By Dr. Jim Dahle, WCI FounderAs I've gotten older, I've noticed a trend. Many doctors think there was a “golden age” of medicine where doctors made dramatically more than they make now. And when was the golden age of medicine? The actual dates of this supposed “golden age,” of course, are extremely variable. It always seems like the golden age ended 5-10 years before the doctor talking about it came out of training.
When I was in medical school in 1999-2003, the golden age was before HMOs became popular in the 1990s. But what's happened to average physician incomes during my career? Well, they've gone up, even after accounting for inflation. While the increases in each decade are not the same and while there are plenty of worrisome trends, there have always been worrisome trends. In this post, we'll go over the data, and you'll see what I mean.
Dr. Shippen's Records
Dr. William Shippen kept payment records from his practice beginning about the time of the American Revolution. Many patients paid in kind with goods rather than cash. He was making good money on smallpox inoculations and “male-midwifery” (aka obstetrics). But he was paid in everything from bread (a baker) to lottery tickets to a “bad painting.” He also dabbled in real estate investing. While he only made 3 pounds sterling from treating a Spanish diplomat, he made 350 pounds sterling renting him a house. He was the head of the Continental Army Medical Department. A senior surgeon at that time was paid $4 a day plus six rations. That's $4 per day x 365 days = $1,460 a year. Given that the average income back then was $65 a year, that surgeon was raking in the money. Maybe the Revolutionary War was the “golden age” for doctors.
Physician Income in the 1800s
In the early 1800s, there just weren't very many paying patients so doctors often had second jobs—such as school teacher, hotel operator, or farmer. One was even a superior court judge.
Physician Wealth in the UK
A very interesting article about the wealth (not income) of “distinguished doctors” in the UK showed a significant decline between 1860-2001.
From this, it appears the “golden age” was from 1840-1880. I'm a little skeptical, though, as the same article showed this for everyone else:
Saying people were wealthier in 1880 than in 1980 just doesn't pass the sniff test for me.
More information here:
The Most Athletic Doctor Ever and Andy Warhol’s Cookie Jar Collection
Physician Incomes Between 1914-1929
The earliest data set I could find on physician salaries begins in 1929.
This was kind of a tough time to be a doc, though. About HALF of the country's 129,000 doctors in 1941 were recruited into the Armed Services for World War II. But here's how incomes shaped up in 1949:
I thought this was interesting because, just like now, there was a very wide range of incomes among docs 75 years ago. It's always hard to sort out all of this stuff, given the effects of inflation. So, let's compare this 1949 income of $19,710 to the senior surgeon in 1776 ($1,460) and the 2023 Medscape Salary Survey figure ($352,000).
Adjusted for inflation to 2023 dollars:
- 1776: $51,129
- 1949: $252,288
- 2023: $352,000
Hard to look at that and conclude the “golden age” was before 1949.
The Medusa and the Snail
A very interesting excerpt from this 1974 book reads as follows:
“I had forgotten what things were like in the good old days of medicine, and how different . . . I found in the other day while glancing through the yearbook of my class at Harvard Medical School at the time of graduation, in 1937 . . . Coons, as editor, decided to do something more ambitious for the yearbook than simply record the class statistics, and prepared a long questionnaire which was sent to all the alumni of the medical school from the classes which had graduated 10, 20, and 30 years earlier . . . To everyone's surprise 60% of the 265 alumni filled out the questionnaire and returned it . . . The findings of greatest interest, presented in some detail in the yearbook, concerned the net incomes of the alumni, which were, by the standards of the day, significantly higher than the AMA's figures for American physicians in general . . . We knew that interns and residents got room and board but no salary to speak of. We were glad to hear that Harvard graduates did better financially once out in practice . . .”
The median net income of the group of 165 HMS graduates, 10-30 years out of school, was between $5,000-$10,000 a year [about $80,000-$160,000 in 2024 dollars]. In the 10-year class, 43% made less than $5,000. Only five men earned over $20,000 [~$354,000 in today's money] and a single surgeon, 20 years out, made $50,000 [more than $1 million today]. Seven graduates of the class of 1927 had incomes below $2,500 [about $44,000].
