By Dr. Dustin Schuett, Guest Writer
Most military physicians know they are getting paid less than their civilian counterparts. Exactly how much less varies by specialty with some primary care physicians having the ability to make more than the median pay for their specialty at higher ranks. Surgeons and physicians in procedural specialties often are paid less than half of what their civilian colleagues in the same specialty make, and two-thirds of medical specialties don't even reach the 20th percentile of private sector pay for their specialty while they're in the military—even if they reach the rank of Captain/Colonel with 20+ years of time in the military.
Military Doctor Salary vs. Civilian Doctors
In January 2020, the Government Accountability Office (GAO) released a report on the total pay and incentives for military physicians and dentists. A significant focus of this report was aimed at evaluating the pay of military physicians and dentists by specialty at the ranks of O3 (Army or Air Force Captain/Navy Lieutenant), O4 (Major/Lieutenant Commander), O5 (Lieutenant Colonel/Commander), and O6 (Colonel/Captain) compared to their counterparts in the private sector. This report looked at 21 specialties (Anesthesiology, Cardiothoracic Surgery, Critical Care Medicine, Critical Care Trauma Surgery, Emergency Medicine, Family Practice, Internal Medicine, General Surgery, Infectious Disease, Neurosurgery, OB/GYN, Occupational Medicine, Ophthalmology, Orthopedic Surgery, Otolaryngology, Pediatrics, Psychiatry, Pulmonary Medicine, Diagnostic Radiology, Interventional Radiology, and Urology).
The GAO report provided a large amount of data of interest to military physicians and dentists. Notably, the report compared military physician pay at O3-O6 paygrades to civilian pay in those same 21 specialties. grouping pay into four groups: below 20th percentile, 20th percentile to the median, median to the 80th percentile, and over 80th percentile. The report used maximum compensation for a physician including BAH (Basic Allowance for Housing) with dependents, BAS (Basic Allowance for Subsistence), Board Certification Pay, and Incentive Pay on a four-year retention bonus, essentially the highest pay possible for a physician at each paygrade.
At the O3 paygrade, 100% of military specialties were paid below the 20th percentile of their civilian counterparts. At the O4 paygrade, four specialties (Family Practice, Internal Medicine, Pediatrics, and Psychiatry) were between the 20th percentile and the median for civilian pay, while 17 specialties remained below the 20th percentile of civilian pay.
At the O5 level, six specialties (Family Practice, Internal Medicine, Infectious Disease, Occupational Medicine, Pediatrics, and Psychiatry) were between the 20th percentile and the median for civilian pay, while 15 specialties remained below the 20th percentile of civilian pay.
At the O6 paygrade, two specialties (Infectious Disease and OB/GYN) were between the 20th percentile and the median for civilian pay. Five specialties (Family Practice, Internal Medicine, Occupational Medicine, Pediatrics, and Psychiatry) were between the median and 80th percentile for civilian pay, while 14 specialties remained below the 20th percentile of civilian pay.
In essence, physicians in 67% of specialties in military medicine could not reach even the 20th percentile of pay for their specialty, even if they made the rank of Captain/Colonel. For many specialties (Cardiothoracic Surgery, Critical Care Surgery, Neurosurgery, Orthopedic Surgery, and Radiology—both diagnostic and interventional), the gap between maximum military compensation and the 20th percentile of private sector compensation is more than $100,000 per year. An O6 military Neurosurgeon makes approximately $300,000 less than the 20th percentile and $500,000 less than the median private sector Neurosurgeon. For an Orthopedic Surgeon, those gaps are $125,000 and $300,000, respectively. These numbers are for non-fellowship trained surgeons, and these gaps increase for many fellowship-trained surgeons.
More information here:
Personal Finance for Military Physicians
Military Dentist Pay
For comparison among Dental specialties, military General Dentists, Oral Surgeons, and Pedodontists are at or above the 20th percentile of private sector pay from O3 on, and military General Dentists are above the median compensation for General Dentists at O5 and O6 paygrades. Military Orthodontists are below the 20th percentile for O3 and O4 and then rise to between the 20th percentile and the median at O5 and O6. Periodontists are below the 20th percentile as O3s and O4s. Endodontists are below the 20th percentile of private sector pay from O3 to O5.
