What the National Benchmarks are Telling us About Primary Care Productivity and Compensation
For three straight reporting cycles, the Medical Group Management Association's (MGMA) provider compensation data has told a consistent story: primary care total cash compensation keeps rising. Yet the 2026 report (reflecting 2025 performance-year data) reveals something health system leaders haven't seen in years; the productivity engine that has historically justified those pay increases is now running in reverse.
Work RVUs fell across 16 of the 23 tracked specialties, and total patient encounters declined across all 23 of the tracked specialties, including primary care. Compensation rose anyway.
For health systems with employed primary care practices, this isn't a one-year blip. It's the culmination of a three-year trend visible across the MGMA productivity and compensation benchmark reports. Over the past three years’ surveys, median benchmarks for the Primary Care Physician Rollup specialty have shown that total patient encounters are down 2.8%, while total cash compensation is up 9.5%. This has direct implications for how compensation plans, fair market value (FMV) benchmarks, and productivity targets should be built going forward.
The pattern is unmistakable: Productivity has declined while compensation has continued to rise, creating a widening disconnect between physician pay and traditional productivity measures. At the same time, compensation growth has decelerated in each successive cycle, and real (inflation-adjusted) pay turned negative for the first time in 2025.
Against this backdrop, compensation plan design has also quietly shifted. Straight salary and pure wRVU-based models are giving way to hybrid structures that blend base pay with quality, patient access and other risk-based incentives.
A Compounding Factor for 2026
If the disconnect between compensation and productivity wasn't already significant enough, 2026 introduced another variable that compensation committees cannot afford to overlook.
Effective January 1, 2026, CMS implemented an efficiency adjustment that reduced work RVU values by approximately 2.5% across roughly 7,700 CPT codes. Physicians performing identical work will register measurably fewer wRVUs, which will mechanically push published compensation/wRVU benchmarks upward even without any real change in physician productivity. Organizations that rely on published benchmark ratios without accounting for this adjustment risk real FMV and Stark Law exposure at the next contract renewal cycle.
With this in mind, compensation committees should begin preparing now, focusing on the following areas to stay ahead of the changes:
1. Move beyond wRVU only productivity targets. With encounters and wRVUs falling in most specialties while compensation keeps rising, compensation/wRVU ratios are becoming distorted rather than directional. Rebuild Primary Care plans around a blended scorecard that includes productivity, patient panel size, quality/HEDIS performance metrics, patient access, and patient experience.
2. Pre-model the 2026 CMS efficiency adjustment into every FMV benchmark. Don't wait for conversion factors to drift upward without acting. Adjust compensation/wRVU benchmarks proactively ahead of renewals to avoid inadvertent overpayment and FMV/Stark compliance risks.
3. Use rolling three-year benchmarks, not “single year” snapshots. Productivity from a wRVU and encounter perspective have swung sharply year to year. A rolling average smooths anomalies and produces more defensible FMV opinions than any single yearly cycle can on its own.
4. Benchmark employed Primary Care Providers (PCPs) against independent private-practice peers, not just internal or employed practice groups. Private-practice PCPs continue to outproduce hospital owned counterparts on encounters and collections despite lower measured wRVUs. Understand this data when setting realistic, market-defensible targets for employed groups.
5. Build automatic true-up mechanisms into compensation plans. With PCP compensation on a slight decline, and roughly one in three practice groups reporting a provider retiring or leaving the practice due to burnout, static annual increases will likely erode retention. Insert Consumer Price Index (CPI) linked or economic market triggers into compensation plans rather than waiting for the next full employment agreement renewal cycle period.
The Bottom Line
The past few years of national compensation and productivity survey data marks an inflection point for primary care compensation strategy. Health systems that continue to design plans around wRVU-only productivity measures will find their compensation practices increasingly disconnected from what's taking place in their practices.
Organizations that adopt balanced compensation models – combining productivity with quality, patient access, patient experience, and other strategic performance measures – will be better positioned to maintain compliance, align physician incentives with organizational goals, and recruit and retain primary care provider talent in an increasingly competitive market.
Ronnen Isakov is Managing Director Advisory Service of Management Group, LLC. His background includes extensive work in areas including business advisory, valuation, network optimization, transaction support, and project management.