The alumni were invited to send in comments along with the questionnaire, in a space marked “Remarks,” with the understanding that since so much of the form was directed at finding out how much money they were making, they might like to say something about life in general. As it turned out, most of the “Remarks” were also about money, a typical comment being the following: ‘I am satisfied with medicine as a life's work. However, I should recommend it only for the man who has plenty of money back of him. Many men never make much in medicine.' Forty-one years ago, that was the way it was [author Lewis Thomas wrote this in the 1970s].”
I loved the reference to the “good old days” in a book published in 1974 and talking about a survey done in 1937. The more things change, the more they stay the same. But residents used to live at the hospital and work for nothing but room and board. That doesn't sound like the golden age to me compared to how residents now are being paid about the average American household income.
More information here:
A Doc Created the Coolest Shoe in the Whole World
Physician Incomes in the 1950s
Here's a fun article from the 1950s that talks about nurses ($2,000), physicians ($11,000), dentists ($6,000), pharmacists ($4,000), and optometrists ($2,000-$5,000).
Is Physician Income Affected by Employer Health Insurance and Medicare?
In response to World War II-related inflation, the Wage Stabilization Act was passed in 1942. In response to that, employers started offering benefits, such as health insurance, instead of giving raises. These insurance companies apparently didn't negotiate much and just paid whatever doctors asked. Medicare and Medicaid went into effect in 1965, modeled on the earlier private medical insurance plans. Surgeon Richard Patterson describes the effects, promoting the oft-held view that the 1980s were the “golden age”:
“For decades, physician income had tracked cost of living increases very closely. Employer-provided insurance plans produced a significantly higher rate of growth, and Medicare blew the walls out. Private practice physicians experienced raw collection rates (without discount or fee schedule negotiation) of 98%. Doctors who were no more than ordinary in ability could, if sufficiently affable and available for their referring colleagues, realize incomes that vaulted them into the highest percentiles. Doctors suddenly had the wherewithal to invest heavily in the stock market and shopping centers, to buy airplanes and island retreats, and the health sector was mainly immune to cyclic contractions in the general economy. Just because ‘rich doctor' was a new phenomenon does not mean that it was not embraced as the just and proper standard and expectation. It became a redundancy.
Then things changed. Spiraling costs prompted controls on physician reimbursement, and doctors have experienced income reductions in real, inflation-adjusted dollars, and all that preceded the Great Recession. A colleague joined his father’s surgical practice. He was disposing of some records after his father’s death around 2000, and he came across what Blue Cross paid his father for gallbladder surgery in the 1980s. It was about 150% more that BC was paying my colleague in 2000, and that’s not even adjusting for inflation. Since inflation in the costs of running a medical practice is higher than the general inflation rate, that reduction in real income is substantial.”
But were the 1980s as good as doctors seem to think? Let's look at the data.
Physician Income in the 1970s
Let's start with this chart comparing 1970 to 1980.
Let's adjust each of these data points to 2023 dollars and compare them to the Medscape compensation report figures for each of those specialties and see what we get.
Now, I'm just a simple doc with some elementary spreadsheet skills, but, if anything, doctors were better off in 1970 than in 1980 and sometimes (but not usually) even better off in 1970 than in 2023 on an inflation-adjusted basis. It varies by specialty, but, in general, physician incomes ARE NOT dramatically less in 2023 than they were in 1980. That means 1980 (15 years after Medicare) was NOT some sort of golden age for physician incomes, at least on average. Physician incomes have ALWAYS been highly variable. The intraspecialty income range has always been dramatically higher than the interspecialty variation. If you're comparing an average physician's salary to a very high physician's salary from an earlier time, you're really not comparing apples to apples.
More information here:
Living Our Lives in a Dual-Physician Income Household
Here’s How Much We Make, Save, and Spend as ‘Moderate Earners’
1960 to Present
In fact, data suggests that physicians have done just fine and better than many professions over the last 60 years.
This chart is adjusted for inflation and basically says that doctors in 2015 were making 3X what doctors were making in 1960, 2X what doctors were making in 1980, and 50% more than doctors were making in 1985. I think this chart does explain the “1980s as the golden era” idea, though. Look at the slope of the line from 1980-1990 and then from 2000-2010. Real incomes weren't higher, but they were increasing faster in the 1980s.
There is also a very interesting 2023 paper that looked at physician income tax returns from 2005-2017. While it doesn't do much to compare doctors to doctors in prior decades, it does suggest that doctors are doing even better these days than many people think and it contains lots of interesting figures. Let's go through a few:
In A, I was surprised to see physician earnings peak in their late 50s just like they do for most other professions. In B, I thought the comparison of wages to wages + business income to total income from the tax returns was interesting. In D, it suggests that the best-paid physicians are in groups with about a dozen docs. Apparently, medium-sized partnerships are better than solo practices and huge groups, but a huge group is still better than a solo practice.
