Gastroenterology reaches the top of physician pay as recruitment pressure intensifies
Gastroenterologists now command the highest average starting salary among physicians, a shift that speaks to how quickly recruiting priorities can move when specialist access is tight. The average offer reached $654,000, pushing orthopedic surgery out of the top spot after four straight years at the top of the compensation rankings.
The change is not just symbolic. It reflects a market in which hospitals and medical groups are competing more aggressively for clinicians who can fill high-volume specialty services, manage procedural demand, and sustain revenue-sensitive programs. When patient backlogs grow and referral pipelines tighten, compensation often moves first.
Average starting salaries for orthopedic surgeons fell 12% year over year to $507,000, while gastroenterologist offers climbed 18.5%. Those two figures tell a clear story about relative scarcity and employer urgency. In a system still struggling with access bottlenecks, procedural specialties with strong downstream demand can see their market value reset quickly.
Signing bonuses climbed as employers competed for scarce specialists
The average physician signing bonus increased 29% to $49,306 from $38,215 a year earlier. AMN Healthcare linked the rise to sharper competition among hospitals and medical groups for specialists, a dynamic that often appears when recruitment timelines shorten and open positions become harder to fill.
A signing bonus is rarely just a courtesy payment. In practice, it is an incentive designed to secure commitment before a rival employer makes a stronger offer or before a candidate decides to delay relocation, fellowship completion, or practice change. For employers, the bonus can be cheaper than leaving a subspecialty line unstaffed for months. For physicians, it signals a labor market in which leverage has shifted toward in-demand proceduralists.
Specialists accounted for 84% of AMN’s physician searches, compared with 16% for primary care. That imbalance explains much of the compensation pressure. When most searches center on specialists, salary surveys begin to mirror a system where hospital throughput, referrals, and procedural capacity drive hiring decisions more than broad-based outpatient coverage.
Primary care remains essential, but compensation trails specialty demand
Family medicine physicians were offered an average starting salary of $291,000, while internal medicine physicians averaged $289,000. Those figures remain far below the gastroenterology and orthopedic surgery offers, and the spread illustrates how differently the market values broad access care versus high-revenue specialty services.
The gap carries bedside consequences, even if indirectly. Primary care controls referral patterns, chronic disease follow-up, and early detection, yet the recruiting market continues to price specialty positions higher. In many communities, that can widen access delays if organizations devote more hiring energy to procedural services than to the outpatient base that feeds them.
Academic positions also lagged non-academic roles, averaging $362,000 versus $452,000. Lower pay in academic settings is often tied to teaching, research, administrative expectations, and a different mix of clinical volume. Physicians who accept those jobs may trade earnings for protected time, mentorship, or academic affiliation, but the compensation gap can still make recruitment harder for medical schools and teaching hospitals trying to staff complex services.
Nurse practitioner demand stayed elevated across the recruiting market
Nurse practitioners remained the most requested recruiting category for the sixth consecutive year, with average starting salaries of $180,000. Their continued prominence indicates that employers are still relying on advanced practice clinicians to extend capacity, stabilize staffing models, and absorb clinical work that does not require physician-level intervention.
In many systems, that strategy is less about substitution than survival. APP recruitment helps preserve appointment access, procedure follow-up, and continuity in settings where physician supply remains constrained. The salary figure also shows how different parts of the labor market are being priced: nurse practitioners remain highly sought after, yet their compensation is still far below the physician-level offers driving the specialty surge.
The data come from a representative sample of 1,293 permanent physician and advanced practitioner search engagements conducted or ongoing from April 1, 2025, to March 31, 2026. That sample gives the findings practical relevance because it reflects live recruiting activity rather than theoretical wage modeling. It also captures a full year in which employers were evidently willing to pay more to secure specialty coverage.
What the salary shifts suggest about access, leverage, and workforce strain
The compensation pattern points to a labor market under pressure at the specialty end. Gastroenterology’s rise to the top suggests sustained demand for procedural throughput, endoscopy access, and inpatient-outpatient continuity in a field where delayed care can quickly create queue pressure. Orthopedic surgery’s decline does not mean the specialty has lost value; it means the relative ranking changed in a market where employers are adjusting bids to match immediate hiring needs.
For health systems, these numbers have immediate planning implications. Higher starting salaries and larger bonuses increase the cost of opening or keeping specialty services staffed, and they may push organizations to narrow search criteria, expand locum coverage, or rethink incentive structures for hard-to-fill posts. For physicians, the figures offer a snapshot of bargaining power in a system still shaped by procedure volume, hospital economics, and regional shortages.
The report does not break down regional variation, contract length, call burden, or bonus structure, all of which can materially change the true value of an offer. It also does not show whether higher pay translated into faster fill rates or lower vacancy time. Those missing details matter because salary alone never tells the full story of workforce strain; call schedules, administrative load, and retention after the first contract year can be just as decisive as the headline number.