Realistic new attending salary expectations start with one correction: your first job is priced off the starting-salary market, not the national median for your specialty. Average starting salary across all physician specialties was $403,000 in AMN Healthcare's most recent recruiting review, covering April 2024 through March 2025, but the spread inside any single specialty is wide enough to make the average close to useless on its own. [1] Your number is a range you can defend with data, adjusted for geography, setting, and the production formula that takes over once your guarantee ends.
Nobody taught you this, and that is not your fault
When AMN Healthcare surveyed final-year residents, 61 percent said they had received no formal instruction on the business side of medicine during training. Only 9 percent felt very prepared to evaluate a contract. Nearly half described themselves as unprepared. [2]
That is the actual starting position for most people reading this. You spent seven to eleven years becoming very good at something, and then someone emails you a number with a lot of zeros in it and gives you two weeks to decide. The number feels enormous compared to what you have been living on. That feeling is the problem.
Why the median is the wrong anchor for new attending salary expectations
Almost every compensation report you will find publishes averages across all career stages. Medscape's 2026 report put average primary care compensation at $298,000 and specialist compensation at $417,000, drawn from a survey of about 6,000 full-time physicians fielded between September and December 2025. [3] Doximity's 2026 report, based on roughly 23,000 physicians surveyed during 2025, found compensation grew about 2 percent year over year. [4]
Those numbers describe a population that includes people fifteen years into partnership, with a mature panel, a full block schedule, and leverage you do not have yet. Using that figure as your anchor sets you up to feel cheated by a fair offer, or to accept a bad one because it looked close enough.
The starting-salary market is a different dataset. Here is what AMN reported for first-year offers in its most recent review:
Source: AMN Healthcare, 2025 Review of Physician and Advanced Practitioner Recruiting Incentives, based on 1,420 search engagements. [1] Reported internal medicine figures varied slightly between published summaries of this report.
For your own specialty and state, pull the live figure rather than a national headline.【MARKET BOARD DATA】
The range tells you more than the average
This is the part that changes how people negotiate.
In AMN's prior edition, covering April 2023 through March 2024, internal medicine starting salaries averaged $271,000. The reported low was $180,000. The reported high was $375,000. Family medicine averaged the same $271,000, with offers running from $120,000 to $460,000. [5]
Read that again. Two internists finishing the same year, both board-eligible, both competent, can be separated by nearly $200,000 in year one. Not because one is a better doctor. Because of geography, setting, payer mix, call burden, employer type, and whether anyone pushed back on the first number.
That spread is your leverage. It means "the market rate" is not a point. It is a distribution, and where you land inside it is partly a decision you make.
If you are trying to work out whether an offer you already have sits in the right part of that distribution, our guide on how to benchmark your physician salary walks through the comparison step by step.
Your number has four parts, not one
Most residents evaluate an offer by looking at the base salary. Base is one input of four.
Base and guarantee period
Almost every first job pays a flat guaranteed salary for a defined period, usually the first twelve to twenty-four months, while you build a panel. That guarantee exists because you cannot generate production on day one. The real question is not the guarantee amount. It is what happens the day it expires.
The production formula for year two and beyond
Once the guarantee ends, most employed physicians are paid on work RVUs, collections, or a base-plus-production hybrid. Ask for the conversion factor in writing, ask what wRVU threshold you must clear before production pay begins, and ask what the physicians already in that group actually produced last year.
Context matters here. MGMA's 2026 provider compensation data found that work RVUs declined in 16 of 23 common specialties and total encounters fell in all 23, even while compensation continued to rise. [6] Production targets set against older, higher-volume assumptions can be harder to hit than they look on paper.
Medicare rates set the ceiling that most of this is negotiated under. CMS finalized a 2026 conversion factor of $33.57 for qualifying APM participants and $33.40 for everyone else, effective January 1, 2026, an increase of 3.77 and 3.26 percent respectively. [7] It moved up this year, which is not always the case.
Our physician compensation and negotiation playbook covers how to ask these questions without sounding adversarial.