I don't think anyone is surprised to see Dermatology come out of this comparison smelling like a rose. I bet EM would have looked pretty good, too, if it had been included.
Geographic arbitrage, anyone? Maybe if you think you missed the golden age of medicine it's because you settled down in the wrong place. Portland (either one) might be prettier than Amarillo, Sioux Falls, and Indianapolis, but the golden age might just be now in the latter three places.
And for those of you who think Obamacare ruined your life, you might want to check the data:
Feeling competitive? Want to know if you're in the top 1%, 5%, or 10% of docs? There's a chart for that too:
The median individual physician total income is $309,000. That means $473,000 gets you into the top 25%, $719,000 gets you into the top 10%, $960,000 gets you into the top 5%, and almost $2 million gets you into the top 1%. And there are a few doctors out there absolutely killing it, such that the mean of the top 1% is $4 million. Again, if you're feeling like you missed the golden age of medicine, maybe it's just you. Maybe you need a new job. Or to start your own business. Or to move to a new state. Or to work more. Or to have spent more time training in a higher-paying specialty.
What Happened to the Big Squeeze?
That was an interesting field trip into that paper, but let's get back to our main thesis—that there was no golden age of physician income. Lots of primary care docs, in particular, feel squeezed. I talked about the “big squeeze” in the original WCI book written in 2013 and published in 2014. I talked about how demands on physicians were increasing, salaries were not really increasing much, and (especially) that the cost of becoming a doctor was skyrocketing. The trends I feared when I wrote that in 2013 have, for the most part, failed to materialize. Take a look at primary care incomes:
The Medscape survey shows a similar trend.
Those seem, at least, to be keeping up with inflation, no? And yes, tuition is going up, but med school indebtedness is not.
Fewer students are indebted. The average debt is not increasing. Incomes are rising. It's not much of a squeeze. It's worse for DOs, but it isn't worsening for them either.
And with PSLF becoming ever more generous, it's hard to argue for a squeeze.
More information here:
Here’s How Much We Make, Save, and Spend as ‘Moderate Earners’
The Counterargument
Now, I can find some data that suggests that there have been periods when physician incomes actually decreased, at least on an inflation-adjusted basis. Here's a survey from 1995-2003.
And I have seen data on Medicare reimbursements not keeping up with inflation. But I cannot find anything long-term that suggests a trend of lower physician incomes, even when adjusted for inflation.
My Worries
There are a couple of trends that I do worry about. The first is the increasing trend toward employment and away from ownership. From 2012-2022, the percentage of self-employed doctors dropped from 60% to 47%. As a general rule, owners earn more and are happier because they have more control over how their work is done. The second is that burnout continues to increase and happiness at work continues to decrease by just about any measurement.
Yes, I do think those two statistics are related. But I can't relate them to physician income. If there is a “golden age” for physician incomes, one can argue that it is just as much now as it was during any other time in history.
Looking to increase your income or renegotiate an existing contract? Hop on over to the WCI physician contract review page, where you can find vetted lawyers and compare your contract to other docs.
What do you think? Was there a golden age of medicine? Why or why not?
Great article. Not unique to doctors, but in many locations cost of living, foremost housing, has increased significantly faster than our incomes. In my community a large house on the lake just sold for way more than I could ever afford as an anesthesiologist, but it had been owned by a family physician for decades. So naturally it must feel like they had it way better in the good old days.
Nobody is arguing that housing has not become more expensive Of course, a big part of that is that our houses are a lot nicer than they used to be.
True, houses have become bigger and fancier. I grew up in a row house. You could fit a couple of those into the more common suburban houses nowadays. I found this WCI article interesting; it pertains to the above:
https://www.whitecoatinvestor.com/the-real-reason-for-the-housing-unaffordability-crisis/
I am struggling with understanding the adjustments for inflation. When I look at my last salary of 290000$ for Family practice and run the numbers on USAfacts.org, the equivalent salary in 1970 was 37,423.00. I believe that the numbers today do not match COLA adjustments over that same time period.
