By Josh Katzowitz, WCI Content Director
Despite the COVID pandemic that increased burnout among physicians, average doctor salaries in 2021 rose more than twice as much as they did the year before. According to a Doximity study that included survey responses last year from more than 40,000 US doctors, the average physician salary increased an average of 3.8% from 2020 to 2021. Compare that to the 1.5% increase from 2019 to 2020, and you’ll see that, despite the world’s woes and the US healthcare system problems, doctors made more money.
“It’s possible this year’s increase reflects a catch-up from last year’s relatively flat rate, a tight labor market, or a reflection of rising inflation rates in 2021,” the study’s authors wrote.
Even with the increase in doctor salaries, though, the rise in compensation did not keep up with the approximate 7% inflation numbers from 2021, meaning that doctors still experienced a decline in real income last year (of course, that’s no different than most other industries that didn’t average a 7% increase in salaries).
That also means a doctor's net worth also might not have risen much, if at all, in the last year despite the salary increases.
According to Doximity’s data, the gender pay gap was also wide at 28%, as male doctors earn about $122,000 more than their female colleagues per year and about $2 million more over the course of their careers. That disparity also could have led to more cases of physician burnout.
“The widening gender pay gap may be a contributing factor to burnout among women physicians,” Doximity wrote. “Research has found that women physicians carried the burden of increased childcare during the pandemic and were more likely to consider early retirement due to burnout. We found that 25% of women physicians considered early retirement due to COVID overwork.”
Average Doctor Salary
In reality, the average doctor's salary isn't all that useful to know.
As an example: according to the Doximity report, the average pediatric infectious disease doctor makes $210,844 per year. The average neurosurgeon makes $773,201. Between those two, the average is $492,023. Which, when comparing those two specialties, means absolutely nothing. Plus, consider that, according to Medscape, the average primary care physician makes $242,000 vs. a specialist who makes $344,000. That's also a pretty big difference.
It's almost certainly more useful to know the average in a doctor's speciality as opposed to the salary of a physician in general.
Intraspecialty Pay vs Interspecialty Pay
As Dr. Jim Dahle has repeatedly pointed out, “One of the things I have noticed, that no one ever seems to talk about, is that intraspecialty pay variation is higher than interspecialty pay variation.”
As Jim noted in a previous post, here’s a chart from 2015 that shows the results of an Emergency Medicine salary survey. The salaries might be outdated, but the general point remains.
He wrote:
“Look at the 10th percentile for employees—$213,000. Now, look at the 90th percentile for partners—$510,000. Difference? $297,000. GREATER than the difference between the average pediatrician and the average plastic surgeon!
The ability to increase pay and increase it substantially solves a ton of financial problems that real doctors run into and email me about all the time. It's way easier to pay off your student loans or mortgage on twice the income. Even after-tax, it's much easier to become financially independent or have a dignified retirement or send your kids to the college of their choice when you can double your income.”
How Much Do Doctors Make An Hour?
Physician income information is relatively easy to find, but work hours information is notoriously difficult to find. The only information that combined physician work hours with their income is from a survey in JAMA published in 2003 (and obviously using even older data).
The below salary per hour combines the JAMA data from 2003 with Medscape’s 2021 survey, and it's adjusted for the decreased work hours in each specialty. This chart (possibly erroneously) assumes that all physicians work 48 weeks a year. Where Medscape didn’t have survey data, other less reliable sources were used. Those figures have an asterisk next to them in the table.
Physician Salary Per Hour by Specialty
| Specialty | Income | Work Hours per Week | Work Hours per Year (X 48) | Income Per Hour |
| Anesthesiology | $378,000 | 59 | 2832 | $133 |
| Cardiology | $459,000 | 55* | 2640 | $174 |
| Dermatology | $394,000* | 44 | 2112 | $187 |
| Emergency Medicine | $354,000 | 44 | 2112 | $168 |
| Family Practice | $236,000 | 51 | 2448 | $96 |
| Gastroenterology | $406,000 | 55* | 2640 | $154 |
| General Surgery | $373,000 | 58 | 2784 | $134 |
| Hospitalist | $217,000 | 44* | 2112 | $103 |
| Internal Medicine | $248,000 | 55 | 2640 | $94 |
| Neurology | $290,000 | 54 | 2592 | $112 |
| OB/GYN | $312,000 | 59 | 2832 | $110 |
| Ophthalmology | $379,000* | 45 | 2160 | $175 |
| Orthopedic Surgery | $511,000 | 56 | 2688 | $190 |
| Otolaryngology | $417,000 | 52 | 2496 | $167 |
| Pathology | $316,000* | 44 | 2112 | $150 |
| Pediatrics | $221,000 | 52 | 2496 | $89 |
| Psychiatry | $275,000 | 46 | 2208 | $125 |
| Pulmonology | $333,000 | 55* | 2640 | $126 |
| Radiology | $413,000 | 56 | 2688 | $154 |
| Urology | $427,000 | 59 | 2832 | $151 |
Doctor Salary by Specialty
One interesting thing about salary surveys, of course, is that they are garbage in/garbage out. Average specialty pay varies significantly between surveys. Before we focus on the Doximity numbers, which you'll find in the paragraphs below, compare and contrast those numbers with those from the Medscape survey published just eight months previously.
