A new American Medical Association (AMA) study offers a revealing look at how physician compensation has evolved over the last decade and suggests the profession is continuing to move away from purely productivity-driven pay models toward compensation structures anchored more heavily in salary. The shift is not absolute, and productivity remains a meaningful part of physician compensation. But the overall direction is clear: physician pay is increasingly built on blended models in which salary serves as the primary foundation, with productivity and bonuses layered on top.  

Salaried Compensation Structures on the Rise
There has been meaningful growth in models that combine salary with productivity and/or bonuses, often with salary serving as the largest component. This shows a growing effort by organizations to balance financial stability for physicians with continued incentives for output, quality, and other organizational goals. Using nationally representative data from the AMA Physician Practice Benchmark Survey, the report found that 70.5% of physicians in 2024 received at least some compensation from salary, up 9% from 2014. Over the same period, the amount of doctors’ pay coming from productivity-related pay increased more slowly. Most notably, 10% more physicians had their paychecks come from blended compensation arrangements. 

The AMA’s study suggests that the most important development is not the disappearance of productivity incentives, but rather their repositioning within a broader compensation framework. In 2024, salary accounted for 58.2% of average physician compensation, while productivity accounted for 28.0% and practice financial performance accounted for 7.0%. That marks a notable change from 2014, when salary accounted for much less of the total paycheck. In effect, productivity remains prominent, but salary is taking up more of the compensation mix than it did a decade ago. 

Productivity-based Compensation Still Very Relevant for Specialty Care 

The specialty-level findings are also notable. Salary remained the dominant compensation component for nearly all specialties, but a number of procedural and surgical specialties continued to rely much more heavily on productivity-based compensation. Ophthalmologists and orthopedic surgeons, for example, derived a larger share of compensation from productivity than from salary, unlike most primary care and cognitive specialties, where salary remained the primary driver of income.  

Salary-based Compensation Higher with Female Physicians  

The study found that female physicians had a higher share of compensation tied to salary and a lower share tied to productivity and practice financial performance than male physicians. Among owners, the gap was especially pronounced: female owners had a salary share that was 10% higher than male owners, while male owners had larger productivity-based and financial-performance-based shares. The same pattern held among employed physicians, though the differences were smaller. The report places these findings in the context of prior research showing gender differences in physician earnings, negotiation outcomes, and access to resources. 

The AMA stops short of drawing sweeping conclusions from those gender differences alone. The report does not measure total dollars earned under each compensation method, nor does it determine whether male and female physicians have comparable salary levels within similar positions. Still, the findings raise important questions. To the extent that productivity-based compensation creates greater opportunity for upside earnings, a compensation structure that weights male physicians more heavily toward productivity could contribute to longer-term differences in earnings trajectories, even if salary-based pay appears comparable at first glance.  

Compensation and Physician Behavior are Linked, But Further Study is Needed 

The study raises broader questions about how physician compensation design affects care delivery. Compensation methods may influence physician behavior, with salary-based models offering greater stability and productivity-based models creating incentives tied to volume and complexity of services delivered. The data do not answer whether salary-heavy models allow for longer visits, more patient counseling, or greater flexibility for team-based care, just as they do not establish whether productivity-heavy models compress time spent with patients. These are important questions for policymakers and provider organizations to consider as compensation arrangements continue to evolve.  

Taken together, the AMA report suggests that physician compensation is settling into a hybrid model rather than moving toward either pure salary or pure productivity. Salary is increasingly serving as the base, while productivity and bonuses remain important secondary levers. That evolution may offer greater stability for physicians while preserving incentives tied to output and organizational performance. At the same time, it highlights that physician compensation remains an important policy and operational issue with implications for gender equity, specialty dynamics, organizational strategy and potentially even the way care is delivered at the bedside.