You may find this site useful: https://inflationdata.com/
“Lies, damned lies, and statistics”
I think you’re missing something big if you’re not accounting for RVUs and intraspecialty differences.
For radiology for example I absolutely think the golden age was about 20 years ago with far less volume and much higher pay per RVU on top of the cash cow that was imaging centers pre-DRA legislation. You can look at other fields like ophthalmology that had cataract reimbursement cut to ribbons by Medicare.
I remember on an old MTM podcast there was a nephrologist who joked that he made too much money back in the day. I don’t hear anybody saying that nowadays! Does anyone even go into nephrology? For med students it’s like it doesn’t even exist compared to cards and GI.
Finally, of course you have to use something but inflation data isn’t perfect. In the HCOL area where I’m from housing costs literally 4x’d in the last 4 years. 4x! And everyone made fun of how hard it was to build wealth in these places even 4 years ago.
It just seems like a trend in many professions. Doing the same thing that your parents did is not going to afford you the lifestyle it did them.
What are you arguing exactly? Are you arguing that because the ratio of income of the various specialties to each other varies over time? I’ll give you that.
Are you arguing that radiology was better 20 years ago when you couldn’t do it from home and had far worse tools to work with? Seems a tough argument. You might be reading more studies, but maybe it’s also easier to read more studies no?
Or are you arguing because you decided to live in a HCOLA that life isn’t fair? Or that because housing went up a lot that we should only use housing inflation instead of overall inflation to adjust numbers? Those seem like tough arguments to win too.
Yes, my primary argument is that if you’re ignoring that steady incomes have come as a result of drastically increased workloads you’re missing an enormous part of the argument. I didn’t see productivity or RVUs mentioned once in the post.
I think it’s definitely easier to read more studies but its ultimately a higher cognitive load and more liability, and I think plenty of people would prefer to read fewer studies even if there were more inefficiencies.
Not sure where I claimed life wasn’t fair because I wanted to live in a HCOL area, I’m just giving my personal example. As you always say its the big rocks that will sink you and I don’t think incomes have gone up enough in the last 4 years to make up for the 4x’ing of most people’s biggest expense.
Well, my physician income has fallen by 2/3 in the last 6 years so doctors must all be getting paid less, right? Or maybe it has something to do with the fact that I do little admin work and only work 6 day shifts a month.
You may be right that docs could be working harder than they used to. Maybe that explains some of the burnout. I didn’t do some sort of comprehensive payment per RVU analysis, mostly because I could only talk about the data I could find.
Your housing argument seems to be something like “CPI sucks because it doesn’t weigh housing as highly as it should.” I’m sure someone with 3 kids in college would argue that college tuition should be weighed higher and someone with lots of health care expenses would argue that health care should be weighed higher in the formula. Obviously the only inflation rate that matters to an individual consumer is that person’s inflation rate, but we have to use something standardized to evaluate any sort of long term data. So while housing has gone up at a high rate lately, lots of other things have not gone up or have fallen to offset that expense. For example, airfare and computers are crazy cheap compared to some periods of time in the past while boat inflation has been rising at 6%+ in the time period I’ve owned my boat.
If I had to guess the people who are complaining about their pay going down aren’t doing so because they dropped 2/3rds their shifts 🙂
It seems to me that necessities (housing, healthcare) and pseudo-necessities (education) are going up and luxuries (tech, food delivery, etcs) are going down. Unfortunately the former represent a much higher proportion of the average person’s budget
So what you’re saying is the glass is half empty? 🙂
At any rate, I don’t write for the average person. Many of those reading this blog already own their home and its price is irrelevant. I don’t think health care and education pricing have been rising particularly quickly the last 3-5 years that I know of. I know it can be hard to believe when you live in a HCOLA and are spending 40% of a physician income on housing, but a large chunk of the WCI audience spends a majority of its income on luxuries like early retirement, travel, fancy cars and vacations, private school, nannies, housekeepers etc. Travel is by far the largest chunk of what we spend (ignoring savings, giving, taxes etc). Our housing costs only consist of $6K a year in property taxes and maybe $2K in insurance. CPI dramatically overestimates how much of our spending goes to housing. We’re bringing the average down I guess.
I partially agree with Joey. While the data is very useful for comparing incomes, the income for RVU is no doubt much less, when accounting for inflation.
I agree with Jim, that, of course, working at volume is easier with our gains in technology, the trouble is that it is harder to match up positions to jobs based on ability to handle workloads.