Medscape says pediatricians make $221,000. Doximity says $251,000. That's a 14% difference. Medscape says orthopedists make $511,000. Doximity says $633,000, 24% more. What is a new grad or even an established doc who is wanting to negotiate a contract supposed to do with that much variation between averages (besides use the Doximity survey when negotiating)? And what if you're in one of those “specialties in the middle” like OB/GYN or Psychiatry or Emergency Medicine or Neurology that Doximity didn't even report on despite how common they are? Or if you're a Neurosurgeon or CT surgeon, and Medscape doesn't report on your specialty? Are you stuck paying $965 (or hiring a contract management firm) to get MGMA data? Is that data even any better than these surveys?
Highest Paid Doctors
Now, for the Doximity survey numbers that tell us the highest-paid and the lowest-paid doctors. When it comes to the top-earning specialties, those in surgical and procedural specialties dominated the list, and doctors who earn the least mostly practice in primary care and pediatrics.
So, how much do doctors make? Here’s what Doximity found.
Lowest Paid Doctors
And here are the specialties that earn the lowest salaries.
Keep in mind that these charts are of the top-20 highest and lowest average doctor salaries. So, for specialties like psychiatry, adult emergency medicine, and allergy and immunology, those average salaries likely range from about $311,000 to about $384,000.
As for which specialty's salaries are increasing vs. those that are decreasing, here's a chart put together by Medscape.
Even during a pandemic when many cosmetic surgeries had to be curtained, plastic surgeons continue to make more money, as do oncologists and surgeons. While dermatology remains one of the tougher specialties that one can match into, those salaries have dropped slightly.
More information here:
Doctor Salary By State
One way to get closer to financial independence is to practice geographic arbitrage, where a doctor lives in a lower cost of living area and draws a higher salary where the need for physicians might be greater than those in the big cities on the coasts. The following chart from Medscape seems to show that geoarbitrage is not a myth.
Doctors make the highest salaries in states like Alabama, Kentucky, Oklahoma, Indiana, and Missouri. All are so-called flyover states, and none are in the top-15 among the states with the biggest populations.
Obviously, a doctor living in New York City is going to have a much higher cost of living than a physician who's residing in Florence, Alabama. The fact that doctor in the Yellowhammer State probably brings home more money than that physician in the Big Apple is also another point in favor of practicing geographic arbitrage.
Increasing Doctor Salaries
Just because certain specialties didn’t make the top-20 list doesn’t mean those physician salaries are staying flat. As noted in the Doximity survey, here are the top-five specialties with the highest increase in average doctor salary in 2021 (notice the difference between this list and the one above from Medscape).
- Preventative Medicine: $264,539 (a 12.6% increase)
- Hematology: $357,292 (a 12.2% increase)
- Nuclear Medicine: $398,544 (a 10.4% increase)
- Pediatric Nephrology: $247,861 (a 9.5% increase)
- Occupational Medicine: $310,934 (an 8.4% increase)
The setting in which a doctor practices also heavily affects how much they earn. As you can see below, the difference between practicing in a single-specialty group vs. working for the government can be nearly $180,000 a year.
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- Single Specialty Group: $442,024
- Multi-specialty Group: $424,312
- Solo Practice: $415,678
- Hospital: $399,282
- Industry/Pharmaceutical: $395,560
- Health System/IDN/ACO: $394,538
- Health Maintenance Organization: $374,571
- Academic: $350,232
- Urgent Care Center/Chain: $267,516
- Government: $264,546
Need tips for how to increase pay in your specific specialty? Jim has some ideas.