The one-time money and the strings attached to it
AMN reported an average signing bonus of $38,215, up about 23 percent year over year, plus an average relocation allowance of $12,619 and CME allowance of $4,073. Loan repayment appeared in 16 percent of contracts, averaging $104,200 where offered. [1] [8]
Marit Health, which collects self-reported compensation from clinicians, found sign-on bonuses for new graduates tracked roughly to $5,700 plus 7.1 percent of total compensation, with academic medical centers and government positions at the low end and health plans at the high end. Only about one in five new graduates reported receiving relocation support at all. [9]
Now the part people miss. In an MGMA poll of 304 medical groups conducted in February 2026, 80 percent said they use clawback or repayment provisions on signing bonuses if a physician leaves early, with service commitments typically running one to three years. [10] A $50,000 bonus attached to a three-year commitment is not a gift. It is a loan you repay with time, and if the job turns out to be wrong, you repay it with money.
What the job costs you
Call frequency, clinic template, inbox volume, admin days, and commute are compensation. A $310,000 job with 1-in-7 call and a protected admin half day is not obviously worse than a $340,000 job with 1-in-3 call and no admin time. Put a number on the difference before you compare offers.
Set your number using live benchmarks on the market board. Filtering by specialty, state, and setting takes about a minute, and it gives you a defensible range instead of a guess.
How to set your number in five steps
Pull the starting-salary benchmark for your specialty, not the career median. Use first-year or 0-to-2-years-of-experience data where you can get it. 【MARKET BOARD DATA:25th Percentile: $285,000 50th Percentile (Median): $325,000 75th Percentile: $370,000 As-of Date: July 2026】
Adjust for geography and setting. Metro academic positions generally pay less than rural or suburban private and hospital-employed roles. Marit's data on new graduates showed non-academic roles paying substantially more than academic ones for the same specialty. [11] Decide what that gap is worth to you before anyone quotes you a number.
Set three figures, not one. Your walk-away number, your target, and your ask. The ask sits above the target. The target sits at or above the 50th percentile for your specialty and state. The walk-away is the number below which the job is not worth the move.
Model year three, not year one. Take the production formula, apply it to realistic volume for that practice, and see what the job pays once the guarantee is gone. If nobody will give you the group's actual production numbers, treat that as information.
Price the whole package. Base, expected production, signing bonus net of clawback risk, relocation, retirement match, CME, malpractice and tail coverage, PTO, and call. Compare packages, not salaries.
For the wider picture of everything else that changes in this transition, see our complete resident to attending transition guide . For specialty and state benchmarks across all career stages, the 2026 physician salary guide is the deeper reference.
Where new attendings get their number wrong
Anchoring to residency pay. The average PGY-1 stipend was $68,166 as of July 1, 2025, up 2.2 percent from the prior year and slightly down after inflation. [12] Any attending offer will feel like a windfall next to that. Judge the offer against the attending market, not against your last pay stub.
Letting debt drive the decision. Median education debt for indebted medical graduates in the class of 2024 was $205,000, and 71 percent of graduates carried debt. [13] Chasing the highest headline base to clear that faster can push you into a job with a punishing schedule, or out of a nonprofit employer where loan forgiveness would have applied. Run both paths before you decide.
Treating the first offer as the offer. Residents in AMN's survey reported heavy recruitment volume, with 78 percent receiving 51 or more job solicitations. [2] Demand for your signature is real. It is very hard to negotiate well from a position of having exactly one option.
Assuming your gender does not cost you. Doximity's 2026 report found a 26 percent pay gap between men and women, unchanged from the prior year, amounting to an average of $122,276. [4] The same AMN resident survey found expectation gaps starting before the first job. [2] If you are a woman entering your first negotiation, benchmark harder, and anchor to the data rather than to what feels reasonable to ask for.
Key takeaways
Anchor new attending salary expectations to starting-salary data for your specialty and state, not to career-wide medians that include physicians decades ahead of you.
Average starting salary across all specialties was $403,000 in AMN's most recent review, but within-specialty ranges are wide, with internal medicine offers reported from $180,000 to $375,000 in the prior edition. [1] [5]
Model year three, not year one. The production formula that replaces your guarantee determines most of your earnings.
Signing bonuses usually carry repayment obligations. Eighty percent of medical groups surveyed by MGMA use clawback provisions. [10]
Bring three numbers to the table: your ask, your target, and your walk-away.
Set your number using live benchmarks on the market board before your next conversation with a recruiter, so the first figure you hear is not the first figure you have seen.
