Medscape put out their annual physician salary survey and I found the results pretty surprising. This isn't my favorite survey out there, and I have my own suspicions about the quality of the data.
Quality of Data
Although the survey includes over 20,000 physicians, they use a third party surveying site and I don't know how good the sampling is. There is also the issue of self-reporting of data, and physicians have all the incentive in the world to under report their income in surveys like this. Not to mention the fact that many survey responders, whether physicians or not, don't actually read the instructions before completing a survey. In this case, income for employees includes salary, bonus, and profit-sharing contributions. For the self-employed, it includes earnings after tax-deductible business expenses, but was unclear if that included retirement contributions. I also had to wonder when they reported that HIV/ID docs had fallen below Pediatrics (the lowest-earners in last year's survey) despite the fact that they had a higher increase in their earnings. With those caveats, let's proceed.
The Data
| Specialty | Compensation (in thousands) | % Change from 2011 |
| Orthopedics | $405 | 27% |
| Cardiology | $357 | 13% |
| Radiology | $349 | 1% |
| Gastroenterology | $342 | 13% |
| Urology | $340 | 2% |
| Anesthesiology | $337 | 7% |
| Plastic Surgery | $317 | 11% |
| Dermatology | $306 | 10% |
| General Surgery | $279 | 4% |
| Oncology | $278 | -4% |
| Ophthalmology | $276 | 5% |
| Emergency Medicine | $270 | 12% |
| Critical Care | $268 | 13% |
| Nephrology | $263 | 20% |
| Pulmonology | $263 | 12% |
| Pathology | $247 | 12% |
| OB/GYN | $242 | 7% |
| Neurology | $217 | 18% |
| Rheumatology | $186 | 5% |
| Psychiatry | $186 | 1% |
| Internal Medicine | $185 | 9% |
| Endocrinology | $178 | -3% |
| Family Medicine | $175 | 7% |
| Pediatrics | $173 | 7% |
| HIV/ID | $170 | 12% |
A Few Observations
The sky hasn't fallen. Despite all of our collective angst about falling incomes, most specialties saw an increase in income far larger than the rate of inflation. According to the survey, only two specialties had a decrease in income, and one of them WASN'T radiology. There is also far less income disparity than I would expect. The average person in the highest-earning specialty only made 1.4X the average person in the lowest-earning specialty. Finally, I'm always surprised when I see surveys like this, and then talk to financial advisors who tell me nearly all of their clients are making more than $600K. Either physicians are dramatically under reporting their salaries, or, more likely, there is a huge disparity even within any given specialty. For example, a military orthopedist might be making $140K and a busy back surgeon may be grossing over $1M. Sure, it might average out to $405K, but that really doesn't tell much of the story. It would be far more interesting to see the standard deviations or percentiles for these numbers. For example, in the Daniel Sterns survey of emergency physicians, they report the average total compensation (this survey included benefits) of $327K, but with a 10th percentile of $236K and a 90th percentile of $472K. I would bet that most specialties have far greater disparity than that (and I know many emergency docs making less than $236K, including military doctors, part-timers, and academics.)
What do you think of the results of this survey? Heartening, or suspicious?
I think the most interesting data comes not from the income per specialty slides, but the information it provides with regard to the perceived quality of life for those practicing medicine.
Despite some of the very high incomes in certain specialties, only about half of all physicians feel “fairly compensated”
Even worse is that only 51% of those surveyed said they would choose medicine as a career if they had to do it over again. This number is also down from 69% in 2011 and 54% in 2012.
It was interesting to see that although Derms make over $300,000 per year, only 37% would choose medicine as a career again. Also, only 19% of internists would do it over again, much lower than I expected.
I think there are a few things to consider.
1. The threat of Obamacare and the fear of decreasing pay probably had some impact on these results. Unlike our members of Congress, I actually read the bill and I can tell you that while the new healthcare legislation will increase the number of people who have healthcare, it certainly won’t save the healthcare system any money and in fact will cost a whole lot of money to implement. The numbers provided in the media about how much money this bill will save are totally fictitious and if you really get into it are laughable.
There are a ton of new taxes in the bill but this can’t make up for it, which means that reimbursements are indeed going to have to go down in some way (unless you are in a primary care specialty in which case you are safe for the first three years).
If you felt that in your profession you were going to lose more control and make less money, it makes sense you would feel less enthusiastic about the future.
I am in no way trying to make this a political discussion but the bill is going to have financial implications for physicians.
2. Work life balance is becoming increasingly more difficult. People on the outside may be looking and think “this guys a doctor and makes good money, he must be happy.” What they don’t think about is what it took for that person to get there and what it takes to stay there. This is not at all about money, it is about finding harmony in your life and being able to find the right balance of work, hobbies, exercise, time with family, etc.
