[Founder's Note: This post addresses a topic I have spoken about several times in the past but brings some data to the discussion.]
By Chris Musto, Guest Writer
I am a fourth-year medical student who is just matched. I am fresh out of the process of deciding which specialty to practice. Many factors go into making the choice of specialty for medical students, but students are encouraged not to use money as a deciding factor. They are supposed to view medicine solely as a calling and pick a specialty based on the love they have for it. This is all well and good, but we are picking a career we are going to practice for our entire adult lives.
No other profession is told that they need to pick a job without considering the potential money they may make. I don’t think that this should be any different for physicians. Several factors need to be considered such as:
- personality fit
- passion for certain specialties
- need to perform procedures, and
- desired work/life balance.
However, money should not be left out of this equation. It would be unwise to borrow upwards of $80,000 a year without knowing your future earning potential.
I always thought that the salary you would eventually make would be directly correlated with the specialty you choose. I really only had looked at average salaries posted online and had a couple of conversations with attendings willing to discuss their salary.
Intra-Specialty Salary Differences
After reading The White Coat Investor blog, I noticed he often talks about how the difference in intra-specialty salary difference is greater than the inter-specialty salary difference. This means that two people in the same specialty can have much greater differences in salary than two people from different specialties. A pediatrician can make more than a cardiologist in the right setting. I set out to find out if this was true. This is not a scientific paper, so this isn’t a rigorous study. Holes can be poked in my methodology, but the intention of this post is to make you think.
Merritt Hawkins Job Board Search
I searched each specialty on the Merritt Hawkins job board and found the job with the highest and lowest income potentials in each specialty. Not all of these jobs are the same. They will differ in vacation time, benefits, call schedule, etc. The point is, however, there are ways in each specialty to reach the highest income potential posted. This is just from one set of job postings on Merritt Hawkins and does not take into consideration negotiating. Sometimes the income differs because of location. I list the location of each of these job postings. This is simply to show you that people in each specialty are capable of making salaries well above average or well below average.
If you want to make more money, you might need to work more hours, move locations, take more call, or join a different type of practice. I’m not saying that everybody should do this because other considerations are important. I am simply trying to illustrate the White Coat Investor’s point that there are people in every specialty making more money than the average salaries within the specialty. To my fellow medical students, factoring salary into specialty choice may be much more about choosing the right practice type and location than it is about choosing the right specialty. This is good news for those struggling with choosing a specialty with a perceived low average salary.
For each specialty, I will post the jobs listed on Merritt Hawkins with the highest and lowest potential income and their locations. If some had more than one job posted at that salary, I listed each of them. This job search was completed on March 2, 2020. These job postings may change by the time you read this post. The point is not to show specific jobs or current salaries. It’s simply to provide examples of how salaries vary within a specialty. If you would like to do this yourself, you can search here. A table of the findings is listed below.
For those of you who are interested, I chose Radiology as my specialty. I loved my rotations and went with my gut. I was happy to know that this specialty had one of the highest average salaries. I now understand that my salary will be better determined by what job I choose than by what specialty I picked. I am, however, looking forward to a rewarding career in a field I love.
To Medical Students
As you choose a specialty, go with what you love, talk to as many people about their salaries as you can, and frequent job postings to see how much people in the specialty can make.
To current attendings, always look for what other jobs are out there in your specialty. Consider a change, or use this information to negotiate at your own job. You should never feel that you can’t make enough money because of the specialty you chose.
What do you think of Chris's findings? Does the intra-specialty salary variation he discovered surprise you? Comment below!
[Editor's Note: Chris Musto matched at Geisinger for Radiology. This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]
Hi, can any fellow internal medicine hospitalists mention what their going rates/salaries are in their locations? How can one maximize their internist salary? Will this be possible by working more hours? Are locums a possibility?
I can tell you by personal experience that hospitalists can get up to $1M per year if you do it right. Like be self employed, aggressive billing company, be out of network, don’t take Medicaid, self pays, bad insurances, work hard, be efficient, etc.
How do you not take Medicaid as a hospitalist?
It’s very easy, just be selective on primary care doctors that you work with, choose only to admit for the ones that see patients with great insurance companies. Avoid taking ER back up calls…
Boy I’d love to see your tax returns…
JustSayin’
My tax return does not have big numbers anymore, I retired last year.
I find it fascinating that a private practice hospitalist can survive without taking ER admissions. Must be a big hospital. The vast majority of our hospitalist admissions are ER admissions or transfers from outside ERs.