REFERENCES
AMN Healthcare. "Report: The Average Starting Salary for Physicians Exceeds $400,000" (news release on the 2025 Review of Physician and Advanced Practitioner Recruiting Incentives; review period April 1, 2024 to March 31, 2025; 1,420 search engagements). GlobeNewswire, August 5, 2025. https://www.globenewswire.com/news-release/2025/08/05/3127413/0/en/Report-The-Average-Starting-Salary-for-Physicians-Exceeds-400-000.html. Accessed September 5, 2026.
AMN Healthcare / Merritt Hawkins. "Survey of Final-Year Medical Residents: Many Job Choices, Many Reservations." AMN Healthcare, 2023. https://www.amnhealthcare.com/siteassets/amn-insights/surveys/survey-of-final-year-medical-residents-2023.pdf. Accessed September 5, 2026.
Advisory Board. "The current state of physician compensation, in 6 charts" (summary of Medscape Physician Compensation Report 2026; survey fielded September 5 to December 17, 2025; approximately 6,000 physicians). Advisory Board Daily Briefing, June 3, 2026. https://www.advisory.com/daily-briefing/2026/06/04/physician-compensation. Accessed September 5, 2026.
Doximity. "2026 Physician Compensation Report" (nearly 23,000 U.S. physicians surveyed January to December 2025). Doximity, 2026. https://www.doximity.com/reports/physician-compensation-report/2026. Accessed September 5, 2026.
AMN Healthcare. "2024 Review of Physician and Advanced Practitioner Recruiting Incentives" (review period April 1, 2023 to March 31, 2024). AMN Healthcare, 2024. https://www.amnhealthcare.com/siteassets/amn-insights/physician/incentive-review-2024-final.pdf. Accessed September 5, 2026.
MGMA. "2026 Provider Compensation Data Report." Medical Group Management Association, 2026. https://www.mgma.com/2026-provider-compensation. Accessed September 5, 2026.
Centers for Medicare & Medicaid Services. "Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F)" fact sheet. CMS, October 31, 2025. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f. Accessed September 5, 2026.
Peckenpaugh, Jason. "Physician starting salaries average $403k, but specialty gaps persist" (coverage of AMN Healthcare 2025 Review). Medical Economics, August 11, 2025. https://www.medicaleconomics.com/view/physician-starting-salaries-average-403k-but-specialty-gaps-persist. Accessed September 5, 2026.
Marit Health. "Physician Sign-On Bonuses and Relocation for New Grads in 2025." Marit Health, August 26, 2025. https://www.marithealth.com/posts/physician-sign-on-bonuses-and-relocation-for-new-grads-in-2025. Accessed September 5, 2026.
MGMA. "Clawbacks on clinician sign-on bonuses are more common, and not a retention strategy" (MGMA Stat poll, February 3, 2026; 304 applicable responses). MGMA, February 5, 2026. https://www.mgma.com/mgma-stat/clawbacks-on-clinician-sign-on-bonuses-more-common. Accessed September 5, 2026.
Marit Health. "Starting Strong: What New Physicians Really Earn in Their First Jobs." Marit Health, August 20, 2025. https://www.marithealth.com/posts/starting-strong-what-new-physicians-really-earn-in-their-first-jobs. Accessed September 5, 2026.
Murphy, Brendan. "Resident physician pay still rising, but growth trails inflation" (reporting AAMC 2025 Survey of Resident/Fellow Stipends and Benefits; figures as of July 1, 2025). American Medical Association, January 22, 2026. https://www.ama-assn.org/medical-residents/residency-life/resident-physician-pay-still-rising-growth-trails-inflation. Accessed September 5, 2026.
Association of American Medical Colleges. "Medical Student Education: Debt, Costs, and Loan Repayment Fact Card" (class of 2024 education debt; class of 2025 cost of attendance). AAMC. https://students-residents.aamc.org/media/12846/download. Accessed September 5, 2026.
This article is educational and is not legal advice. Contract terms vary by state and employer. Have any agreement reviewed by a licensed attorney before signing.
FAQs
It depends almost entirely on specialty, geography, and setting. AMN's most recent review put the average first-year offer across all specialties at $403,000, with primary care specialties generally in the $258,000 to $292,000 range and procedural specialties well above $450,000. [1] Compare against your specialty and state rather than the all-specialty average.