Of course, only takes a little creativity to design jobs for half an FTE or some other ratio.
Certainly, the cost of housing is a factor way all of us choose to do these pedal to the metal jobs until we have reached some degree of financial security
But wait! All this so-called “data” of yours doesn’t conform to my limited anecdotal experience! All kidding aside, this is a great, thoughtful post.
As an aside, it is interesting to read occasional blog comments and forum posts about people complaining one cannot afford to live like previous generations, even as a doctor. My parents are retired and many people who have had to cut back on their lifestyle significantly, or even work much longer into their 70s or beyond. Your “rich” neighbors growing up might have just been flashy folks who traded their future for big spending back in the day.
The income kind of has to grow so that people could tolerate the worse working conditions (mostly no control of what they could do since small groups and single practice are squeezed by big systems). So despite income growth on paper, people are not happier or more satisfied and want to leave even sooner. That is the bigger issue. On the other hand, with careful planning and sufficient understanding of what the real job would look like, one could still go into medicine to build a profitable and relatively balanced career. Those who are equipped with accumulated wealth and knowledge would have an even greater edge over those without.
I was just on a vacation with a big family including a half dozen college students, 3 of which were putting in their secondary applications for med school this week. There is no shortage of good qualified people who still want to be docs despite the fact that 50% of docs are burned out and 90%+ would cut back or quit completely if they had the money.
Of course there will always be fresh bodies to get into medicine. It just would be nice to show them more accurate information to aid them in the process, like income, workload, burnout, etc.
You mean like the burnout chart I included in this very post?
Yes, lot of good information in that post. Income data, burnout data, etc. With the knowledge of gerlneral data, each individual still has the ability to make choices to be the mean data point or the outlier. Medicine is still attractive in many ways and it is always better to know a little more especially the ugly sides before going into it.
Interesting article. There is a lot of doom and gloom in medicine, especially when you’re in medical school / training. Some of this negative sentiment is unfounded, but all of it is discouraging – especially when you take out loans to be there like me. Attendings always tell you that they are telling their kids to stay out of medicine. I think the one thing that’s always understated is that physicians are amongst the few lines of work where you can make high percentile money almost anywhere in the country. You don’t have to be in a large metropolitan area or a coastal city to accomplish that, and if you decide to move to an area where your services are in demand, you can very easily find a job there. The fact of the matter is that the vast majority of physicians I know who live in high COL areas choose to be there, for family, or for quality of life / recreation, and I respect that. It is clear that you need a very profitable side hustle or business interest to get into that multi-million annual comp. But as a physician who has a W2 income at around $1M with a physician spouse, I can say that the real advantage of that salary is not making that number, but making it in Iowa, where there is very little pressure to overspend amongst my peers, and where the tax burden is much lower. Not too many people making comparable money working in finance / big law / tech can say that. Cost of living adjustments are always overlooked, but having grown up in NJ, I can tell you that it costs about 1/3 of what I would need in NJ for the typical spendy physician lifestyle compared to Iowa. If you’re frugal and smarter with your money than I am, it doesn’t matter, you win everywhere.
THIS.
Medicine has been, and continues to be a truly wonderful professsion that’s both financially and professionally very rewarding. I’m nearly 13 years out of training (although I still consider myself a PGY16), would be extremely proud if my 20 month old child grew up to become a physician.
Unfortunately several unhappy physicians are trained/raised with the expectation that – because they completed medical school – they are entitled to be a partner/owner, make their own schedule, live where they want, and have a million dollar house + vacation home.
The reality of it is medicine is like most jobs – to do well you have to understand the finances/business of the industry, be willing/able to move to achieve a desirable lifestyle/income, and have an understanding of your own personal finances. More importantly, you have to constantly look for opportunities and ways to maximize your value and practice.
There are too many figures, tables, and varied sources of data. This would have been a more effective post if it had been half the length and in mostly words. It was provocative, and that ain’t nothing, but far from dispositive.
Reminds me of the old saying (perhaps first said by Pascal) that if I had had more time I would have made this letter shorter.
My goal for this particular post was to be relatively comprehensive. I included everything I could find on the subject and included the links.
I personally prefer the data and graphs that accurately show data and sources. As a physician that’s used to depending on data, having the direct source as opposed to summaries is always appreciated.
I think you answered your own thesis in the last section. Burnout is going up, happiness is going down, and physician ownership is going down.
