Productivity, rather than quality, is gaining prominence in physician bonus structures, according to a recent report from recruiting firm AMN Healthcare.
Last year, 62% of physician contracts featured a production bonus, the report found. That figure has grown to 66%. In comparison, 16% of contracts included a quality metric in its bonus structure, down from 26% in 2024 and 31% in 2023.
Productivity metrics include relative value units, net collections, gross billings and patient encounters. Quality ranges from patient satisfaction scores to readmission rates, according to the report.
Despite initiatives “to steer physician payments toward quality metrics and away from volume-based formulas,” according to the report, “finding the right compensation formula … has been elusive.”
Other industry reports have found a similar trend, with base salary and work RVU productivity remaining the most common aspect of physician compensation plans.
Between April 2024 and March 2025, AMN Healthcare researchers analyzed financial and other incentives offered to physicians and advanced practice providers. A representative sample of 1,420 permanent physician and APP positions were assessed. Seventy-eight percent of physician job postings were for specialists.
The company has published this data annually for 32 years. Here are other findings to know from AMN Healthcare’s report:
Average starting salary
- In 2025, the average physician’s starting salary was $403,000, slightly lower than 2024’s average of $406,000.
- For their starting salaries, physicians in academic positions usually earn less than physicians in nonacademic roles, with a difference of $338,000 and $425,000, respectively.
- There was variation among primary care specialties. While family medicine and general internal medicine starting salaries both averaged $271,000 in 2024, family medicine saw a slight increase to $275,000 in 2025, while general internal medicine saw a 7.9% increase to $292,000. At the same time, average starting salaries in pediatrics saw an 8.5% tumble, from $280,000 to $258,000.
- Nurse practitioners saw a 9.6% increase in average starting salary, from $164,000 in 2024 to $180,000 in 2025.
Average singing bonus
- For physicians, the average singing bonus in 2025 was $38,215, up from $31,103 in 2024.
- Nurse practitioners and physician assistants also saw an increase in average signing bonus, from $11,758 to $12,869.
Most in-demand physicians
To measure demand, the report calculated the concentration of job openings per number of physicians in various specialties. The most in-demand specialties are:
1. Hematology/oncology
2. Gastroenterology
3. Endocrinology
4. Cardiology
5. Radiology
6. Urology
7. Rheumatology
8. Anesthesiology
9. Neurology
10 (tie). Otolaryngology
10 (tie). Family medicine