Private hospitalists are not allowed to take ER backup admission calls in my area, the hospital have their own employed hospitalist group to do that. However if the ER admission is from a PCP that I work with, they will have to send the patient to me. Even though the hospital don’t like it, they allow it because otherwise the PCP can just send their patients to another hospital in town. The key is to work with PCPs, it’s very easy to look better than the employed hospitalists as they are not incentivized to go for the extra mile.
You covered almost every specialty, and this is very interesting. Why did you leave off nephrology?
When I preformed the search there were no Nephrology jobs posted. I just checked and there is one posted now. It lists an income potential of $600,000 in Pensacola, Florida.
That’s even more interesting that few jobs are posted! I guess we really do have a shortage.
Thanks for all the work you did on this & for sharing!!!
The link in the bio doesn’t work for me. If you are having the same trouble, you could find my blog at http://www.investingbasicsmd.com/. I am just getting started so I hope you like!
Looks like it works to me.
Nice job. Especially as a med student! Good luck with your blog. We can’t have too many docs teaching the basics of investing.
This and other data confirm that although you CAN make a lot of money in any medical specialty it is a heck of a lot easier in some. I know doctors who make seven figures in fields that have some of the lowest income averages. So the intra-specialty gap is real.
But look at neurosurgery, ortho, and plastic surgery data and you will see it is hardly an uphill battle to make a lot of cash. My favorite example here is that plastic surgery offers a $1M in the highest and the lowest jobs!
Thank you for your comment! I have been a long time reader of blogs like this and wanted to give it a shot myself. It was a lot of fun and I hope to get more opportunities. Your point is absolutely right. The floor is much higher in many specialties. The higher paying specialties might also have much more reasonable hours and responsibilities for the same salary as other ones. I wish the best to physicians of all fields and hope that whatever we make, we hold on to and wisely invest as much of it as we can.
I appreciate the intent, but the Pathology ceiling income is pretty low.
I agree. These did not seem like well paying pathology jobs compared to the average income for the specialty. I know the methodology is not perfect. This was not intended to set a income ceiling on any specialties. There were not many pathology jobs posted on this particular job board. Perhaps a search elsewhere would reveal higher paying pathology jobs.
I hope some good ones are out there. I feel bad for anyone graduating from any training right now. I’m curious about cutbacks or people who decide not to retire.
Solid article, and good luck with residency. You’re well ahead of the game.
Stay safe, everyone.
Thank you. The timing of this article may not be opportune. However, I think these topics need to continue to be talked about during any climate. Solid foundational principals are always valuable may be even more valuable when your convictions are tested in times like these. I hope things return to normal as quickly as possible so there isn’t too much damage to the job markets for all specialties. I hope you and those around you remain healthy and safe as well.
Nice to have another radiologist blogging about finance! FYI, the AMA’s advice for choosing a medical specialty does include financial considerations: “One of the most important decisions you will make during medical school is which specialty to choose. Many factors go into this decision, including your personal history, your clinical interests, your experience during rotations, the duration of the training involved and financial and lifestyle considerations.” https://www.ama-assn.org/residents-students/career-planning-resource/choosing-medical-specialty
Thank you for sharing this. I based my statements largely on the interactions I had with faculty and other students at my school. It was sort of taboo to speak about salary considerations with most people. I feel as though the other aspects of a career are equally as important. I just think that financial considerations also need to be taken into account. I am looking forward to entering the radiology community!
Congrats on completing medical school and matching into radiology (as a radiologist I think it is an incredible specialty).
I always knew about the wide differences in potential income within a specialty, which highlights the benefit of geoarbitrage if you are open to locale. It is further magnified that the areas with typically lower salary offerings (such as California) have the highest cost of living as well, so it is a double whammy (triple whammy if you also throw in taxes).
Good luck with your blog. For me blogging has been a great creative outlet, but also comes with a warning that it can also be a huge time vacuum if you let it (I never knew how much time/effort it takes to churn out a 3-5 min read until I started doing it myself).
Thank you! I follow you on twitter and read your articles as you share them. I agree with what you said about location. Each job really needs to be evaluated in its entirety before signing on. Cost of living and taxes can make a huge difference. I always found it interesting that some areas with the lowest costs of living have some of the highest salaries for physicians. I don’t believe this is true for most professions.
A lot of the floors are much lower
I know full time peds making 125000. Certain cities are low paying and will happily offer lower salaries to resident who don’t want to move after residency, or are tied down by family who can’t move. With so many residency programs in the city, someone is bound to take it.
