2026 Urogynecologist Salary Guide: Female Pelvic Medicine & Reconstructive Surgery

Urogynecologists — formally trained in Female Pelvic Medicine and Reconstructive Surgery (FPMRS), a dual subspecialty recognized by both ABOG and AUA/AUGS — are among the most supply-constrained procedural specialists in medicine. Fewer than 2,000 AUGS-credentialed physicians practice FPMRS in the United States, serving an estimated 20 million women with symptomatic pelvic floor disorders. That supply-demand imbalance drives compensation above what OB/GYN generalists earn and creates persistent recruiter demand in both academic and community settings. Total cash compensation in 2026 ranges from $350,000 to $620,000+ depending on practice model, procedural volume, and geography.

Salary overview by practice setting

• Academic medical center FPMRS division: $350,000–$480,000; NIH NICHD and PCORI funding opportunities; AUGS fellowship training program; research protected time; PSLF-eligible employment; strongest environment for clinical trials (SUI, POP mesh vs. native tissue comparative effectiveness)
• Employed community or health system FPMRS: $390,000–$560,000; no research requirement; faster surgical scheduling; wRVU-based incentive on top of base; direct pipeline from OB/GYN partners and primary care referrals; hospital investment in OR block time for prolapse and continence programs
• Private practice or multispecialty group (urology or OB/GYN): $480,000–$640,000+; ASC ownership captures technical fee on sacrocolpopexy and sling procedures; full wRVU upside; highest earners own or co-own the ASC performing their most common cases
• Hybrid urology-FPMRS groups: $440,000–$580,000; integrated male/female pelvic floor programs; shared ASC infrastructure with urology partners; voiding dysfunction and cystoscopy practice often combined

Fellowship pathway and board certification

FPMRS requires a 3-year ACGME-accredited fellowship from either an OB/GYN or urology residency. The fellowship is jointly governed by ABOG (OB/GYN pathway) and AUGS, with ABOG board certification in Female Pelvic Medicine and Reconstructive Surgery requiring completion and successful examination. Approximately 200–250 fellows complete FPMRS training annually — a relatively small number given the scale of demand from health systems building pelvic floor programs and the retirement of OB/GYN generalists who previously handled less-complex prolapse cases.

Surgical procedures and CPT billing

FPMRS wRVU production comes from a mix of high-value reconstructive pelvic procedures and office-based continence management. Key procedures:

