Pay per wRVU by Specialty (2026): Is Your Rate Low?

Most employed physicians are paid at least partly per work RVU, and the dollar rate per wRVU is often the most negotiable number in the contract. It is also the hardest to benchmark, because the best-known survey data are sold to employers, not published. This guide collects the public figures for 2026 with the source of each, explains why two sources can disagree by more than $30 for the same specialty, and shows how to work out the rate an offer actually pays. If you are new to RVUs, start with what a wRVU is.

Compensation per wRVU by specialty

AMGA's 2026 Medical Group Compensation and Productivity Survey covers 451 medical groups and health systems and about 188,000 providers, with 2025 pay. Its public chart lists ten specialties. Each column is a separate median, and the last two are the median compensation-to-wRVU ratio this year and last.

Because each column is its own median, dividing one by another doesn't give the ratio. For hematology/oncology, $591,080 divided by 6,146 wRVUs is $96.17, not the $99.97 median ratio. The ratio comes from each physician's own pay and production.

MGMA, SullivanCotter and AMGA's full report publish compensation per wRVU for many more specialties and at every percentile, but only to subscribers; see our guide to MGMA physician compensation data for what is free. Your employer most likely priced your offer with one of them, so ask which survey, which year and which percentile.

Contract rates physicians report

SalaryDr collects the per-wRVU rate in physicians' own contracts. These are self-reported and moderated, the samples are small, and each page updates as reports come in, so the dates differ. Across all specialties, the median is $60 (2,281 reports, as of Oct 6, 2026).

SalaryDr's emergency medicine, dermatology, nephrology and endocrinology pages still held 2025 data in October 2026, so they are left out. There is no hospitalist page.

Why the two numbers differ

For the same specialty, AMGA and SalaryDr can be far apart. AMGA's ratio is total clinical compensation divided by wRVUs, so it includes base salary, call pay, stipends and quality bonuses. A contract rate is just the dollar figure paid per wRVU, often only on wRVUs above a threshold.

• What counts as pay: AMGA's ratio counts everything paid for clinical work, so call pay, stipends and quality bonuses raise it, and a guaranteed salary spread over modest production gives a high ratio. A contract rate leaves all of that out.
• Who answers: AMGA's figures come from payroll data submitted by medical groups and health systems. SalaryDr's come from individual physicians in every setting, and most specialties have fewer than 100 reports.
• No fixed direction: AMGA is higher for hematology/oncology, neurology, gastroenterology, and orthopedic and general surgery; SalaryDr is higher for family medicine, pediatrics and OB/GYN. Neither source runs consistently above the other. (SalaryDr's cardiology figure covers all cardiologists; AMGA's is for noninvasive cardiology.)

The practical rule: compare your contract rate with contract rates, and your total pay divided by your wRVUs with AMGA-style ratios. Mixing them can make a fair offer look low or a low offer look fair.

The rate inside your offer

Most offers combine a base salary, a wRVU threshold and a rate above it. Two numbers tell you what the offer pays per wRVU:

1. The implied rate on the base: base salary divided by the threshold. It is what each wRVU up to the threshold is worth.
2. The effective rate: total clinical pay divided by the wRVUs you produce. This is the number to compare with AMGA-style ratios.

Take a family medicine offer of $320,000 with a 6,000-wRVU threshold and $48 per wRVU above it. The base works out to $53.33 per wRVU, so the bonus rate is lower than what the base already pays.

At AMGA's family medicine median of 6,505 wRVUs, this offer pays $344,240, or $52.92 per wRVU, close to AMGA's $342,411 and $52.61 medians. The effective rate falls as you produce more, because each extra wRVU pays $48, less than the base does. If you expect to be busy, negotiate the rate above the threshold; if you don't, the base and the threshold matter more.

Watch the threshold. Move the same $320,000 base to a 7,500-wRVU threshold, above AMGA's family medicine median, and the implied rate drops to $42.67. A physician at the median would earn no productivity pay at all; it takes 995 more wRVUs a year to reach the first bonus dollar. Ask what wRVUs physicians in the position actually produced in each of the last two years, then run the numbers in our contract analyzer.

