In the first two parts of this series, we looked at starting salaries for new physicians (Part 1) and the role of sign-on and relocation bonuses in shaping first-year packages (Part 2). Now, we turn to what happens after that first contract.
After the first few years in practice, physician compensation continues to evolve, both in total earnings and in how income is generated. Using salary data shared anonymously by the Marit community, we’ll look at how growth trajectories vary across specialties and how the composition of pay changes over time.
Compensation Growth Beyond the First Contract
Physician pay rises steadily in the early years, increasing from about $397k in the first two years out of training to $544k at 16–20 years. Beyond that, compensation levels off, with physicians reporting an average of $515k at 20+ years.
The trajectory highlights that most of the financial upside comes in the first 15–20 years of practice. Incomes rise as physicians gain experience, improve efficiency, and move into more productivity-based models. Later in careers, compensation tends to stabilize or decline slightly, often reflecting lighter schedules, reduced call, or shifting priorities.
For new grads, this curve underscores the importance of early and mid-career years as the prime window for financial growth.
Growth Trajectory By Specialty
Not all specialties follow the same trajectory. In some fields, compensation climbs sharply over time as productivity ramps up or as physicians transition into more entrepreneurial settings. In others, salaries remain relatively flat, reflecting standardized pay scales and hospital employment structures.
Specialties That Gain Momentum
The steepest increases are observed in procedure-heavy specialties and those where private practice is more prevalent. Podiatry shows the most dramatic rise, with compensation growing 60% from $228,000 as a new grad to $366,000 at mid-career. ENT, ophthalmology, nephrology, and plastic surgery all grow between 41% to 50%.
Early-career physicians in these specialties often start in hospital-employed or salaried roles, then move into models where income is tied to productivity, collections, or equity. As they build surgical volume or buy into partnerships, their earning power accelerates.
Specialties That Level Off
Other fields show much more modest changes over time. For example, anesthesiology increases only 9% between new grad and mid-career, while compensation for psychiatrists, emergency medicine physicians and hospitalists rises less than 10%. Pediatrics and family medicine show somewhat higher growth, in the 18% to 26% range, but still fall well short of procedural specialties.
The common denominator is that these roles are typically hospital-employed with standardized compensation scales. Salaries grow steadily but modestly as physicians accumulate more experience, with fewer opportunities to boost income through productivity or ownership.
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Shifting Compensation Models
Compensation models evolve just as total pay does. In the first two years of practice, 72% of physicians are on a straight salary model. By 20+ years, that drops to just 50%.
This trend reflects how physicians gradually transition away from guaranteed salary as their careers progress. While salary-heavy contracts provide stability early on, many physicians eventually move into productivity-based or hybrid models that tie more income to performance.
What’s in a Paycheck: Salary vs Bonuses
The shift away from straight salary is mirrored in the composition of pay. For new grads, most of a physician’s total compensation comes from base salary. On average, only about 8% of income is tied to bonuses or other supplemental pay. By mid-career, that share climbs to 13%, which means base salary makes up a smaller slice of the pie.
While that shift may not sound dramatic, it reflects an important change in how physicians are paid as they progress in their careers. Earlier on, contracts are usually built around guaranteed salary, giving new grads stability as they transition out of training. Over time, guarantees give way to more variable pay, tied to productivity, incentives, or additional responsibilities outside of routine clinical work.
The growth in variable income is especially striking in certain specialties. In ENT, the share of pay coming from bonuses and other sources more than doubles, from 7% as a new grad to 17% mid-career. Pathology and neurology follow a similar trend, while nephrology shows the steepest relative increase, from just 3% to 10% of total comp. Even in fields where productivity-based models are less dominant, such as anesthesiology or pediatrics, the share of pay tied to bonuses still grows over time, though not as dramatically.
Beyond base and bonuses, “other” income streams may include partnership income or earnings from teaching or leadership responsibilities. They remain small in absolute terms but grow as physicians advance in their careers. For new grads, this category typically accounts for only 1-2% of total compensation. By mid-career, that number rises to 3-5%. While not the primary driver of income, these opportunities expand with experience and can meaningfully supplement base pay and bonuses.
Why This Matters for New Grads
As a new attending, it’s natural to focus on the immediate jump in pay after training. But it also helps to look ahead and get a sense of how compensation can change as your career takes off.
If you’re in a specialty with lots of growth potential, like orthopedics or ENT, that first salary is just the starting point. As you gain experience, take on a greater workload, or become a partner in a private practice, your earnings can climb much higher. One key metric to watch is your $/wRVU. Since compensation growth is often tied to how your productivity is valued, knowing where your specialty benchmarks fall can help ensure you’re being paid fairly for the work you are doing. We recently published a breakdown of 2025 wRVU benchmarks by specialty on the Marit blog, which can be a helpful reference point as you evaluate offers or renegotiate contracts.
If you’re in a specialty with flatter growth, like anesthesiology or emergency medicine, your first contract may carry extra weight in shaping your career trajectory. But that doesn’t mean your earnings are fixed. There is still significant opportunity to grow your total compensation within these fields, especially when you understand the wide pay variance that exists among physicians in the same specialty. We recently published a blog post on intra-specialty variance that highlights just how much compensation can differ and why knowing these benchmarks can help you position yourself for stronger offers.
We hope this gives you a clearer picture of what’s ahead. Knowing both how much pay tends to grow in your specialty and how the mix of salary vs. bonus shifts over time can help you plan with confidence as you progress in your career.