“Golden age” may be a reflection of not only income but also happiness. I’m sure it’s difficult to find this data from 100 years ago but although physician income may have gone up, how they are treated, work environment, and satisfaction have likely gone down. As you mentioned, medicare payments have not kept pace with inflation. The only way to increase income is to increase productivity and volume. This means seeing more patients within the same amount of time. I think this is a big part of burnout and decreased happiness. As physician ownership goes down, hospital systems will further exploit physicians to work harder and see more patients.
This is tangentially related to the topic of your post. I was recently chatting with another physician friend about hiring and the overall job market. We both had a few years of experience with multiple jobs, and noticed that practices and hospitals were extremely inefficient with HR in the past. Previous short-staffed employers kept talking about “hiring more docs” but we never noticed any action. Coming out of residency it was sometimes challenging to find employment (and neither of us were particularly picky). What we had assumed would be multiple job offers in a major city turned into one (if we were lucky).
Perhaps we are actually now entering into more of a “golden age” or medicine, since the job search process has gotten much easier (at least for us). I see that people regularly promote contract review services online, recruiters (as annoying as they can be with constant phone calls) are usually on top of their game, and I feel like salary data is much more accessible.
With your multiple sources each with their own errors, it is a bit of a challenge to follow your argument. However if you simply use your chart for increase in Family Practice income you will find that the increase in income covers inflation, barely.
Total inflation from January 2014
to January 2024 is 31.85%
$230819 after inflation is $304,333.62
And since we KNOW that REAL inflation is much higher, buying power for this individual will be dropping over that time. Of course no other profession would consider a flat salary for a decade reasonable as their skills and efficiency improves. Additionally you don’t account for the increased overhead and the hours required to cover THAT to simply come out even. We are much worse off than you are trying to demonstrate here.
The real golden age of medicine is here right now because of all the technological advantages. I do hip & knee replacements. We now do same day surgeries where people used to stay up to 6 weeks in the hospital after a joint replacement. The parts used to wear out in 10-15 years, now it is much more rare to find mechanical failures as the implant technology has improved. I do 4-6 total joint replacements a day 2-3 days a week. A full OR load used to be two joint replacements a week. Our ability to help patients at scale & volume with improved outcomes has dramatically increased in the past few decades. We have never been as useful to humanity and society as we are now as physicians & I believe our pay increases over time reflect that reality. I’m sure if you go field by field you will find the same advances and increased benefit to society.
As long as we avoid regulatory capture by PE, large hospitals, large insurers and federal government health care nationalization then we should continue to be well compensated for our very valuable, ever improving and life changing work.
This is a great point – I feel like the progress several specialities have made in their ability to impact patient care has gone up significantly – leading most of us to personally have more job satisfaction and enjoyment.
The above poster was talking about the progress in Orthopedics – in Emergency Medicine we used to barely exist as a specialty and had far less departmental and organizational support. While some hospitals still operate in that kind of an environment – in most places EM is a full recognized specialty and department. Likewise the availability of CT’s, MRI’s, Point of Care Ultrasound, make us far more efficient and effective doctors. Let alone the ability to become a better physician with an abundance of podcasts, post-intubatiuon tape review, recorded phone lines, etc.
I’d venture most specialties have seen comparably similar improvements making medicine as a whole more gratifying than it was just 15 years ago.
You are absolutely wrong with respect to specialty surgeons. I am a spine surgeon. Came out in 84. Income only from practice was about $400k. Increased steadily to over $1 million in the early 90s. Absolute dollars started to decrease in the late 90s. Have continued to decrease 30 years. Absolute $ amount has stayed steady now with multiple side gigs. ie.consulting , medicolwegal work etc.
So your anecdotal experience should somehow outweigh all the data available? How do you explain the lack of data agreeing with your argument?
Sorry you are so sensitive about any discussion. My point remains that the amount of reimbursement from the insurance companies with respect to RVUs and actual work done is much less than it was in the 90s for subspecialty surgeons. Your data does not have the detail to answer that question. Happy Sunday!
I’d love to see data that did. It’s a bit like the radiology discussion above. Basically people are saying “I get paid less now so everybody must be getting paid less” despite the data showing that no, everybody is not getting paid less.
Emailed you an article from JNS. Keep up the good work. Randy
Not seeing the email. Where did you send it? I’ll try to Google something on this topic from the Journal of Neuro Surgery.