Tiered rates

Some plans pay a higher rate once production passes a tier line. The contract language decides whether the higher rate applies only to wRVUs above the line or to every wRVU once the line is crossed. Here is a plan paying $48 per wRVU and $55 above 7,000, read both ways:

Under the second reading, the 100 wRVUs past the line are worth $54,500, which creates a strong pull toward the line near year-end and a large loss if a denial or a coding change drops you just under it. Get the wording, the measurement period and how late charges and corrections are counted in writing.

High producers and fair market value

In survey data, compensation per wRVU tends to fall as production rises. Physicians with low production on a guaranteed salary show high ratios, because the salary is divided by few wRVUs, while the busiest physicians show lower ones, as the effective-rate column in the offer above shows. Valuation firms such as VMG Health and LBMC describe this inverse relationship.

It matters in negotiation. Asking for a 90th-percentile rate because you produce at the 90th percentile usually pushes total pay well above 90th-percentile compensation, which health systems treat as a fair market value problem under the Stark Law and the Anti-Kickback Statute. Contracts commonly cap total pay at a set percentage or percentile of a compensation survey. That is not a legal bright line: in its 2020 Stark rule, CMS said it has no policy that pay at or below the 75th percentile is always appropriate, and it declined to create a safe harbor based on survey percentiles. A high producer usually gets further asking for a total-pay figure supported by their production than for a top-percentile rate.

The 2026 efficiency adjustment

Starting January 1, 2026, the Medicare physician fee schedule cut the work RVUs and intraservice time of non-time-based services by 2.5%. Office visits and other evaluation and management services, care management, behavioral health, services on the Medicare telehealth list, maternity codes with a global period and new 2026 codes were exempt. CMS plans to recalculate the adjustment every three years. Our guide to the 2026 CMS changes covers the conversion factor side.

• What it does to wRVU pay: the same procedures credit fewer wRVUs, 25 fewer for every 1,000 procedural wRVUs. At AMGA's gastroenterology median of $72.28, that is about $1,807 less for every 1,000 procedural wRVUs, unless the employer adjusts.
• Who it hits: procedural, surgical and imaging specialties. SullivanCotter's April 2026 estimates put the largest wRVU cuts in hospital-based radiology, with small increases for psychiatry and some primary care.
• How employers responded: in SullivanCotter's polling, about a third of organizations planned no change, a third were still evaluating, and the rest were considering an adjustment. MGMA and PYA describe two fixes: keeping 2025 wRVU values for internal pay, or raising the rate per wRVU.
• 2027: CMS's 2027 proposed rule keeps the adjustment in place and proposes to apply it to new and revised non-time-based codes. The final rule is expected in early November.

If your production fell in 2026 while your work didn't change, ask your employer which values your pay uses and whether the rate was adjusted. A survey benchmark built on 2025 production will also look higher than what the same work earns in 2026 wRVUs.

2026 pay and productivity trends

• AMGA: median total clinical compensation rose 4.3% and wRVUs 2.4% in 2025 data; AMGA's consulting arm said about half of the increase was supported by growth in wRVU production. Compensation per wRVU rose in nine of the ten specialties above and was flat in internal medicine.
• SullivanCotter (September 2026): median total cash compensation rose in every specialty group, from 4.3% in adult surgical specialties to 7.2% in adult medical specialties, while wRVUs rose 0.8% to 2.8% and median compensation per wRVU rose 1.4% to 2.9%.
• MGMA (June 2026): pay rose 1.79% to 2.90% by specialty group, while wRVUs fell in 16 of 23 specialties and encounters fell in all 23.

The surveys disagree on production, but all three show pay rising faster than production, which supports asking for a higher rate at renewal. For a look at whether documentation tools raise wRVUs, see AI scribes and wRVUs.

What to ask before you sign

1. The benchmark: which survey, which year and which percentile the rate and threshold came from.
2. Real production: wRVUs that physicians in this position produced in each of the last two years.
3. The implied rate: base salary divided by threshold, compared with the rate above the threshold.
4. Tiers: whether a higher tier pays on all wRVUs or only those above the line.
5. What counts: whether wRVUs are credited when billed or when paid, and whether supervised APP visits, teaching or administrative time count.
6. The fee schedule year: which year's RVU values the contract uses, and what happens when CMS changes them.
7. Reconciliation: how often productivity pay is calculated and paid, and whether overpaid salary is clawed back.

For negotiation tactics, see physician salary negotiation and contract red flags.