It gets even lower when people cut back to part-time. Frankly, I’m amazed at what some doctors will work for. You can make more than $125K as a military pediatrician, probably never be deployed, and not have any student loans.
Totally agree on the part-time bit! 50% FTE is not 50% of the pay- at least not in smaller private practice settings. As soon as you mention part time, the low balling begins.
Out of touch much? “No other profession is told that they need to pick a job without considering the potential money they may make.” This is an absurd statement. Nearly all guidance counselors advise students to choose professions based on passion, not compensation. Stop trying to gin up undeserved sympathy for the “plight” of medical students.
I think many of those guidance counselors are doing their students a disservice by giving that advice. And I think you’re doing the same to tell a medical student to choose a specialty without actually knowing the range of incomes people in that specialty earn.
Jim completely misses the point. “I think you’re doing the same to tell a medical student to choose a specialty without actually knowing the range of incomes people in that specialty earn.” Nonsense unrelated to my comment. I did not state or suggest anything of the sort.
One can make a compelling argument that students should consider compensation as an important factor in their career/specialty decisions without suggesting (incorrectly) that “no other profession” is discouraged from doing so.
Fair enough.
One shouldn’t take career advice from someone who ended up as a guidance counselor.
My high school guidance counselor told me not to bother applying to my nationally competitive undergraduate institution. Four years later, I sent that turkey a invitation to the graduation out of spite.
Interesting data for sure. On how to factor in money, it’s essential to first pick areas that you will enjoy doing for 8 to 12 hours a day. After that bring money into the mix. Doing the opposite is a fast track to misery.
Check out the interesting advice from Mike Rowe of Dirty Jobs concerning passion as the driving force in choosing a career
https://www.huffpost.com/entry/mike-rowe-gives-grad-advice_n_57597c03e4b0e39a28acb092
Jonathan Clements gives similar advice. Find something in your 20s and 30s that’ll pay well and follow your passion in your 50s when you’re set financially.
Missing rad onc as usual
Is that a real specialty? 🙂
What is the deal with salary surveys anyway? RadOnc is almost never on them. Are you folks just that tight-lipped about your salaries or do they never bother asking?
I think it’s the latter given the size of our field. Suspect we get lumped in with diagnostic radiology as well.
@BeamOn: HUSH…we’re trying hard to keep out of the spotlight here 😉
Hello! Thanks for the post. I will be recommending this post to all the newly minted MDs I still keep in contact with!
I’ll admit that my financial knowledge needs a stimulus, but was wondering what you would recommend in regards to a time horizon for someone that recently matched? Obviously contribute to 403b, but what about those institutions that do not offer taxable accounts?
https://www.whitecoatinvestor.com/the-five-big-money-items-you-should-do-as-a-resident/
https://www.whitecoatinvestor.com/intern-financial-survival-guide-from-one-intern-to-another/
The advice I would give is to build good habits now. What you do with your resident income isn’t going to make or break your retirement goals, but the habits you form now will. Step one is to stop taking on debt. Do not build up credit card debt thinking you will pay it off as an attending. You have student loans to pay off because you spent that money over the last 4 years. Don’t put yourself in a worse position after these 3-7 years. Also, that investment you made over the last 4 years was in yourself. Protect that investment with life and disability insurance. Contribute to a Roth IRA now. It is made for people who are in a lower tax bracket now than they will be later on. That’s the perfect scenario for a resident who will later become an attending. If you max out a Roth IRA during residency, it will not be enough for you to fully retire on. However, it will get you in the habit of maxing our your tax advantaged accounts when you’re an attending. Also, don’t try to become rich overnight buying individual stocks. It is easy to do when you first get your hands on some money. It won’t work, and will be a very hard habit to break. Be careful who you take advice from. Many doctors are full of hot stock tips. This is not a plan for long term success. Much of this advice will overlap with what you hear from the White Coat Investor, but as a long time reader much of my plan is based on topics he discusses. Definitely continue reading.
Good read, Dr Musto and congratulations on matching! Thank you for the research in this post. You are so right, what turns out to be a couple of minutes read takes hours of work. Wish you all the best in both your endeavors in medicine and blogging!!
-PFB
I am glad you enjoyed. Thank you for the kind comments!
Similar question to the one above about employer not offering taxable accounts, should a starting resident start a Roth IRA or a Traditional IRA or even something elese, or can the resident only do one of those? Also do we notify the employer that we started one so they can forward that over from our pay stub? THanks to everyone and Dr. Acton!
