New data from AMN Healthcare suggest employed clinicians are increasingly rewarded for the volume of care they provide as quality-based incentives lose traction.
The Physician Solutions division of AMN Healthcare, a physician recruiting firm, recently released a report based on a representative sample of over 1,400 search engagements the company conducted from April 1, 2024, to March 31, 2025.
The report found 66% of physician and other health care professional contracts feature a starting salary with a production bonus that allows clinicians to earn more based on the volume of patients they see in addition to other metrics. Only 29% of physician contracts featured a straight starting salary with no production bonus.
Among proposed contracts that offered a bonus in addition to salary, quality metrics – such as patient satisfaction scores and readmission rates – were used to determine bonuses just 16% of the time in the 2024-2025 period. That was down from 26% between 2023-2024, and four times lower than the 64% rate during the 2019-2020 period. The report notes, however, in the 16% of contracts that used one or more quality-based metrics, 16% of the physician’s total compensation will be determined by such quality-based metrics, up from 10% last year.
The use of relative value units (RVUs) in production bonuses, intended to reflect the amount of work required by a physician for a service, saw a slight increase. AMN’s research found 65% of contracts included an RVU component in 2024-2025, up from the 57% figure between 2023 and 2024.
Karen Johnson, the Texas Medical Association’s director of practice and information services, notes for some physicians, volume-based metrics, like the use of RVUs to gauge physician performance may present less confusion than other methods of measuring a physician’s performance. She says quality metrics, which are often fluid, may have been, for some physicians, time-consuming and frustrating.
“Many physicians’ perception has been quality metrics often focused on physicians clicking the right boxes within their electronic health records, rather than true clinical outcomes,” she said.
As volume-based components increasingly shape physicians’ bonuses, so do bonuses shape physician compensation as a whole.
While salary remains the largest share of income for physicians, bonuses are increasingly factoring into compensation, according to an American Medical Association Policy Research Perspective report issued last year that examined trends on physician compensation methods from 2012-2022.
In 2022, 68.2% of physicians received at least some compensation from salary, up from 60.2% in 2012, the AMA report shows. Sole compensation by salary has dropped slightly, however, as more doctors receive a combination of salary and bonus. Per AMA, 39% of physicians were compensated by a single method in 2022, compared with 51.8% in 2012.
Educational loan repayments are included in 16% of physician contracts, AMN found, but the average repayment amount dropped to $104,200 this year, down from $117,217 last year.
TMA offers its members resources concerning how to negotiate a salary or navigate common physician contracts, including how to review and amend agreements. TMA does not provide legal advice. Have questions about contracts? Call or email TMA’s Knowledge Center at (800) 880-7955.
NOTICE: This publication is intended for general informational purposes only. The information provided in this publication does not constitute legal, financial, business, investment, medical, accounting, or tax advice. You should not rely on the information in this publication when dealing with personal financial, business, or investment decisions; rather, advice from an appropriate professional should be sought.
The Texas Medical Association (TMA) provide this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TMA nor their attorneys are engaged in providing legal advice, financial advice, business advice, or investment advice, and 3) the information is of a general character. This is not a substitute for the advice of an attorney. Although TMA has attempted to present information that is accurate and useful, some material may be outdated and TMA shall not be liable to anyone for any inaccuracy, error, or omission, regardless of cause, or for any damages resulting therefrom. Any reliance you place on such information is strictly at your own risk. We disclaim all liability and responsibility arising from any reliance placed on such information. You should not rely on this information when dealing with personal legal matters; rather, legal advice from retained legal counsel should be sought.
Certain links provided with this information connect to websites maintained by third parties. TMA has no control over these websites, or the information, goods or services provided by third parties. TMA shall have no liability for any use or reliance by a user on these third-party websites or information provided by third parties.
References in this publication to any product, service, model, program, or entity does not constitute an endorsement or implied endorsement by TMA.