaped by value-based care, consolidation, telemedicine, and persistent workforce shortages, understanding healthcare compensation has become a strategic necessity for anyone in medicine.

For medical students and residents deciding on a specialty, physician salaries and compensation trends influence career paths, location choices, and long-term financial planning. For practicing physicians, staying informed about Salary Trends 2023 helps in contract renewal, practice transitions, and negotiations with hospital systems or private groups.

This article synthesizes the latest 2023 data from major reports—including Medscape, Doximity, AMA, and telehealth compensation surveys—to give a clear, practical overview of the current physician salary landscape. You’ll find:

• Average compensation trends across Medical Specialties
• Key drivers of income differences (specialty, geography, practice type, and telemedicine)
• How benefits, bonuses, and loan repayment shape total compensation
• Ongoing challenges in Gender Pay Equity
• Actionable advice for students, residents, and early-career physicians

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Physician Salaries in 2023: The Big Picture

The National Average: Where Things Stand

According to Medscape’s 2023 Physician Compensation Report, the average physician salary in the United States is roughly $300,000 per year. This is a modest increase from prior years and reflects a gradual recovery after COVID-era disruptions.

However, “average” can be misleading. Compensation varies widely by:

• Specialty (cognitive vs procedural vs surgical)
• Practice setting (employed vs private practice vs academic)
• Region and local cost of living
• Level of experience and subspecialization

For residency applicants, the key takeaway is that compensation is highly stratified. Understanding where your intended specialty falls on the spectrum—and why—can help you set realistic expectations and plan accordingly.

Specialty-Based Compensation: Cognitive vs Procedural

Physician salaries continue to reflect the historical divide between procedural/surgical specialties and primary care/cognitive specialties.

High-earning specialties (approximate average 2023 compensation):

• Orthopedic Surgery: ~$513,000
• Cardiology (non-invasive + invasive): ~$460,000
• Dermatology: ~$466,000
• Other high earners often include:
  • Gastroenterology
  • Radiology
  • Plastic surgery
  • Ophthalmology
  • Urology

Primary care and generalist specialties (approximate 2023 compensation):

• Family Medicine: ~$230,000
• Pediatrics: ~$226,000
• Internal Medicine (general): ~$275,000

This ~2x difference between many primary care fields and certain procedural specialties is one of the most persistent patterns in healthcare compensation. It affects workforce distribution, with chronic under-supply in primary care and over-demand in select lucrative procedural areas.

Why These Gaps Exist

Several structural factors drive these discrepancies:

• Reimbursement models: Fee-for-service payments often reward procedures more than evaluation and management (E/M) visits.
• Training length and barriers to entry: Longer, more competitive training (e.g., neurosurgery, interventional cardiology) can command higher compensation.
• Malpractice risk and intensity: High-risk specialties typically negotiate higher pay to offset liability and stress.
• Revenue generation: Specialties that drive high facility or technical fees (e.g., surgeries, cath lab procedures, imaging) are often compensated more, especially in hospital-employed models.

For trainees, understanding the “why” behind Physician Salaries is as important as the numbers themselves, especially when balancing lifestyle, interest, and financial goals.

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Core Drivers of Physician Compensation in 2023

Supply, Demand, and Workforce Shortages

Demand for physicians remains strong, particularly in:

• Primary care (family medicine, internal medicine, pediatrics)
• Psychiatry and behavioral health
• Geriatrics and palliative care
• Certain surgical and interventional subspecialties

Rural and underserved regions often experience severe shortages. To attract physicians, employers in these areas may offer:

• Higher base salaries or guaranteed income floors
• Larger signing bonuses (sometimes $25,000–$100,000+)
• Loan repayment or retention bonuses
• Flexible schedules or reduced call burdens

The underlying economics are straightforward: when supply is limited and community demand is high, compensation tends to rise—particularly for high-need specialties.

Geographic Disparities: Where You Practice Matters

Location is one of the most potent determinants of healthcare compensation. On average:

• States in the Midwest and certain parts of the South often offer higher nominal salaries due to strong demand and lower physician density.
• Coastal states may offer slightly lower nominal salaries but significantly higher cost of living.
• Within each state, pay can differ dramatically between urban academic centers and rural community hospitals/clinics.

For example (illustrative 2023 trends):

• California: Average physician salary around $335,000—higher than the national average, but with substantial cost-of-living pressures (especially in the Bay Area and Los Angeles).
• Arkansas: Average closer to $230,000, but with much lower housing and living costs, so adjusted purchasing power may be comparable or higher.

For residents contemplating where to practice:

• Don’t look at salary in isolation. Consider take-home pay, taxes, housing, childcare, and lifestyle.
• Research state-specific income tax, malpractice environment, and availability of academic vs community positions.

Practice Setting and Ownership

Practice type significantly affects Healthcare Compensation:

• Hospital-employed or health-system employed:
  • Often offer stable base salaries, productivity bonuses (RVU-based), and robust benefits.
  • Less income volatility, more administrative oversight and metrics.
• Private practice (single or multi-specialty groups):
  • Potentially higher long-term earnings, especially with partnership track and profit sharing.
  • More exposure to business risk, overhead, and payer mix issues.
• Academic medicine:
  • Frequently lower base salaries than private or hospital-employed roles.
  • Compensation may be supplemented by stipends, grants, administrative roles, or moonlighting.
  • Non-financial rewards include teaching, research, prestige, and specialized clinical niches.

