Orthopedic surgery's median compensation reached $748,799 in the latest data, up 3.5%, on 9,915 work relative value units, according to Becker's ASC. General surgery compensation rose 2.6% while wRVUs actually fell 0.6%, from 6,959 to 6,917. Across specialties, the link between what a physician produces and what a physician gets paid is loosening, and it is loosening at different speeds depending on the specialty. A practice manager comparing this year's compensation review to last year's cannot use one national number for every provider on staff.
Productivity growth has slowed across the board
Overall physician wRVUs grew just 1.5% in the most recent annual comparison, down sharply from 5.2% growth the year before and 18.3% two years before that, Becker's ASC reports. That is three straight years of deceleration, not a single bad year. General pediatrics was nearly flat, with wRVUs up only 0.1%. Family medicine physicians generated a median 6,342 wRVUs and were paid $51.66 per wRVU, one of the few specialties where Becker's ASC published a direct per-unit rate.
The slowdown is not evenly distributed. Compensation for the top surgical specialties rose 3.3% while their wRVU productivity grew only 1.1%, a gap Becker's ASC calculates as a 0.7% improvement in pay per wRVU produced. That is a small number, but it moves in one direction only: up, regardless of whether the underlying work grew to match it. Extend that 0.7% across a group practice with a dozen surgeons on a wRVU conversion formula, and the annual cost of holding the formula flat adds up well before anyone notices it in a single paycheck.
The specialty-level gap, side by side
The table below lines up the specialties and specialty groups where Becker's ASC published both a compensation change and a productivity change for the same period. Family medicine's $51.66 per wRVU figure is the only specialty where a direct dollar-per-unit rate was reported; the others are shown as compensation and wRVU changes.
| Specialty | Compensation change | wRVU change | Median wRVUs or rate |
|---|---|---|---|
| Orthopedic surgery | +3.5% | Not separately broken out | 9,915 wRVUs; $748,799 median compensation |
| General surgery | +2.6% | -0.6% (6,959 to 6,917) | 6,917 wRVUs |
| Top surgical specialties (aggregate) | +3.3% | +1.1% | Pay-per-wRVU improvement of 0.7% |
| Family medicine | Not separately broken out | Flat overall wRVU trend | 6,342 wRVUs; $51.66 per wRVU |
| General pediatrics | Not separately broken out | +0.1% | Nearly flat |
Source: Becker's ASC, Physicians' wRVU problem, by the numbers, 2026.
What the SullivanCotter survey adds
SullivanCotter's 2025 Physician Compensation and Productivity Survey, drawn from more than 500 healthcare organizations and roughly 231,300 physician records across 232 specialties, found the largest year-over-year rise in total cash compensation in a decade. Adult medical specialties led with a 7.5% increase from 2024 to 2025, and primary care specialties posted a 21.8% cumulative rise over five years.
Productivity moved far more slowly than pay in the same survey. Adult medical wRVU growth was 3.0%, pediatric surgical growth was 2.4%, adult surgical growth was 2.0%, and the overall average across all groups was about 1.5%, a figure that matches Becker's ASC's separately reported 1.5% aggregate wRVU growth. Two organizations, two datasets, the same slowdown.
The five-year primary care figure is worth sitting with. A 21.8% cumulative rise in total cash compensation over five years, against family medicine wRVUs that Becker's ASC describes as essentially flat, means a family medicine physician's pay per unit of work has climbed by roughly a fifth without a matching rise in patient volume or coded complexity. That is not a one-year anomaly; it is a five-year trend line practices need to plan around, not just react to at contract renewal.
Why compensation keeps climbing anyway
SullivanCotter's survey points to supply and demand, not output, as the driver. Ninety percent of the organizations surveyed used sign-on bonuses to recruit physicians, and 52% offered student loan repayment. Outcomes-based pay components, separate from wRVU volume, grew 4.6% from 2024 to 2025, meaning organizations are shifting part of the compensation formula away from raw productivity even as they keep raising overall pay.
Physicians do not report feeling ahead of this trend. Medscape's 2025 Physician Compensation Report found only 48.0% of physicians said they felt fairly paid for their work, the lowest share in ten years, and Becker's ASC notes that close to 4 in 10 physicians take on outside paid work. Regional pay varies too: physicians in the Midwest reported the highest average salary among U.S. regions, at $385,000, per the same Becker's ASC compilation.
What this means for an independent practice
Most independent practices set compensation off collections or a wRVU conversion factor rather than a health-system subsidy model, so the specialty-level detail matters more than any single national average. A practice paying orthopedic surgeons on a wRVU formula unchanged since 2023 is effectively giving a 3.5% raise on close to flat output, per the Becker's ASC figures, unless the formula itself already accounts for the shift. General surgery is the sharper case: wRVUs fell 0.6% and compensation still rose 2.6%, a combination that only works if the practice's payer mix or collections rate improved enough to cover it.
Family medicine's published rate of $51.66 per wRVU gives independent primary care practices a specific number to check their own conversion factor against, rather than guessing at what market rate means this year. For any specialty a practice employs, the practical move is the same: pull the wRVU trend for that specialty specifically, not the practice average, before renewing a compensation plan for another year.
The satisfaction numbers add a retention argument to the financial one. With only 48.0% of physicians telling Medscape they feel fairly paid, and close to 4 in 10 taking on outside work, an independent practice that lets its wRVU rates drift below what a hospital-employed alternative offers, including the kind of sign-on bonus 90% of organizations in the SullivanCotter survey now use, risks losing a physician over pay structure even when total collections could support a competitive offer. Reviewing the conversion factor is as much a recruiting decision as an accounting one.
Sources
- Becker's ASC, Physicians' wRVU problem, by the numbers, 2026
- SullivanCotter, Physician Total Cash Compensation Seeing Highest Increase This Decade, October 15, 2025
- Becker's ASC, Physician pay in 2026: 20 stats, 2026
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