The friends I went to school with that are still in medicine are “ok” with their careers, and I recently heard one of them got divorced. Medicine takes a toll on you so even while you are succeeding professionally, deep down you may be suffering personally. You can be the a great doctor and do the right thing by your patients, but be left feeling unhappy and fulfilled.
Felix
I suspect many people in many jobs would say they don’t feel appropriately compensated. It would be interesting to compare doctors to everyone else in this regard.
“The average person in the highest-earning specialty only made 1.4X the average person in the lowest-earning specialty.”
Did you mean 2.4X?
Yes. Good catch.
The oddest thing on there was the large jump in orthopedics. 27% in 2 years for a specialty that was already in the top 3. What changed?
Perhaps some physicians just need a reality check as well. If you make 400K and work 4 to 4.5 days a week, then you aren’t being under compensated. You may want to make more but you are working less than a full week and making about 10 times as much as the average worker.
I feel for providers that make less than 200K working full time (as I do) given the costs and time it takes to get there but to here fellow physicians complain about their 350K income when they are only open four days a week just doesn’t hit home with me.
I to looked at this data pretty extensively and big difference is in the breakdown vs. the mean. For instance in Family Medicine, most docs work 4.5-5 days a week to make that pay but some make quite a bit more (I know a family doctor who takes in well over 300K). Some do work part time but not nearly as many as I see in pediatrics and OB/GYN that work part time.
I would love to see a breakdown that uses income per hour of patient care to help eliminate some of the outliers.
Just because someone’s office is only open 4 days a week does not mean they don’t work full time. Many specialists that work 4 or 4.5 days/week do so because they take ER call some eves and weekends that frequently requires going to the hospital after hours. I can’t speak for everyone, but I know I would happily work a “full” 5 day scheduled week if it meant I never had to go to the hospital after hours or on weekends.
As far as the survey data, it would be interesting to know what percentage of a physicians income is derived from direct patient care vs practice income. Optho is a great example, as there is a wide variation of income within this specialty that has a lot to do with ownership of ancillaries, employment of optometrists etc. I think it’s pretty hard to make $276k/yr in optho off just office visits and surgery unless you have a great payer mix. And many of the spine surgeons making 7 figures are able to do so because of secondary income from implants, ASC ownership etc.
I’m a gastroenterologist in a hospital-employed model. I’m contracted for 4.5 days per week. This past week, I put in almost 75 total hours spent either in the office seeing patients, doing procedures, reviewing results, calling/emailing back patients, etc. And no I’m not slow. I’m not even on-call this week.
I make slightly more than the $342K mentioned in this survey if you include my benefits of paid vacation, CME, and a small amount of loan payback. I would HAPPILY take a REAL 4.5 day work week any day so I can get home at a decent hour and spend time with my family.
As for whether these numbers are accurate, they probably are. We all know physicians that make MUCH more than the posted results, and also physicians that make FAR LESS than the posted amounts. There is so much variability… for example, I know several hospitalists that make well over $300K, and also an internist who practices primary care in Texas who makes over $500K. I also know MANY gastroenterologists in non-academic positions on the west coast that have still yet to break the $200K barrier despite being in practice for several years. I also know a few GI docs making over 1 million. I know this because I was offered a job with one of their groups and they opened up their books.
The point is: who cares. You need to find a job with a good work/life balance. I drive a shitty 15 year old car because I could care less what anybody else thinks of me. I wear scrubs every day. I have a nice home, but the mortgage is still <10% of my monthly income. One day, I want to retire. I could care less about status. As long as my kids grow up to be healthy, happy, responsible adults, and my wife continues to love me, this cannot be measured by one's income. The lowest income on this list is HIV/ID at $170K. That is still over 3x the median income in the US, and you have the option of living just about anywhere in the US.
75 hours/week without call is essentially 11 hours a day 7 days a week. That seems like a pretty bad work/life balance. Is this work load typical for GI?
I am an academic anesthesiologist and I make more than the listed average above.
These are very very low numbers across most of the upper half of specialties. Ortho academic is pulling in 500k, Anes academic low 400s, Rads academic mid 500s…The private guys around here double that and then some.
I am not including any benefits. My 1099 would probably be close to 600k, all-in.
If you don’t mind me asking, where in the country are you at? Those are some impressive numbers.
Academic GI (assistant professor position) where I trained at started at $170K. This is in California.
How can an IM doc make over 500k? Is reimbursement that much more in Texas? It seems like service is limited by the number of people that a doctor can see per hour. Any thoughts?
Maybe like this
http://www.renew-youth.com/about-dr-adamcik/
How this would probably have a detrimental effect on your income
http://blogs.miaminewtimes.com/riptide/2010/05/dr_captain_america_will_not_go.php