Residents should clarify early whether a position is salary-only, salary + productivity, or purely productivity-based (e.g., RVU or collections). This dramatically changes your real earning potential.

Telemedicine and Hybrid Practice Models

The pandemic catalyzed the integration of telemedicine into mainstream care. By 2023, telehealth has stabilized into several common models:

• Fully remote telemedicine roles (e.g., urgent care, primary care, mental health)
• Hybrid practice models (part in-person clinic, part telehealth sessions)
• Subspecialty teleconsults (e.g., tele-stroke, tele-derm, tele-ICU)

Recent telehealth compensation reports indicate:

• Many telemedicine roles now offer salaries comparable to in-person outpatient positions, especially in primary care and psychiatry.
• Telemedicine can allow geographic arbitrage—living in a lower-cost area while serving patients in higher-reimbursement regions.
• Some telehealth roles pay per-visit or per-encounter, which can significantly vary based on volume and platform policies.

For physicians prioritizing flexibility, work-from-home, or reduced commuting and overhead, telemedicine can be a powerful tool—though it may come with trade-offs in procedure volume, leadership opportunities, or in-person team culture.

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Beyond Base Salary: Benefits, Bonuses, and True Total Compensation

Understanding the Full Compensation Package

Base salary is only one component of healthcare compensation. A comprehensive package often includes:

• Incentive or productivity bonuses:
  • Commonly RVU-based in hospital systems
  • Quality or value-based performance metrics
  • Patient satisfaction or panel size bonuses in primary care
• Signing bonuses and relocation assistance:
  • Particularly prevalent in rural or high-need specialties
• Retirement contributions:
  • 401(k), 403(b), or 457(b) plans with employer match
  • Defined contribution or less commonly defined benefit plans
• Health, disability, and malpractice insurance:
  • Occurrence vs claims-made malpractice (and whether tail coverage is included)
• Paid time off (PTO):
  • Vacation, CME days, holidays, and sick leave
• CME allowance:
  • Annual funds for conferences, courses, and board fees

Doximity’s 2023 Compensation Report notes that roughly 60% of physicians receive incentive bonuses, with an average bonus exceeding $50,000. In some specialties, this can represent a substantial percentage of total pay.

For residents evaluating offers, always calculate “total compensation,” not just base salary. Two jobs with similar salaries may differ by tens of thousands of dollars once benefits and bonuses are considered.

Student Loan Repayment and Forgiveness

With educational debt commonly exceeding $200,000–$300,000 for new graduates, loan-related benefits are more prominent than ever:

• Employer-based loan repayment programs:
  • AMA data suggest about 35% of institutions offer some form of loan repayment assistance.
  • Structures vary: annual lump sums, incremental payments over several years, or performance-linked benefits.
• Public Service Loan Forgiveness (PSLF):
  • For physicians employed by qualifying non-profit or government entities, PSLF can erase remaining federal loans after 120 qualifying payments.
• State and federal loan repayment incentives:
  • Common in rural or underserved settings (e.g., National Health Service Corps, state-specific rural health incentives).

Residents and fellows should consider:

• Whether an employer-based repayment program would disqualify or conflict with long-term PSLF strategy.
• Obligations tied to repayment benefits (e.g., multi-year commitment, repayment penalties if you leave early).

A slightly lower base salary with robust loan repayment and PSLF eligibility may be more financially advantageous than a higher salary without those benefits—especially early in your career.

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2023 Salary Trends, Gender Pay Equity, and the Future of Physician Compensation

Salary Trends 2023: Modest Growth, Persistent Pressures

Across most specialties, 2023 saw modest year-over-year increases. Key forces shaping recent trends include:

• Persistent physician shortages in many regions and specialties
• Rising burnout and early retirement, shrinking the workforce
• Ongoing shift toward value-based care and quality metrics
• Increased adoption of NP/PA staffing models, sometimes affecting physician demand
• Hospital and system consolidation, which can influence bargaining power

While demand for physicians remains robust, inflation, changing reimbursement structures, and administrative burdens continue to shape real income and job satisfaction.

Gender Pay Equity: Gains, But Gap Persists

Gender Pay Equity remains one of the most scrutinized aspects of physician salaries. Recent 2023 data:

• Average male physician income: ~$322,000
• Average female physician income: ~$260,000

This represents women earning roughly 80–85% of male compensation, depending on specialty and practice type. The gap persists even after accounting for:

• Specialty distribution
• Part-time vs full-time status
• Years in practice

Contributing factors may include:

• Disparities in negotiation outcomes and initial offers
• Fewer women in the highest-paying procedural subspecialties or leadership roles
• Differences in sponsorship, mentorship, and access to high-revenue opportunities
• Subtle biases in productivity metrics or call distribution

However, there are promising signs:

• Increased transparency in salary data (reports, online platforms)
• Growing institutional focus on equity audits and standardized compensation frameworks
• Professional societies advocating for equal pay for equal work

For women in training, it’s critical to:

• Know your market value using updated compensation data for your specialty and region.
• Negotiate assertively and ask for clarity on how RVUs, bonuses, and raises are determined.
• Seek mentors who can review contracts and share real-world benchmarks.