Military Salary Increases Were Authorized but Not Incorporated
The 2021 National Defense Authorization Act (NDAA) authorized an increase in Physician Board certification pay from $6,000 per year to $15,000 per year as well as significant increases in the allowances for Incentive Pay (from a max of $100,000 to a max of $200,000 per year) and Retention Bonus (from a prior max of $75,000 to new max of $150,000). None of the three services (Navy, Army, and Air Force) incorporated these increases in their Fiscal Year (FY) 2021 medical special pay plans.
Despite being released over 13 months after the 2021 NDAA was signed, the FY 2022 Navy Physician Special Pay guidance did not incorporate these increases. In fact, Navy Physician incentive pay and board certification have not increased since 2016 for any specialty. For comparison, the cumulative US inflation rate over that time period has been approximately 22%.
Value of USUHS or HPSP
A counterargument can be made that those with a military obligation because the military paid for medical school (either via the Uniformed Services University of the Health Sciences, aka USUHS, or via a Health Professional Scholarship Program, aka HPSP contract) are better off because they graduated medical school debt-free.
The average graduating medical student in 2021 had $203,062 in debt, whereas physicians who attended medical school on a military contract (definitely not a scholarship) are typically debt-free or have significantly less debt. An orthopedic surgeon making a median civilian salary can pay off that debt in under six months using just the differential between their pay and the starting O3 Military Orthopedic surgeon pay. An HPSP contract takes four years, excluding training, to pay off; a USUHS contract takes seven years. Also, the pay differentials discussed here are much more relevant for military physicians who have completed their payback and are making the decision to stay in or get out of the military.
More information here:
Should I Stay or Should I Go? Financial Implications of Military Separation
How Much Is a Military Pension?
Another argument that could be made is that those who last 20 years on active duty earn a pension. The current pension for an O5 retiring after 20 years is about $48,400-$60,500 pretax depending on whether the physician’s retirement is under the newer Blended Retirement System or the legacy High-36 plan. While this is a significant amount and a guaranteed pension, it requires staying in the military, typically at a significantly lower-than-civilian payrate (for 67% of specialties) for that entire time, facing the uncertainty of deployments and PCS moves at an age where many physicians have families with growing kids who aren’t always thrilled about saying goodbye to their friends and changing schools every 2-3 years.
Military physicians do pay less in tax than their civilian counterparts for a number of reasons—foremost because they typically make a lot less money than their counterparts. Also, BAH is not taxable. This can be $45,000 per year (San Diego O4) or more depending on duty station and rank. For those at a 30% marginal tax rate, this is a $13,500 tax savings per year. Keep in mind that BAH was included in the GAO calculations of military compensation discussed above. Saving $13,500 a year in taxes is nice, but that is far less than the difference between military pay and civilian pay for nearly all physicians, especially those not at the O6 paygrade.
Many questions loom for the FY2023 Military Physician Special Pay Guidance. Will Orthopedic Surgeons and other surgical/procedural specialists pay get closer to civilian compensation, or will they remain well below the 20th percentile of private sector pay? Will any medical specialty pay touch the 20th percentile of private sector pay at the rank of O3? Will more than six specialties reach the 20th percentile by O5 or more than seven by O6?
The answers to these questions will likely continue to have significant implications on the stay-in-or-get-out decision for many active-duty physicians. It certainly has for me. As much as I have enjoyed the people I work with in the Navy and the patients I get to treat, it is hard to justify doing the same amount of work or more while getting paid about one-third of the mean civilian orthopedic surgeon pay.
Disclaimer: I am a military service member or employee of the US Government. This work was prepared as part of my official duties. Title 17, U.S.C., §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, U.S.C., §101 defines US Government work as a work prepared by a military Service member or employee of the US Government as part of that person’s official duties. The views expressed are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.
If you were a military doc, did you feel like you were underpaid? Did that affect whether you stayed in the military? Was the military paying for medical school worth the below-average salaries? Comment below!
[Editor's Note: Dr. Dustin Schuett, DO, CDR Medical Corps, US Navy, is an adult reconstruction fellowship-trained orthopedic surgeon currently serving in the US Navy in San Diego. This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]