Internal medicine salary report: What internists really make in 2026

Internal medicine physicians in the U.S. reported average total compensation of $307,000 in 2025, according to the Medscape Internist Compensation Report 2026—up from $294,000 in 2024 and $282,000 in 2023, a compounding climb of roughly 5% a year that outpaced inflation. That's real progress.

It's also, by Medscape's own measure, still one of the lower averages among the specialties it tracks, and it shows in how internists feel about it. Fewer than half say they're paid fairly individually, and more than a third say their paycheck doesn't cover their family's needs. A raise doesn't undo that gap on its own, and 2025's growth looks more like a step forward than a resolution.

Take a look at where internal medicine pay actually stands, the different ways physicians can increase their compensation, and why a growing number of internists are also building locum tenens into their financial plan.

Where internal medicine pay stands today

At $307,000, internal medicine trails both the average across all physicians ($386,000) and the average across specialists ($417,000) in Medscape's broader 2026 Physician Compensation Report. Cardiology, radiology, and anesthesiology currently rank in the top five specialties for both pay level and pay growth—the same handful of fields are essentially getting richer while others hold steady. Internal medicine's 5% growth is genuine, but it's growth from a lower base, and it isn't closing that distance.

Whether that paycheck actually covers what an internist's family needs is where the gap becomes personal: more than a third say their pay falls short of family needs, a larger share than most specialties report.

A couple of numbers help explain why growth doesn't always feel like growth: 39% of internists say productivity metrics (RVUs) now factor into their base pay, not just their bonus, and 61% say they never negotiated their contract more than “moderately” aggressively—often because there wasn't a real opportunity to. Employed compensation, in other words, is increasingly something that happens to internists rather than something they negotiate.

Ways to increase your compensation

Before considering supplemental work, it's worth asking what room there is within a standard employment contract. For a lot of internists, the honest answer is: less than they'd like.

Negotiation

Sixty-one percent of internists say they didn't get more aggressive than “moderately aggressive” the last time they negotiated, and many didn't have a real opportunity to negotiate at all. That's not a reflection of anyone's ability to advocate for themselves—it's a sign that a meaningful share of the field is leaving room on the table simply because the conversation never happened.

Understanding how productivity factors into pay

RVU-based productivity metrics now shape base pay for 39% of internists, not just bonus pay. A physician who understands exactly how their employer weighs RVUs against other factors is in a far better position to influence their own number than one treating base pay as fixed.

For internists who've pushed on negotiation and productivity pay and still feel like they've hit a ceiling, locum tenens is another option—and it's one built around a genuinely different pay structure than employed work.

Why internists are turning to locums to build wealth

Locum tenens internists are currently earning $120–$145 per hour, according to Locumstory's 2025 data, up from $100–$140 the year before.

Assignments average about 60 days and typically run a Monday through Friday, 8am to 5pm schedule with little to no call—a more predictable rhythm than the on-call unpredictability that can come with an employed hospital role. Locums income also isn't capped by the same negotiation ceiling as a base salary, because it's priced per assignment rather than set once and revisited every year or two.

Learn how locums works: What is locum tenens? A beginner's guide

Gross pay is only half the picture, though. How reliably you get paid matters just as much, and it's often the part an employed comp statement doesn't capture.

Early career: Paying down debt faster

Medical school graduates in the class of 2025 carried an average of $223,130 in education debt, according to the AAMC. Dr. Bankim Patel went straight into locum tenens from residency with that math in mind.

Patel worked with a financial planner and an accountant to plan his contributions and file taxes as a 1099 earner. His advice to physicians just finishing residency is to start retirement-account planning—a 401(k) or a 529—as early as possible, before family and other responsibilities crowd it out.

Find out: How to pay off medical school debt: A comprehensive guide

Mid-career: Diversifying income without giving up stability

Dr. Trung Tran worked full-time as a locum tenens physician for about two years before transitioning into a permanent position, and he still picks up locum assignments at facilities where he's built relationships.

For internists who already have a permanent position, locums doesn't have to mean starting over. It can mean adding a second, more flexible income stream on top of the first.

Bring the balance back: How locum tenens jobs help you achieve better work-life balance

Long-tenure: Locums as a deliberate strategy, not a stepping stone

Dr. Matthew Dothager took a locums assignment right out of residency because he wasn't sure which direction he wanted his career to go. Seven and a half years later, he's still doing it.

Here I am, seven and a half years later, still doing this with what I thought was initially going to be just a temporary bridge to the next step of my career. Locums has actually turned into a long-term process for me.

— Dr. Matthew Dothager

For internists who assume locums is only a short-term move, Dothager's experience is a useful counterpoint. For some physicians, it becomes the long-term financial and lifestyle strategy—chosen again every year rather than defaulted into.

The real cost of going independent

Working locum tenens typically means being paid as a 1099 independent contractor rather than a W-2 employee, which opens up planning opportunities—solo 401(k) contributions, deductions for business expenses—that employed physicians don't have, along with new responsibilities like paying estimated quarterly taxes.

Patel's approach was to start early and get help:

He researched the basics—how to file 1099 taxes, how loan repayment timelines compare—before meeting with a financial planner and an accountant to build out one-, two-, three-, and five-year plans. For a deeper walkthrough of solo 401(k) contributions, quarterly estimated taxes, and deduction planning specific to 1099 locum income, Weatherby's Annual Tax Webinar covers this in more detail.

Read: How to choose the right tax structure for your locums lifestyle

Pay also varies by state and setting, largely with cost of living and local demand. Nationally, demand for internal medicine locums is strong across the board, but the West currently accounts for roughly a third of all open assignments, the highest concentration of any region.

Next steps

Whether you're fresh out of residency and staring down loan payments, mid-career and looking to diversify, or long past the point where locums was supposed to be temporary, the $307,000 average is a starting point, not a ceiling. The next step is the same either way: see what the numbers actually look like for your specialty, your state, and your schedule.

Ready to get started? Explore today's IM locum tenens opportunities, or give us a call at 954.343.3050 to speak with a consultant.