Resilience and Adaptation in the Physician Workforce

Despite the strain of the COVID-19 era, the physician workforce has shown remarkable resilience:

• Demand for physicians remains high, particularly in high-need specialties and locations.
• Many physicians are diversifying income streams—locums, telemedicine, consulting, expert witness work, medical writing, or entrepreneurship.
• There is growing emphasis on work-life balance, flexibility, and mental health, which may influence future compensation models (e.g., more part-time options, alternative scheduling, fewer overnight calls).

As healthcare continues to evolve, those who understand both the clinical and financial contours of their careers will be best positioned to negotiate fair compensation and sustainable work arrangements.

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Practical Guidance: How to Navigate Physician Salaries and Contracts

For Medical Students and Residents

1. Learn the data early.

   • Use Medscape, Doximity, specialty society reports, and regional salary surveys to understand typical ranges for your specialty and desired location.

2. Think in terms of total compensation and lifestyle.

   • A $30,000 difference in base salary might be outweighed by better call schedules, more supportive colleagues, or superior benefits.

3. Consider debt strategy alongside compensation.

   • High-paying specialties can accelerate payoff of large loans, but PSLF-eligible roles may reduce total repayment even at lower salaries.

4. Use electives and away rotations strategically.

   • Exposure to different regions and practice models gives valuable insight into compensation and culture.

For Fellows and Early-Career Physicians

1. Get comfortable with contract language.

   • Understand RVUs, collections percentages, non-compete clauses, and termination terms. Consider consulting a physician contract attorney.

2. Negotiate beyond the base.

   • Ask about signing bonus, relocation assistance, CME stipends, loan repayment, schedule flexibility, and tailored bonus metrics.

3. Benchmark regularly.

   • Revisit salary reports every 1–2 years to ensure your compensation remains competitive.

4. Align your career trajectory with your values.

   • If academic work, teaching, or research brings high satisfaction, a lower salary may be offset by non-financial rewards. Conversely, if financial independence is a top priority, aim for settings and specialties that align with that goal.

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FAQs: Common Questions About Physician Salaries and Compensation in 2023

1. What is the average physician salary in 2023?

In 2023, the average physician salary in the United States is around $300,000 per year, based on national compensation reports. This figure includes all specialties and practice settings. However, actual income varies widely:

• Primary care physicians often earn in the $200,000–$275,000 range.
• Many surgical and procedural specialties fall in the $400,000–$600,000+ range.
• Academic roles and certain geographic regions may pay below national averages.

2. Which medical specialties earn the highest salaries?

As of 2023, some of the highest-earning Medical Specialties typically include:

• Orthopedic Surgery (often >$500,000)
• Cardiology (especially interventional)
• Dermatology
• Gastroenterology
• Radiology
• Plastic Surgery
• Certain urology and ophthalmology subspecialties

Keep in mind that compensation ranges depend on region, practice setting, call burden, and individual productivity.

3. How does geographic location impact physician compensation?

Geographic variation is substantial. Factors include:

• Supply and demand: Rural or underserved areas often offer higher salaries and more incentives.
• Cost of living: Coastal urban centers may pay higher dollar amounts but offer less purchasing power.
• State policy and payer mix: Medicaid rates, commercial payer dominance, and malpractice climate impact reimbursement.

When comparing offers, consider take-home pay adjusted for cost of living, including housing, taxes, childcare, and commuting.

4. Are bonuses and benefits a significant part of physician compensation?

Yes. For many physicians, bonuses and benefits can add tens of thousands of dollars to annual compensation:

• Incentive and productivity bonuses (often $20,000–$100,000+)
• Signing bonuses and relocation assistance
• Retirement contributions, CME funds, and paid time off
• Loan repayment programs for high-need areas or specific employers

When evaluating a job, ask for a written breakdown of total compensation, not just base salary.

5. What is the status of the gender pay gap among physicians in 2023?

In 2023, women physicians still earn less on average than male physicians, even after adjusting for specialty and hours. Data suggest:

• Men: ~$322,000 average
• Women: ~$260,000 average

This is gradual improvement compared to previous years, but the gap persists. Efforts to improve Gender Pay Equity include:

• Institutional salary transparency and equity reviews
• Standardized starting salaries for new hires in the same specialty
• Increased awareness and training around negotiation and bias

Women physicians—and all physicians—are encouraged to use current compensation data, negotiate assertively, and seek mentorship during contract discussions.

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Staying informed about Physician Salaries and broader Healthcare Compensation trends is not just about maximizing income; it’s about building a sustainable, satisfying career. By understanding the drivers of income across specialties, regions, and practice settings—and by factoring in benefits, debt, and lifestyle—you can make deliberate, informed decisions at every stage of your medical journey.