• Anterior colporrhaphy (cystocele repair): CPT 57240; professional fee $1,500–$2,800; 3.8 wRVU; correction of anterior vaginal wall prolapse; frequently combined with apical suspension and posterior repair in single-setting pelvic floor reconstruction
• Posterior colporrhaphy (rectocele repair): CPT 57250; professional fee $1,500–$2,800; correction of posterior vaginal wall prolapse; perineorrhaphy often performed concurrently
• Robotic/laparoscopic sacrocolpopexy: CPT 57425 (laparoscopic sacrocolpopexy); professional fee $2,500–$4,500; gold-standard apical prolapse repair via permanent lightweight mesh from vaginal apex to sacral promontory; highest-wRVU procedure in FPMRS; robotic platform broadly adopted; simultaneous Burch colposuspension (CPT 51840) or midurethral sling for concurrent SUI management adds additional wRVU
• Sacrospinous ligament fixation (SSLF): CPT 57282; professional fee $1,800–$3,000; native-tissue apical prolapse repair via vaginal approach; anchors vaginal apex to sacrospinous ligament; preferred at programs limiting mesh use post-FDA 2019 mesh withdrawal order for transvaginal POP mesh
• Uterosacral ligament suspension (USLS): CPT 57283; professional fee $1,800–$3,000; native-tissue high-uterosacral suspension; vaginal or laparoscopic approach; risk of ureteral kinking requires cystoscopy at completion
• Midurethral sling — retropubic (TVT): CPT 57288; professional fee $1,500–$2,500; retropubic tension-free vaginal tape; gold-standard stress urinary incontinence treatment; level I evidence for long-term SUI cure
• Midurethral sling — transobturator (TOT): CPT 57287; professional fee $1,500–$2,500; transobturator sling; same SUI indication; lower risk of bladder injury vs. TVT; equivalent cure rates in most comparative studies
• Urethral bulking injection (Bulkamid): CPT 51715; professional fee $500–$1,200; in-office or ambulatory periurethral polyacrylamide hydrogel injection; appropriate for SUI patients who are not surgical candidates; repeat injections drive return visit volume
• Botulinum toxin — intradetrusor (onabotulinumtoxinA for OAB): CPT 52287; professional fee $700–$1,400; buy-and-bill on J0585 (onabotulinumtoxinA per unit) if physician supplies Botox directly; meaningful ancillary revenue in high-volume overactive bladder practices; repeat injections every 6–12 months create durable recurring revenue
• Urodynamics (multichannel UDS): CPT 51726 (complex cystometrogram) + 51741 (complex uroflowmetry); professional fee $400–$900 per study; in-office when practice owns urodynamics equipment; essential diagnostic workup prior to surgical SUI intervention; drives E&M and procedure volume
• Office cystoscopy: CPT 52000; professional fee $300–$600; in-office flexible cystoscopy; hematuria evaluation, post-sling complication assessment; high-volume practices with in-office cystoscopy generate steady ancillary revenue
• Vaginal hysterectomy with prolapse repair: CPT 58260 (vaginal hysterectomy, uterus ≤250g) or 58262 (with tubes/ovaries); professional fee $2,000–$3,500 for hysterectomy component; combined with SSLF or USLS generates 8–12 total wRVU for complex combined pelvic floor case
• Vesicovaginal fistula repair: CPT 51900 (vaginal approach) or 51920 (abdominal approach); professional fee $2,000–$5,000; complex reconstructive case; referral magnet for high-volume FPMRS programs
• Pessary fitting and management: CPT 57160; professional fee $200–$400; conservative first-line for POP and SUI; generates E&M return visits every 3–6 months; builds patient panel depth

Ancillary revenue and ASC economics

FPMRS practices that own their ambulatory surgery center capture technical fees that effectively double net revenue from sacrocolpopexy, sling, and colporrhaphy cases. A robotic sacrocolpopexy generating a $3,500 professional fee yields another $3,500–$5,000 in technical/facility fees to the ASC — which the physician-owner shares. At 100–150 sacrocolpopexy cases per year, ASC ownership generates $350,000–$750,000 in additional pre-tax income beyond the professional component. Similarly, in-office urodynamics and cystoscopy generate technical fees when the physician owns the equipment and space.

Geographic variation in urogynecologist compensation

• Major academic FPMRS programs (Cleveland Clinic, Mayo, UCSF, Brigham and Women's, Penn Medicine, Duke): $360,000–$520,000; strongest research infrastructure; AUGS leadership pipeline; NIH funding access; PSLF-eligible
• Large urban health systems (Midwest, Mid-Atlantic): $400,000–$570,000; employed model; strong referral networks from OB/GYN departments; robotic sacrocolpopexy volumes sufficient to maintain expertise
• Sun Belt community markets (FL, TX, AZ, GA): $420,000–$620,000; high aging-population density drives pelvic floor demand; growing comprehensive pelvic floor program investment by health systems; FPMRS supply thin relative to demand; competitive recruiting environment
• Rural markets: near-zero dedicated FPMRS supply; general OB/GYNs perform simpler prolapse cases; complex reconstructive cases (sacrocolpopexy, fistula) require referral to regional academic center

What we see at Ava Health

FPMRS is the subspecialty where our physician database most dramatically understates supply relative to employer demand. The national fellowship pipeline of roughly 220 graduates per year cannot keep up with the volume of new pelvic floor program investments health systems are making. FPMRS physicians respond well to outreach because they are genuinely evaluating opportunities — both academic moves with better fellowship programs and community moves with stronger ASC economics. The consistent ask from employers: a physician who can build a standalone pelvic floor center, not just fill OR blocks. Physicians who can credibly pitch program-building capability — fellowship training infrastructure, multidisciplinary incontinence clinic, urodynamics suite — command the top of the compensation band.

Related: Gynecologic Oncologist Salary Guide, OB/GYN Salary Guide, Urologist Salary Guide, Maternal-Fetal Medicine Salary Guide.