10 Reasons Why Some Doctors Earn More (Even in the Same Specialty)

Leigh Page

Disclosures

August 12, 2019

Most physicians work longer than the standard 40-hour workweek, according to a 2018 report[8] by the US Bureau of Labor Statistics, based on information from 13,575 physicians. The survey showed that 36% worked 40-50 hours a week, 26% worked 50-60 hours a week, and almost 25% worked more than 60 hours a week. Of the latter group, 5% worked 70-80 hours a week, and another 5% exceeded 80 hours—the mandated limit for resident physicians.

Singleton thinks more physicians would be happy to work longer hours if it meant not having to do the paperwork that has deluged modern practices. This is why some hospitals hire scribes to take care of physicians' chart entry, he says.

The kinds of patients whom physicians treat also affects their income. For example, those who treat a high volume of Medicaid patients have lower incomes. In 2016, Medicaid paid 72% of what Medicare paid, according to a 2019 report on the Health Affairs blog.[9]

Will seeing more patients become unnecessary under value-based payments, which reward physicians for quality and outcomes? It's too early to tell. Value-based incentives are more common for salaried physicians, but these payments still only make up 8% of total compensation, according to a 2018 report by Merritt Hawkins.[10]

It's also too early to tell whether accountable care organizations (ACOs)—value-based arrangements available to self-employed physicians—will substantially boost their income.

The Medscape Physician Compensation Report 2019 reported that 28% of physicians were in ACOs.[11] Most ACOs have been losing money, but their track records have been improving. About 34% of ACOs in the Medicare Shared Savings Program ACOs earned shared savings payments, up from 31% in 2016, according to a 2017 report.[12]

4. You Make Money From Your Ideas

Entrepreneurialism—coming up with innovations that make a lot of money—is an obvious way to earn more than your colleagues.

On the Forbes list of billionaires, the richest individual physician, worth $8 billion, is Patrick Soon-Shiong, MD, inventor of a blockbuster cancer drug and founder of two pharmaceutical companies.[13]

The net worth of the family of Thomas Frist, Jr, MD, cofounder of Hospital Corporation of America, is $12.5 billion. Gary Michelson, MD, with a net worth of $1.7 billion, holds patents for more than 250 orthopedic devices and procedures. And James Leininger, MD, founder of a medical device company, is worth $1.4 billion, according to Forbes.

Going a couple of rungs down the wealth ladder, physicians worth $10 million or more are often plastic surgeons for celebrities, sports physicians for pro athletes, and TV personalities.

Among TV personalities, Drew Pinsky, MD, is worth $20 million and Mehmet Oz, MD, is worth $14 million. Among plastic surgeons, Garth Fisher, MD, and Robert Rey are worth $15 million, and Paul Nassif, $14 million.[14]

James Andrews, orthopedic surgeon to athletes, is worth $10 million to $100 million, according to a 2018 report.[15]

On the next rung down, many physicians are worth several million dollars through such ventures as ambulatory surgery centers (ASCs), small for-profit hospitals, and inventions. Among orthopedic surgeons, who quite often own ASCs or invent medical devices, 18% are worth more than $5 million, according to the 2019 Medscape Physician Wealth and Debt Report.[1]

With the trend toward physician employment, the amount of entrepreneurialism may have declined. "Employment tends to wring out entrepreneurialism," Singleton says. "Employed physicians tend to be attracted by the predictable hours and don't expect to make a lot more money."

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