--- title: "When the salary guarantee ends" canonical: "https://www.joinandwise.com/crossings/salary-guarantee-ends" checked: "2026-10-21" claim: "andwise:crossing/salary-guarantee-ends@2026-10-21" license: "CC BY 4.0" --- # When the salary guarantee ends Many attending contracts guarantee a base salary for a set period, then pay on a production formula. This page shows what changes that year, which fee-schedule changes reach the formula, and where to compute it. **The decision:** The first year paid on the productivity formula instead of the guaranteed base. Usually nothing new is signed. ## What changes - Pay switches from the guaranteed base to the contract's formula, often a dollar rate per work RVU above a threshold. Some contracts reconcile pay against production and allow payments above the guarantee to be taken back. ([Andwise clause library: compensation](https://www.joinandwise.com/contracts/clauses/compensation); checked 2026-10-21) - For 2026, CMS applied a −2.5% efficiency adjustment to work RVUs for services that are not time-based. Evaluation and management, care management, behavioral health, telehealth-list services and some maternity codes are exempt. CMS describes the adjustment as periodic without fixing an interval. ([CMS, CY 2026 Medicare Physician Fee Schedule final rule fact sheet](https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f); [CY 2026 Physician Fee Schedule final rule, 90 FR (2025-11-05)](https://www.govinfo.gov/content/pkg/FR-2025-11-05/html/2025-19787.htm); checked 2026-10-27) - A contract that pays a fixed rate per wRVU, counted on the 2026 values, pays less for the same procedural work than on 2025 values unless the employer restated them. ([Andwise: the 2026 wRVU cut](https://www.joinandwise.com/answers/wrvu-cut-2026); [CMS, CY 2026 Medicare Physician Fee Schedule final rule fact sheet](https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f); checked 2026-10-21) - The CY 2027 proposed rule (July 16, 2026) estimates a conversion factor of $32.8409 for clinicians not in a qualifying APM, 1.7% below 2026, because a one-year 2.5% increase lapses. The conversion factor reaches a physician's pay where the contract ties its rate to Medicare's conversion factor or pays on collections. ([CY 2027 Physician Fee Schedule proposed rule (2026-07-16)](https://www.govinfo.gov/content/pkg/FR-2026-07-16/html/2026-14327.htm); checked 2026-10-21) - Not measured: No published survey measures typical guarantee lengths or wRVU thresholds. The contract's own terms are the only figures that apply. - Not measured: No source counts how many employers restated wRVU values after the 2026 change. ## Who is paid for what - **The employer.** Pays the contract's formula. In PAI's 2026 survey, 41% to 53% of employed physicians reported patient-volume targets in their compensation. ([Physicians Advocacy Institute, 2026 Employed Physician Survey](https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI%202026%20Employed%20Physician%20Survey%20-%20final.pdf)) Not part of its role: Restating wRVU values after a CMS change, unless the contract requires it. ## Costs that come later - Guarantee length and the formula after it (agreed at signing) → The first production year — https://www.joinandwise.com/contracts/compare#after-guarantee - The fee-schedule year named in the contract → Each CMS revaluation — https://www.joinandwise.com/answers/wrvu-cut-2026 - Reconciliation and take-back terms → Year-end reconciliation — https://www.joinandwise.com/contracts/wrvu-statement - How time off counts against the wRVU threshold → Any bonus year with leave — https://www.joinandwise.com/contracts/pto-threshold ## Deadlines - The guarantee's end date — Set in the contract - The CY 2027 fee schedule: proposed July 16, 2026; the CY 2026 final rule was published November 5, 2025 — Set by law ## Tools - [Offer comparison: after the guarantee](https://www.joinandwise.com/contracts/compare#after-guarantee): Last guaranteed year beside the first formula year, at the contract's rate and threshold. - [wRVU statement checker](https://www.joinandwise.com/contracts/wrvu-statement): A productivity statement against the contract's terms. - [Time off and the wRVU bonus](https://www.joinandwise.com/contracts/pto-threshold): What leave does to a threshold bonus. - [Compensation clause](https://www.joinandwise.com/contracts/clauses/compensation): Two versions of the clause, and the questions it raises. ## Questions ### The employer - What formula applies after the guarantee, and does any base remain? - Which fee-schedule year sets wRVU values, and are thresholds restated when CMS revalues codes? - How often is pay reconciled, and can amounts above the guarantee be recovered? ### A CPA - If pay changes after the guarantee, how do estimated taxes and retirement contributions change? ## Sources - [Andwise clause library: compensation](https://www.joinandwise.com/contracts/clauses/compensation) - [CMS, CY 2026 Medicare Physician Fee Schedule final rule fact sheet](https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f) - [CY 2026 Physician Fee Schedule final rule, 90 FR (2025-11-05)](https://www.govinfo.gov/content/pkg/FR-2025-11-05/html/2025-19787.htm) - [Andwise: the 2026 wRVU cut](https://www.joinandwise.com/answers/wrvu-cut-2026) - [CY 2027 Physician Fee Schedule proposed rule (2026-07-16)](https://www.govinfo.gov/content/pkg/FR-2026-07-16/html/2026-14327.htm) - [Physicians Advocacy Institute, 2026 Employed Physician Survey](https://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/PAI-Research/PAI%202026%20Employed%20Physician%20Survey%20-%20final.pdf) Reviewed 2026-10-27; oldest source check 2026-10-21. General information, not legal, tax or financial advice. The site describes what the law and rules say; it does not say whether a clause is enforceable or what you should do.