Physician pay is squeezed from every direction. Much of what determines our compensation is completely out of our control. The RUC committee, which advises the Centers for Medicare & Medicaid Services (CMS) on how to value codes, plays a key role in assigning Relative Value Units (RVUs).

RVUs measure the value of physician services by assigning a numeric weight to each service or procedure. The value reflects three key components:

While the RUC committee advises the CMS, it’s ultimately Congress that sets Medicare reimbursement rates, so this is influenced as much by politics and lobbying efforts as it is by logic.

Medicare and commercial insurance payers use these conversion factors to calculate reimbursements. However, how those values are determined is not something most physicians have visibility into. It’s a complete black box.

And yet, many of these changes have significant consequences on our pay. For example, the American Society for Radiation Oncology (ASTRO) recently flagged a proposed change from CMS that could dramatically reduce reimbursement for radiation oncology services in 2026, slashing total reimbursement by as much as 40%.

Such changes could have a substantial impact on Radiation Oncology compensation for practices and physicians

The net effect?

Physician pay is down 22% in real terms from 2001 to 2025, while practice costs have climbed nearly 60%. At the same time, facility fees, i.e., payments made to hospitals, have gone up steadily.

So the people delivering care are asked to do more for less, while the reimbursements to the infrastructure around them continue to grow unchecked.

Source: AMA

And we’ve seen the long-term effects of these changes. Family medicine, pediatrics, and internal medicine – the specialties that handle prevention and the bulk of chronic disease management – consistently have lower RVUs assigned.

Which means they are not able to generate as many wRVUs in a year as their peers in procedural specialties. They also receive lower reimbursement per wRVU from their employers because their work doesn’t generate facility fees for health systems, which often augment wRVU rates. It’s a double whammy!

Over time, this adds up. These specialties, which are critical to keeping people healthy and reducing long-term costs, are among the lowest-paid in medicine. Not surprisingly, fewer and fewer medical students are choosing to enter them.

So, why not just open your own practice? It’s not so simple anymore.

The declining reimbursement rates for Medicare and Medicaid and the increasing costs of running a practice make it hard to sustain a profitable practice. Smaller practices also have less negotiating leverage with insurance companies for commercial contracts.

Add to that regulatory complexity, and investor interest in buying out private practices.

And then there’s the student debt burden, which drives many early-career physicians to stick with PSLF-eligible jobs, which usually means working for large systems. So, it’s no surprise that nearly 80% of physicians today are employees of health systems, private equity groups, or hospitals.

And once you’re in an employed role, the numbers get even more murky. Offers are often presented as being based on the Medical Group Management Association (MGMA) or a similar benchmark, but most of us never get to see that data.

Unless you’re paying $$ for access, you’re left negotiating with vague anecdotes and guesswork. It’s hard to make smart decisions when the information you need is kept behind a paywall.

There is opacity across the board.

Also read: Physician Salaries and Latest Compensation Benchmarks Revealed

When it’s time to negotiate an offer, we all ask around. What are others making? What’s the going rate in our specialty? The more data you have, the better you can advocate for yourself.

We know that this kind of transparency leads to better and fairer pay. This isn’t a new or radical idea. I’ve seen it work because my brother was part of the early team at Glassdoor. I watched them as a small startup crack open the black box of employee pay and employer reviews.

Glassdoor championed the age of pay transparency in Tech. Surely, medicine could use something like this?

What if we simply choose to share what we’re paid and the context around it, anonymously, securely, and safely? If we can do this at scale, we can begin to change the power dynamics around physician compensation.

We can confidently negotiate and hold others accountable based on real data, not a number set by someone else.

It’s called Marit. It’s a community-powered, anonymous salary sharing for medicine. It shows not just the averages and medians that you see on Google, Glassdoor, Medscape, etc., but all the detailed anonymized salaries with the depth of information we need.

It has all the salary components: wRVUs, tax structure, hours worked, call schedule, practice type and setting, location, benefits, and more.

Almost 10,000 clinicians have contributed to it, making it one of the largest and richest compensation data sets of its kind in medicine. And best of all, it’s fully accessible to verified clinicians and will always be free.

If you’re pursuing FIRE, every underpaid year doesn’t just cost you money; it costs you time. Say you’re making $50,000 less than your peers. Not because you negotiated poorly, but because you didn’t have the right data to make a fully informed decision.

If you had invested that $50K each year with a 6% return, you’d have more than $2 million after 20 years. $3M over 25 years. It’s the difference between retiring at 55 and working until 65.

Under-earning compounds too, unfortunately. It’s invisible in the moment, but it adds up fast. And the truth is, no amount of budgeting can offset a chronic earnings gap.

That’s why making smart, informed choices about compensation, especially early in your career, is the single most powerful FIRE lever you have. But you can’t improve what you can’t see.

No two jobs in medicine are the same. Practice type, compensation model, location, schedule, hours – all of it shapes what you earn.

That kind of variability can be frustrating. But in a world where salary data is transparent, it can also be empowering. When you understand what drives the differences, you can make better decisions for your own career.

Take my own situation. Earlier this year, this kind of salary transparency allowed me to jump into night shifts, which gave me both a meaningful positive compensation adjustment and more time during the day to build Marit – where I can make an even bigger impact on medicine.

Or take this internist salary in Massachusetts who works 40 hours a week, and earns $660K – because they work at a Concierge Medicine practice. Or this OBGYN salary in Indiana, who’s at the 75th percentile, but works 55 hours a week as a partner in a private group.

Or this Pediatrician salary in Oklahoma of $325K, well above the norm for the specialty, thanks to a strong productivity bonus and other incentives.

These aren’t outliers. They’re real jobs, real data from real people – but fully anonymized. And when you can see what’s possible, it becomes a lot easier to chart a path that fits your own goals.

The system will likely continue to squeeze, but transparency gives us one way to push back. We probably do need to overhaul the system, but that will take time, and we can simply start by talking to each other.

As more people share and participate, this just continues to get bigger and stronger for all of us. We already have one of the richest data sets at Marit, and we’ll be sharing some insights from this data in the coming weeks.