P.S. and would it be any different if we want to do PSLF in a state with income tax (i know there’s lowering agi, but was wondering if it evens matters?
Employers don’t ever offer taxable accounts. You can just open those yourself.
As a general rule, a resident should get any match available in their employer plan and then max out a personal and spousal (if applicable) Roth IRA. There are situations (primarily going for PSLF and trying to minimize IDR payments) where it could make sense to use a traditional 401(k) or IRA too. Best to get professional advice if you’re in that situation.
https://www.whitecoatinvestor.com/student-loan-advice/
No, you don’t need to tell your employer about any taxable accounts or IRAs. It’s none of their business and they don’t fund them for you.
I think you’re referring to employer not providing a tax advantaged retirement account. That’s ok, you’ll have plenty of time to do that.
Start a Roth IRA if you are under the income limit for it, as you likely are, being a resident. Or contribute to it via the Backdoor if you are over the limit (or when you get over the limit in a few yrs on attending income).
The Traditional or Roth IRA is something you do on your own, the employer doesn’t have anything to do with it.
Hope this helps,
PFB
At my place the hospitalists are employees and do not have the option to pick which patients to take. How does a service like that function? What happens with the patients no one wants?
I agree that med students are discouraged from considering income in picking their fields. I learned quickly not to discuss this with others in the medical world when I let income be the single largest consideration in my choice. I did talk with my college roommate who was finishing up a JD MBA program. They were amazed to hear that standard advice was to ignore income.
Keep in mind that those high incomes of proceduralists require doing a lot of cases. For the surgeons it can mean a lot of hours in the OR. For non surgical proceduralists it means doing lots of endoscopy, or whatever.
The people who enter those fields are at least in part motivated by money and work hard to get it.
The choices also are constrained by medical school performance. One can be as money motivated as possible but if you are not a top student you are not getting a residency in derm, neurosurgery or ortho.
Anyone here know of sites that do a thorough walk through of how to start a 401k or Roth, or maybe Dr. Dahle or Musto would be kind enough to write one? I looked through the vanguard and schwab sites and it’s a bit confusing to me. For vanguard do we want the sp500 or are other index funds listed but I can’t seem to see identify them? An step by step guide, however elementary, would be much appreciated.
# 1 You don’t start a 401(k). Your employer does. If you are self-employed, here is a post that may help:
https://www.whitecoatinvestor.com/where-to-open-your-solo-401k/
# 2 The only IRA contribution for most readers of this site (high earners) should be a backdoor Roth IRA. Here’s the tutorial: https://www.whitecoatinvestor.com/backdoor-roth-ira-tutorial/
# 3 As a general rule, I prefer the total stock market index fund (VTSAX or as an ETF VTI) to the 500 Index Fund due to its additional diversification. You can find either here:
https://investor.vanguard.com/mutual-funds/profile/VTSAX
https://investor.vanguard.com/mutual-funds/profile/VFINX
Do you have a written investing plan? I’d start there:
https://www.whitecoatinvestor.com/investing/you-need-an-investing-plan/
# 4 Realize that if you find the task of opening an IRA at Vanguard complicated and stressful, you may not yet be ready to be a do it yourself investor. You can get good advice at a fair price here: https://www.whitecoatinvestor.com/financial-advisors/
If you still want to try it, here’s where you open an IRA at Vanguard:
https://apps.vanguard.com/web/cf/move-money/funding-method
It walks you through it pretty well, including fund selection (just choose 500 index fund at the appropriate step).
The problem with doing a tutorial on how to open an account is that I can’t actually do it again and take screenshots of it. And it would be hard to get someone else to do it because the screenshots would include their account number. But I think you’ll be surprised how easy it is if you just try it. Let me know if you get stuck on a question.
Hi, to look for a particular Vanguard fund, google it: Vanguard S&P500 Index fund. Go to the VG page for it- read it up- find out Expense ratio, fund summary (if not the entire prospectus). VG index funds come in 3 flavors: Investor class, Admiral class (for accounts with higher dollar amounts) and ETFs. Figure out if your prefer the mutual fund or the ETF and you’re set.
The investor shares have basically gone away these days, so anyone can get the admiral shares now. Good for investors.
You speak about the VTSAX or target retirement. What are your thoughts for the life strategy growth fund? Does that provide more fund diversification, albeit with a higher ER?
I think it’s just fine.