The work relative value unit model was designed to standardize how physician labor gets measured and paid. Decades later, the data suggests it has struggled to keep pace with the realities of modern practice.
Here are six stats that capture the scope of the problem.
1. CMS increased physician pay in 2026, but only after years of cuts.
CMS cut the Medicare conversion factor by 2.83% in 2025, the fifth consecutive annual reduction, amounting to a roughly 10% decline since 2020. In 2026, the conversion factor for practitioners in a qualified alternative payment model rose to $33.56, a 3.77% increase. Many physicians, however, say the increase does not offset rising practice costs.
“While I appreciate the sentiment behind CMS’ proposed 3.6% increase in the physician fee schedule — especially as it relates to supporting primary care physicians — the reality is that this adjustment still falls short,” Triwanna Fisher-Wikoff, MD, a family medicine physician at Fort Worth-based Texas Health Care, told Becker’s. “When measured against inflation and the rising costs of running a practice, the increase does not represent a true raise. Had CMS and Congress addressed the flaws in the sustainable growth rate formula over 20 years ago — ensuring physician payments kept pace with hospital reimbursements and inflation — this increase would be far more meaningful today.”
2. Compensation is up, but it is being driven by supply-demand rather than productivity gains.
SullivanCotter’s 2025 Physician Compensation and Productivity Survey recorded the largest average increase in total cash compensation in a decade. The report attributes these gains primarily to supply-and-demand dynamics rather than productivity growth. Primary care saw a 4.1% one-year increase in total cash compensation and a 21.8% five-year increase, a pattern that suggests organizations may be catching up after years of relative underpayment.
3. wRVU growth has nearly flatlined, even as compensation rises.
Overall wRVUs grew just 1.5% in 2024, down sharply from 5.2% in 2023 and 18.3% in 2022, the latter driven largely by evaluation and management coding changes, according to the AMGA 2025 Medical Group Compensation and Productivity Survey. Compensation, meanwhile, grew 4.9%.
“Current reimbursement models are weighted heavily toward procedures and inadequately address quality and cognitive work, particularly related to prevention,” said Richard Chazal, MD, medical director at Lee Health Heart Institute in Fort Myers, Fla. The slowdown in wRVU growth may reflect what the system is not capturing rather than any reduction in physician workload.
4. Private practice physicians are seeing far more patients and getting less wRVU credit for it.
According to 2025 MGMA DataDive data, private practice surgical specialists saw total encounters grow 105.98% in 2024, while their median wRVUs fell 15.44%. Primary care physicians in private practice saw encounters rise 7.81% as wRVUs dropped 10.19%. Nonsurgical specialists posted a 20.52% encounter gain alongside a 7.73% wRVU decline.
5. For primary care, wRVU productivity gains are hard won and barely moving the needle.
Primary care saw median compensation rise 5.8% in 2024, while productivity grew just 2.1%, from 6,108 to 6,239 wRVUs, per AMGA data. General pediatrics wRVUs were nearly flat, rising just 0.1%. Family medicine physicians generated a median 6,342 wRVUs and earned $51.66 per wRVU.
6. Surgical specialties are working harder for marginally better pay, with almost no improvement in wRVUs.
Compensation for top surgical specialties rose 3.3% while wRVU productivity grew just 1.1%, yielding a compensation-per-wRVU improvement of only 0.7%. Orthopedic surgery median compensation reached $748,799 — up 3.5% — on 9,915 wRVUs. General surgery wRVUs declined 0.6%, from 6,959 to 6,917, even as compensation rose 2.6%. As in other specialties, compensation growth appears tied to market pressure rather than productivity gains or changes in how the work is valued.
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