Physician Compensation -- A Deeper Dive: Does Money Make Them Happy?

Carol Peckham


April 15, 2014

In This Article

The American Physician's Frustration

The Medscape 2014 Physician Compensation Report is based on an extensive survey of more than 24,000 US physicians representing 25 specialties. Although healthcare is undergoing many challenges, the report shows some encouraging trends: Compensation increases were reported in 19 specialties, and the income gap between men and women is narrowing. Among other key professional issues, physicians' responses this year reveal their views on health insurance exchanges; their satisfaction with medicine, their specialty, and practice setting; and how much time they spend with patients and on paperwork.

Does Money Bring Happiness?

High and Low Earners

As in past Medscape compensation surveys, those who perform procedures have the highest incomes compared with those who manage chronic illnesses. At the top of the earnings list are orthopedists ($413,000), cardiologists ($351,000), urologists ($348,000), gastroenterologists ($348,000), and radiologists ($340,000). Radiologists have moved down a bit compared with our earlier surveys, and anesthesiologists have been knocked out of their previous spot among the top five.

The lowest earners are physicians in HIV/ID ($174,000), with primary care physicians and endocrinologists also in the bottom five (family physicians at $176,000, pediatricians $181,000, endocrinologists $184,000, and internists $188,000).

In general, the Medscape survey findings are supported by government reports and other surveys.[1] A 2013 Centers for Medicare & Medicaid Services (CMS) report to Congress provided findings from a government study showing that certain procedural groups and radiologists had calculated annual earnings that were more than twice those for the primary care groups.[2]

Who's Satisfied With Their Compensation?

Whether a physician is in the high or low earnings group does not necessarily correlate with compensation satisfaction or even with whether a physician would choose medicine as a career again.

Satisfaction with compensation has not changed much in the past 4 years. In 2013, 50% of all physicians said they feel fairly compensated; 48% of primary care physicians feel fairly compensated. These figures are extremely close to the 2011 report percentages, in which 48% of all physicians say they feel fairly compensated, and 51% of primary care physicians said they feel that way.

When looking at specialties, dermatologists, at 64%, were the most satisfied with their compensation and they were also among the top 10 earners. The amount of compensation, however, does not necessarily correlate with how fairly a physician believes he or she is paid. Other specialties that were high on the list of feeling fairly compensated were in the middle of or below on the earnings list: emergency medicine (61%), pathology (59%), and psychiatry (59%). Internists and family physicians were also low earners, but at 46% and 50%, respectively, they were in the middle or toward the top of the list of those who felt fairly compensated.

On the other hand, 3 specialist groups at the top of the earnings list are in the bottom half of those who feel fairly compensated (44% of orthopedists and cardiologists and 41% of urologists). Plastic surgeons, who are among the top 7 earners are the least satisfied (37%) with their compensation of all physicians.

Why Wouldn't Some Choose Medicine or Their Own Specialty Again?

When comparing this year's responses with those from 2011 for the question "Would you choose medicine again?" 69% of physicians said "yes" in 2011, but in 2014 only 58% answered in the affirmative. Of note, when comparing these 2 years for the question about who would choose their own specialty again, the bias was reversed, with 47% of physicians answering yes in 2011 and 61% this year.

High earners were not necessarily the ones who were most likely to choose medicine again. In fact, the least likely to choose medicine again (plastic surgeons, orthopedists, radiologists, anesthesiologists) were among the top earners. Conversely, those who are on the low rungs of earnings (internists, family physicians, pediatricians, and infectious disease specialists) were in the top five for choosing medicine again.

Of interest, one could observe an inverse relationship among the highest and lowest earners in regard to those who would choose medicine and those who would choose their own specialty again (Table 1). Those in some of the higher-income specialties would choose their own specialty over medicine, while a higher percentage of primary care physicians would choose medicine again but are far less happy with their particular field.

A 2012 Urban Institute survey found that 30% of primary care physicians between the ages of 35 and 49 planned to leave their practices within 5 years. The rate increased to 52% for those over 50.[3] Although this might seem high, to put this in perspective one should look at other high-pressure professions. For example, nearly half of new public school teachers leave their profession within 5 years.

Table 1. Percent Difference Between Physicians Who Would Again Choose Their Specialty vs Medicine as a Career

Specialty Difference Between Choosing Specialty and Medicine
Dermatology 24%
Orthopedics 20%
Plastic Surgery 16%
Radiology 9%
Gastroenterology 8%
Cardiology 6%
Ophthalmology 5%
General Surgery 4%
Anesthesiology 1%
Oncology 1%
Pathology 0%
Urology -1%
Psychiatry & Mental Health -6%
Rheumatology -7%
Diabetes & Endocrinology -8%
Critical Care -9%
Neurology -11%
Pediatrics -11%
HIV/ID -12%
Emergency Medicine -15%
Nephrology -16%
Ob/Gyn & Women's Health -16%
Pulmonary Medicine -23%
Family Medicine -35%
Internal Medicine -42%

High earners who are less likely to choose medicine again tend to be interventionalists, who are expecting lower incomes due to changes in the way physicians will be compensated under the Affordable Care Act (ACA). In fact, when tracking the percentage by specialty of those who would choose medicine against those facing a decrease in income from health exchanges, there appeared to be an inverse relationship between not choosing medicine again and having greater expectations of an income decrease, regardless of a specialty's actual current compensation level (Figure 1). This relationship was not observed when tracking choosing medicine as a career again vs compensation satisfaction or physicians' relative level of earnings.


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