Physician productivity rose 12% year over year in the second quarter of 2025, according to Kaufman Hall, while compensation rose 6% and reimbursement declined 1%.
Surgical total medical revenue per physician fell 2.74% from 2023 to 2024, to $687,652, according to MGMA’s 2025 “Provider Compensation and Productivity Report,” even as surgical specialist median compensation rose 5.57% over the same period.
The premise of the work relative value unit model, where physicians work more to earn more, is breaking down, and CMS’s 2.5% efficiency adjustment to non-time-based codes in 2026 is accelerating it. For these 10 specialties, the ceiling is becoming visible.
1. Dermatology
Two consecutive years of pay declines — down 11% in the 2025 Medscape report and continuing its slide in 2026 — have pushed dermatology from seventh to 10th in compensation rankings. The 2026 efficiency adjustment hit dermatology procedure codes directly, according to PYA’s analysis of the fee schedule, compounding a reimbursement structure that already excludes the cosmetic side of many practices from RVU-based compensation entirely.
2. Gastroenterology
Gastroenterologists saw 2% compensation growth in the most recent Medscape cycle, below December 2024’s 2.9% consumer price index increase, an effective inflation-adjusted pay cut. Colonoscopy reimbursement has dropped 38% over 15 years, meaning more cases, but less revenue per case. MGMA data reinforce the picture that surgical total medical revenue per physician fell 2.74% in 2024 even as encounter volumes climbed.
3. Urology
Urologists also logged only 2% compensation growth, which is another inflation-adjusted decline. Cumulative Medicare conversion factor cuts have reduced physician payments 33% in inflation-adjusted terms since 2001, according to American Medical Association data, a pressure that falls hardest on specialties with high Medicare procedure volume, such as urology.
4. Ophthalmology
Ophthalmology was the only specialty to end 2024 below its 2021 peak, including a 7% drop in 2022 and a 5% decline in 2024. Compensation per wRVU for ophthalmology runs among the lowest of any procedural specialty, roughly $40 to $45 per unit according to Marit Health, reflecting that high-volume cataract and retinal procedures generate modest per-unit RVU values.
5. Radiology
Radiology reimbursement declined from 2005 to 2021 despite higher Medicare volumes per beneficiary, according to a Harvey L. Neiman Health Policy Institute study. The 2026 efficiency adjustment hits imaging codes directly as radiologists are producing more studies for less reimbursement per study.
6. Cardiology
Cardiology logged the highest pay growth of any specialty in the 2026 Medscape report — 10% year over year — driven by market shortages, rather than wRVU model improvements. In prior cycles, cardiology saw pay increases of 3% or less, placing it in the same inflation-adjusted decline bracket as gastroenterology and urology.
7. General surgery
Surgical specialist median compensation rose 5.57% to nearly $585,000 in 2024, according to MGMA, but surgical total medical revenue per physician fell 2.74% over the same period. That gap is being absorbed through rising per-physician subsidies: The median reached $315,358 in the fourth quarter of 2025, a 4% increase since 2023, with general surgery among the specialties requiring the highest subsidies to sustain employment.
8. Physical medicine and rehabilitation
Physical medicine and rehabilitation reported pay declines in both the 2025 and 2026 Medscape reports. The specialty’s heavy reliance on E&M codes has not offset cumulative reimbursement pressure, according to PYA, and the time-intensive nature of PM&R work generates modest wRVU totals relative to procedural peers.
9. Rheumatology
Rheumatologists logged 2% compensation growth, another inflation-adjusted decline. With no high-volume procedural base to drive wRVU totals and chronic underpayment relative to procedural peers, rheumatology’s productivity ceiling is structural.
10. Orthopedic surgeryAverage annual orthopedic compensation reached $543,000 in 2025 but fell 3% year over year. The average starting salary for orthopedic surgeons dropped 16% year over year in AMN Health’s 2025 recruiting report — a leading indicator the market is beginning to price in structural erosion, not just a one-year dip.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.