To read the entire Doximity report —which also includes information on physician compensation in different metro areas, cities with the fastest-growing doctor salaries, and COVID’s impact on physician retirement—click here. Here’s even more information if you’re looking for a doctor’s hourly rate, broken down by specialty.
What do you think? Are you surprised by any of these numbers? Have you found a way to increase your pay inside your specialty? Comment below!
I think the most critical piece of information and advice here is how Intra-specialty pay ranges are often much wider than inter-specialty pay ranges. No matter our specialty, there are ways that we can identify, define and solve unique problems that will increase our compensation. We are all also by definition high income earners and can use our doctor pay as seed money for additional often more leveraged income streams!
Intraspecialty pay variation is so true…. People don’t realize this and assume your pay range according to your specialty. I’m internal medicine trained and at the peak of my career I was making 7 figures a year without doing a single procedure.
Tell me more…..
Psychiatry has very large intraspecialty differences related to inpatient versus outpatient, group versus solo, employed versus private practice, practice location, call versus not, medical directorship, fellowship status, and many other variables.
I’ve been medical director of something since 1998, taken call throughout, did inpatient on the primary job or as a side gig (since 2011), and these items have pushed up my pay. They come with increased hours, increased work stress, and more weekends and holidays.
My primary job paid $135K in 1994. It took about twenty years to double. Taking on a side gig and working 12-20 “extra weekends” per year and many holidays leveraged the wages up.
Most psychiatrists make $250K to $325K, but as in all other specialties, the hardest working people taking call, doing inpatient work, and working weekends do better. If you are willing to work “harder than the average bear”, one can make $400K to $600K for doing “a job and a half”.
I think this is likely similar in other specialties. Take on a half time side gig, call, and more work…you make more money.
The people who seem to do the best have diversified away from only seeing patients. They own buildings, have NP’s or PA’s working under them, and some “make money while they sleep” with real estate or other endeavors like the WCI.
Couple of thoughts:
1. Lumping a general cardiologist with a procedural cardiologist (or any other lumping of a specialty + procedural version of that specialty) leads to junky data.
2. Lumping a specialty + pediatric version of that specialty together leads to junk data.
3. Lumping VA anything with any other practice setting is junk.
4. Lumping full-time, part-time, and more-than-full-time together leads to junk.
The stats are not usually made by docs, I think, and a lot of important info gets lost. Perhaps it is impossible to do well due to how much variation there is in practice patterns and number of hours worked.
Averages are exactly that…average. Bell curve distributions obviously would be more useful but this gives people a ballpark estimate between specialties. There are companies like Sullivan Cotter which give much more granular percentiles on specialty specific compensation..
How much do they charge for their data?
No idea how much that costs. Our HMO organization uses their benchmarked pay data to adjust our pay.
Great info/discussion. With respect to intra-specialty pay variation, in my field (rads) its essentially a direct correlation with RVU production. Is this different with other specialties?
“Garbage in, garbage out.” This is a great point, and it’s also made worse because it’s sometimes hard as a business owner to know how much you’re making. For a private practitioner (I’m employed), I bet it’s hard to know how much you’re taking home until you file your taxes the next year. You’ve got the practice expenses, the utilities, the various payroll taxes… it goes on and on.
So some of this problem is lack of reporting but some of it could also be that it’s tough to figure out your real salary unless you’re employed and get a paycheck.
Excellent, informative post by Josh Katzowitz. Very useful information. Thanks Dr. Dahle. I enjoy listening to your podcast every week- have learned a lot in the last couple of years about various topics. Not a physician myself- married to one, and also the proud mother of one.
I’m wondering how many doctors here value time more than money, in the sense that we all can make good enough money, and will clearly work long enough to not ever have to worry about it. What’s more, would you sacrifice your health and time with family or doing other things to leave money to family you’ve already taken care of better than 99% of the richest country that ever existed? Some of this stuff borders on bizarre when you … have a few looks at the tax code, and the Jones-ing that most do in society.
On Doximity, they compare compensation. Here, you discuss salaries (until the final graph where you now are showing what is typically compensation breakdowns). I couldn’t find Doximity’s definition of compensation — is it total compensation (ie salary + benefits) or just salary? Important distinction, especially for those working for hospitals or larger groups.
I’m not sure anyone knows, including the folks at Doximity. But you’re right that it makes a difference.
Also, for those doctors that own shares of surgery centers, do these salary numbers include their earnings from these centers? Owning these or not can make a huge difference in your pay & I’d bet for many specialties it separates the bottom 10% from the top 10%.
I agree, but don’t think that’s included in these numbers.