If you’re a physician or practice owner, you’ve probably heard the rumblings. Medicare is planning a major overhaul of its Physician Fee Schedule for 2026. This isn’t just another round of minor tweaks. We’re talking about a fundamental change in how doctors are paid, how procedures are valued, and who gets to decide what your work is worth. As someone who’s spent years navigating the maze of healthcare reimbursement, I can tell you—this is the kind of policy shift that can be scary.

But is it all doom and gloom? Or could there be a silver lining for some specialties?

Let’s break down what’s really at stake, what you can do to prepare, and why this matters for every physician’s bottom line.

A New Era for Physician Compensation

For decades, the value of your work as a doctor—whether you’re a surgeon, a pediatrician, or a primary care physician—has been determined by a committee within the American Medical Association (AMA). This committee meets infrequently, sometimes only once per decade, to decide how much each procedure, visit, or service is “worth.” Their decisions don’t just affect Medicare; private insurers often follow their lead.

But under the proposed 2026 changes, that power is shifting. Instead of the AMA committee, Medicare itself will take the reins. A new internal committee would be created to set these values, representing a huge policy shift. And it’s not just about who’s in charge—it’s about how the entire system of valuing medical work could be rewritten.

Why This Matters: Winners, Losers, and the Primary Care Question

One of the biggest criticisms of the current system is that it tends to favor high-procedure specialties—think surgeons—while undervaluing primary care, pediatrics, and other fields focused on prevention and long-term health. There obviously is a big role for prevention of disease and maintaining the health of the world and of our country. Yet, the way things are set up now, those specialties often get the short end of the stick.

So, could this shakeup finally mean better pay for primary care docs?

Maybe.

This could potentially result in an increase in value, compensation, and reimbursement for primary care physicians, and some of the traditionally undervalued specialties. If the new Medicare committee recognizes the true value of prevention and ongoing care, we might see a long-overdue rebalancing.

But let’s not get ahead of ourselves.

There’s no guarantee that the new system will get it right. In fact, there’s a real risk that things could backfire.

Potential Pitfalls: Efficiency Cuts and the Risk of Burnout

One of the proposals on the table is to cut reimbursement for all procedures, based on the argument that they’ve become more efficient over time. The logic goes: if a surgery takes less time or uses better technology, it should be reimbursed less.

But that efficiency comes with increased responsibility and risk that the physician takes on. So, should that necessarily receive less reimbursement? I don’t agree with that.

The danger is that these across-the-board cuts could penalize doctors who have worked hard to improve their practice, while ignoring the real-world complexity and risk that comes with patient care.

And let’s be honest: physician compensation is often blamed for rising healthcare costs, even though the data tells a different story. Physician reimbursement has actually increased, especially over the past few years, at a rate much lower than inflation. Meanwhile, costs driven by insurance companies, administrators, and regulators have skyrocketed.

If the new system leads to lower pay across the board, the consequences could be severe:

• Increased physician shortages, especially in primary care
• Higher rates of burnout and moral injury
• More doctors leaving the profession or cutting back on hours

If you add decreasing compensation onto that, the physician shortage could increase dramatically and you could see rates of burnout and moral injury within the physician community rise drastically.

The Government Factor: Will Medicare Get It Right?

There’s another big question hanging over all of this: can a government-run committee really do a better job than the AMA?

I’ll be honest—it's possible, but I'm wary. There’s some discord or disconnect between the current administration’s policymakers with healthcare and what physicians think are the best policies to put forward.

Either way, any situation in which doctors’ voices could be drowned out by bureaucrats who don’t understand the realities of patient care is not a good one for doctors, patients, or the healthcare system.

If physician input goes away, we could end up with a system that’s even less responsive to the needs of doctors and patients. That’s a recipe for frustration, inefficiency, and—ultimately—worse care.

Action Steps: How Doctors Can Prepare Now

So, what can you do to protect yourself and your practice as these changes loom? Here’s my advice, drawn from both personal experience and conversations with colleagues:

1. Optimize Your Practice Operations

• Review your scheduling: Are you maximizing your available slots? Are cancellations eating into your revenue?
• Streamline patient screening: Make sure you’re not losing time or money on preventable no-shows or poorly prepared patients.
• Delegate effectively: Use your team to the fullest, so you can focus on high-value activities.

2. Take Control of Your Personal Finances

• Know your net worth: Track your assets and liabilities so you have a clear picture of your financial health.
• Create a budget: Make sure you’re spending less than you earn, and build a margin you can invest for the future. (My budgeting template is right here!)
• Avoid lifestyle inflation: The best advice I could give young doctors is to manage their expenses. Don’t let a higher income lead to higher spending.

3. Plan for Financial Freedom

• Set a target: Know when you want to reach financial independence, so you’re not reliant on every paycheck.
• Invest wisely: Use your savings margin to build a nest egg that can weather changes in reimbursement.
• Prepare for uncertainty: The more financially secure you are, the more freedom you have to practice medicine on your own terms.

4. Advocate for Physician Input

• Get involved: Join professional organizations, attend meetings, and make your voice heard.
• Stay informed: Follow updates on the Medicare fee schedule and be ready to provide feedback during public comment periods.
• Support your colleagues: Share information and strategies so the physician community can respond collectively.

Conclusion: Don’t Wait for the System to Decide Your Future

The 2026 Medicare fee schedule shakeup is likely coming, whether we like it or not. It could mean long-overdue recognition for primary care and undervalued specialties—or it could bring new headaches, lower pay, and more burnout. The only thing that’s certain is that change is on the horizon.

As doctors, we can’t control every policy decision. But we can control how we prepare, how we manage our practices and finances, and how we support each other through uncertain times.

If you’re a physician or practice owner, now is the time to take a hard look at your operations, your financial plan, and your advocacy efforts. Don’t wait for the system to decide your future—take action today.

Here are some additional resources to help:

• How to Increase Your Compensation Both Clinically and Non-Clinically
• Understanding the RVU Compensation Model for Physicians
• I Designed a DIY Financial Literacy Curriculum for Physicians
• Physician Pay Decline: The Simple Solution Most Doctors Are Overlooking

What do you think? Are these potential changes to the Medicare fee schedule good or bad? Why or why not? Will it help specialties like primary care? Let me know in the comments below!