How much do US doctors earn?

In this blog post, I take a peek at the summary slides presented for the Medscape Physician Compensation Report, 2019. Like every year, there are some interesting trends and findings, and, like every year, I long for such a national survey for Indian doctors!

Medscape released the US Physician Compensation Report, for the year of 2019, in April. It always makes for interesting reading, and this time also, shows up a couple of interesting pointers.

1. Survey Methodology

Survey Methodology

2. How much do physicians earn overall?

Overall, Primary Care Physicians earned $237,000 annually, whilst specialists made around $341,000 overall. The significant pay gap is likely a disincentive for people considering a career in Primary Care.

3. Average Annual Physician Compensation by Specialty

Unsurprisingly, the surgical fields of Orthopedics, Plastic Surgery and Otolaryngology made up the top three specialties on the average annual physician compensation by specialties list. The topmost medical specialty, also not a shocker, was Cardiology. Family Medicine, Pediatrics, and Public Health and Preventive Medicine brought up the tail end of the earnings list. None of all these being surprising at all. Just beating the bottom three were Infectious Diseases and Internal Medicine, clocking in at fifth and sixth positions from the bottom.

4. Gender Pay Gap: Primary Care Physicians

Unsurprisingly, the gender pay gap was quite stark, with the annual average incomes for women primary care physicians in the US being $207,000, compared to $258,000 for the men. Whatever the explanations for this, the gap is quite huge!

5. Gender Pay Gap: Specialist Physicians

The gender pay gap was even larger for the Specialist physicians. Women specialist physicians made $280,000, whereas men made almost a hundred grands more every year, making $372,000 on an average every year!

6. Women Physicians by Specialty

As expected, women physicians made up the overwhelming majority of the workforce in Obstetrics and Gynecology. Now ObGyn physicians, overall, earn $303,000 annually, and are placed in the lower-middle tier of earning by specialty list. There was also a preponderance of women physicians in the specialties which were relatively lower paying, like Pediatrics, Diabetes & Endocrinology, and Psychiatry, with around half the workforce comprising of women. On the lower end, less than one in ten Orthopedic doctors were women, one in eight were Urologists, one in seven were Plastic Surgeons, and one in five were Cardiologists – all high earning specialties, and all overwhelmingly dominated by men.

7. Time Spent on Paperwork and Administration

Almost three-fourths of the doctors spent more than 10 hours per week on paperwork and administration, with a third spending more than 20 hours per week – which works out to about 3-4 hours a day at least (depending on whether you consider a six day workweek or a five day workweek)! With such unbelievable loads of non-clinical minutiae to deal with, no wonder physician burnouts is such a big problem.

8. Physician Income by Race/Ethnicity

Nothing unexpected to see here… moving on…

9. Earnings of Employed versus Self-Employed Physicians

Self-employed physicians, on an average, earn about $80,000 more than employed physicians each year. It would be interesting to see how these numbers stack up when broken down specialty wise. I shall try to see if the raw data is available, and see how this fares out… if I can track down the raw data!

10. Where do Physicians Earn the Most?

I never would have guessed that the answer to the question would be Oklahoma! But truth be told, the gap between the top ten states is not very much, and it would be interesting to see how these numbers stack up against the “desirability” of working in these places.

11. Do Physicians Feel Fairly Compensated?

Overall, the answer is yes. Infectious Disease doctors show up at the bottom of this list, as expected, but other than that, a poor compensation package does not seem to be linked to dissatisfaction. Public Health & Preventive Medicine doctors, overwhelmingly feel satisfied, though they are at the bottom of the heap when it comes to earnings. One might argue that they see a lot of altruistic returns in their jobs, as they are in a position to positively impact the lives of hundreds of thousands of people; but detractors may also opine that they are just happy with their lot in life… expecting nothing better! Well, whatever the reason, they are on the top of the satisfaction scores, whereas, less than half of Urologists, who make upwards of $400,000 a year, were satisfied with their paychecks. This graph is perhaps one of my most favorite graphs every year!

12. Challenges of Being a Doctor

Since this is a list of the worries plaguing the doctors in USA, the “Fear of life, limb and liberty due to violence from patients’ families” does not figure on the list. Instead, worries about getting sued bothers one in eight physicians, and one in four is hassled by the multitudes of rules and regulations. One in six doctors is irked by having to work with an EHR system, which, ironically, is supposed to make their lives easier. This is interesting in a counter-intuitive kind of way, and is perhaps linked to the hours upon hours doctors spend on paperwork and administration, instead of doing core clinical work. In India, on the contrary, where EHR systems basically do not exist, or are extremely rudimentary in the public health care facilities, the physicians are pained by the absence of a system which makes documentation, archival and retrieval of information, and enables continuity of care for difficult or patients with chronic diseases.

13. Rewarding Part of Being a Doctor

Patient interactions figures at the top, and earning good money doing a job one likes, figures towards the middle. For a very nihilistic 2% of doctors, nothing feels rewarding in being a doctor! With burnouts and physician self harm being such rampant problems, these numbers are important and need to be looked into more closely, to see what is happening for real, underneath the percentages!

14. Satisfaction with Job Performance

Doctors are often criticized to have a God complex, but, without a certain amount of self-assuredness, confidence, and belief in the work one does, taking charge of someone’s well-being, their very life and death, becomes a difficult thing to achieve. So, I am not surprised, that over 90% doctors think that they are doing a good job. If that was not the case, then that would indicate a deeper malaise in the medical system.

15. Rounding up…

In light of the recent stirrings in the medical fraternity in India, I thought posting these summary slides from the Medscape Survey of US Physicians would be an interesting exercise. I am not aware of any nationwide surveys of Indian Physicians, and if anyone is willing to do the heavy lifting, I am happy and eager to support them… frankly, all one needs is a Google Form, and access to WhatsApp Group for Doctors. It would be interesting to see how the results in the Indian context stack up to be.

In any case, the US numbers show a clear trend, where surgical and intervention-based disciplines have a much, much greater earning potential, when compared to the primary care disciplines. With US Medical Students emerging from Medical Schools with half a million dollars in student loans on an average, it is basically like a Hobson’s Choice when it comes to choosing which discipline to specialize in. Students would naturally aim for the specialty which would enable them to have the highest earning potential, and that they could realistically aim for, given their previous academic and extra-curricular achievements. I guess that leaves the bottom-run earners for International Graduates, and second-choice options for American graduates…

Skeptic Oslerphile. Public Health Scientist and Program Manager, Translational Global Health Policy Research Cell, Department of Health Research, Ministry of Health and Family Welfare, Government of India. Past: Scientist, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases; Senior Research Associate, Public Health Foundation of India. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

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