Gastroenterology Moves Past Orthopedics in Physician Pay Rankings
Gastroenterologists now command the highest average starting salary among physicians, a shift that reflects how aggressively hospitals and medical groups are chasing scarce specialist talent. The average offer reached $654,000, moving past orthopedic surgery after four consecutive years at the top.
Orthopedic surgeons were not far behind, but their average starting salary fell 12% year over year to $507,000. Gastroenterology moved in the opposite direction, rising 18.5% in the same period. In compensation terms, the gap is not cosmetic; it signals a market in which procedural specialists with high downstream revenue potential and persistent referral demand can move quickly when recruitment pressures intensify.
The competition was not limited to base pay. Average signing bonuses for physicians climbed 29% to $49,306, up from $38,215 a year earlier. Hospitals and medical groups are clearly using upfront incentives as a lever to fill hard-to-recruit positions, especially when vacancy costs, lost procedure volume, and scheduling strain make delayed hiring expensive.
Specialists accounted for 84% of physician searches in the sample, compared with 16% for primary care. That imbalance says as much about workforce scarcity as it does about employer strategy. When most search activity centers on subspecialists, compensation pressure tends to concentrate in the very fields that can keep operating rooms, endoscopy suites, and referral networks moving.
Procedural Demand Continues to Drive the Market
The salary spread also tracks with the economics of procedural care. Gastroenterology and orthopedics are both heavily procedure-based specialties, yet the current recruiting cycle favors gastroenterology, likely because clinical demand remains steady while supply remains tight. Endoscopy volume, chronic gastrointestinal disease management, and the need for access to screening and therapeutic procedures can all push employers to raise offers quickly.
Orthopedic surgery remains among the highest-paid specialties in absolute terms, but a 12% decline in average starting salary suggests that employers may be recalibrating after several years of rapid bidding. Staffing shortages do not move in a straight line. Some specialties spike when hiring backlogs build, referral pipelines widen, or candidate availability narrows, and then cool when employers regain leverage or search activity shifts.
Primary care sat much lower in the salary hierarchy. Family medicine physicians were offered an average starting salary of $291,000, while internal medicine physicians averaged $289,000. Those figures help explain why medical groups keep struggling to rebalance their workforce mix: the pay premium for procedural subspecialists remains substantial, while generalist compensation continues to lag despite the central role primary care plays in access, prevention, and chronic disease management.
A one-sentence reality check is unavoidable: the physician labor market is still rewarding scarcity more than systemwide need.
Academic Roles Trail Nonacademic Offers by a Wide Margin
Academic positions offered lower starting salaries than non-academic roles, averaging $362,000 versus $452,000. The difference likely reflects the competing demands placed on academic physicians, who often split time among patient care, teaching, research, and administrative work. Those responsibilities can be professionally attractive, but they rarely match the immediate earning power of purely clinical roles in the private or employed market.
For health systems, the gap creates a familiar recruiting problem. Academic centers depend on mission-driven hiring, yet they compete in the same labor market as non-academic employers that can offer higher guaranteed compensation and simpler productivity expectations. When the market tightens, academic departments may need to lean more heavily on loan support, retention packages, protected time, or ancillary incentives to keep recruitment viable.
The pay differential also has implications for training pipelines. Residents and fellows often compare academic and non-academic career paths through a financial lens long before they finish training. When compensation differences widen, institutions may need to work harder to retain graduates who value teaching and research but cannot absorb a large income gap without support.
Nurse Practitioners Remain a Core Recruiting Priority
Nurse practitioners remained the most requested recruiting category for the sixth straight year, with average starting salaries of $180,000. Their sustained demand reflects a broader shift in how medical organizations staff outpatient clinics, inpatient teams, and specialty practices. In many settings, advanced practice clinicians are no longer peripheral hires; they are central to throughput, continuity, and access.
The recruitment data point to a workforce model that is becoming more layered and more dependent on team-based care. Physicians remain the highest-cost and hardest-to-fill positions, but advanced practice clinicians often determine whether a practice can expand hours, reduce wait times, or absorb referral surges. Employers are therefore competing on two parallel fronts: one for scarce physician specialists and another for the clinicians who help stabilize daily operations.
What the 1,293-Search Sample Says About the Market
The findings came from a representative sample of 1,293 permanent physician and advanced practitioner search engagements conducted or ongoing between April 1, 2025, and March 31, 2026. A sample of that size offers a useful snapshot of recruiting behavior across a changing market, particularly because it captures both completed and active searches rather than a single static moment.
The compensation movement is broad enough to matter, but it still needs to be read as a market signal rather than a universal benchmark. Geography, subspecialty mix, call burden, academic affiliation, and practice ownership all shape final offers. A gastroenterologist in one market may see a materially different package from a peer elsewhere, even when the national average points in the same direction.
For hospital leaders and medical group executives, the immediate implication is straightforward: the cost of vacancy is rising, and so is the price of filling the most sought-after specialties. The next recruiting cycle will likely test whether employers can sustain these higher starting salaries and larger signing bonuses without compressing margins or creating internal pay equity tensions across specialties.
The larger question is whether these compensation patterns represent a temporary response to current search pressure or a durable reset in physician labor economics. The data do not answer that yet, but they do show where the market is paying the most to secure clinical capacity right now.