Thank you for the insightful article. I find seeing the data helps me keep things in perspective.
I am what would probably be considered a low-income physician (230K/yr) and currently work 7 days a week on a ship with air conditioning that can’t keep up and live in a tiny stateroom. Sometimes I’ll engage in self-pity but then I remember I am not down in the engine room where it hit 140 degrees this week. The same self-pity creeps in when I read about salary data on site….but this article shows me I have nothing to complain about and am, in fact, doing quite well historically.
Yet another good article with lots to think about. I feel that the golden age of medicine was not just about income levels but being able to practice with less time pressure and to have time to enjoy that practice. Being in a private group practice was much better than working for a large university corporate practice and being pushed (hard) to see and care for as many bodies as humanly possible. I agree with Jim that the big worry is the trend towards physician employment along with its loss of control.
I have to worry that a profession that talks about work-life balance as an entitlement is going to discover that society will be willing to pay less per service or per hour when the service provider works when she wants to, not when the customers want to obtain the service from her. This market pressure will hurt doctors, particularly female doctors — note I’m a man with a unisex name — coming and going because if you work fewer hours at remunerated work, you will also earn less per hour doing less valuable work (because done on your terms not the customer’s.)
Doctors have usually made out OK because of the first and most important of the three A’s: availability (which trumps affability and ability.). Many doctors in the past were always on call, at least informally. How many are today? (Shift work doesn’t count, any more than it does for nurses.). The gal who is still willing in her 50s to get out of bed at 3 a.m. and hustle in to do an angioplasty is going to command a higher income even for her elective day work than the guy who counsels his patients all day about risk factor modification and doesn’t take call at all other than to tell patients to go to ER with their chest pain.
To paraphrase the character Jane Fonda played in the movie, Coming Home, if medicine had intended you to have a life, it would have issued you one with your white coat and diploma. Beware. The guild can thwart the market and the regulators for only so long.
How do you reconcile this (per the AMA medicare payments are down 29% when inflation is counted) with your above post?
https://www.ama-assn.org/system/files/2024-medicare-updates-inflation-chart.pdf
# 1 The AMA isn’t exactly the least biased source of info out there.
# 2 Medicare isn’t the only payor. Apparently despite Medicare’s cuts docs are still doing okay.
I mentioned the Medicare data in the post above.
Excellent post. Worth noting for the figures from the 2023 paper you cited those numbers are all inflation adjusted to 2017 dollars using the CPI-U deflator from the BLS. Anyone who would like to estimate comparable numbers today would need to inflation adjust to 2024. So, for example, where you say the median physician annual income is $309k, that is in 2017 dollars. The 2024 equivalent would be ~$396k (using inflation from June 2017 to June 2024). The calculator is here: https://data.bls.gov/cgi-bin/cpicalc.pl
I am a hip and knee replacement surgeon. My senior partner, recently retired, received $3500 for a joint replacement in 1985. Inflation adjusted reimbursement would be approximately 10k per joint replacement today. He did 2-4 per week. Average patient load per day in the office was 12. Today, Medicare reimburses roughly $1400 for a hip/knee replacement. I perform 6 joint replacements a day twice a week. My PA and I see between 60-70 patients per day in the office.
I am 46 years old and I have cervical radiculopathy from performing that much surgery, and I’m less than halfway through my career. I make an equivalent income to what my senior partner made in the 1980s, but I’m working substantially harder and I wonder how long my career can continue at this volume. Factor in the inflation and housing costs, and it’s a very different time now for my specialty.
That being said, I love my job. There’s nothing else I would rather do. The improvement in my patients’ lives and the challenge of surgery is what keeps me going. I found your article intriguing, but the fact is that we are working significantly harder to maintain an income that is declining in inflation adjusted dollars.
Are joint replacements easier to do now with improvements in tech? If not, why could your partner only do 2-4/week before? If they’re about the same, what did he do the rest of the week?
Good points all.
i think our expectations for “good life” has gone up, but my issue is the unpaid work i do. out of a 60 hour week, only slightly over 50 % is reimbursable patient care. the rest is admin, emails, phone calls, prior auths, filling out forms, doing referrals, and doing everything twice because they “lose” it, or “can’t find it”. if i were reimbursed for all 60 hours, i’d be rolling in it. But the reality is that i work 6 days, and am only paid for 3.