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

Leigh Page


August 12, 2019

The low pay in academic institutions is due to higher numbers of nonpaying and Medicaid patients and a dependence on fluctuating research support. "Academic medical centers in particular don't make as much money in clinical care," Singleton says.

Still, Greenberg says academic medicine continues to be attractive to many physicians. "It pays less, but the pace can be less hectic than in private practice, and it's more fulfilling if you love to teach or do research," he says.

One of his clients, an anesthesiologist, felt very overworked practicing in a small town for 3 years, so she switched to academia. "She took a pay cut of more than 30%, but she is much happier," he says.

CHCs, on the other hand, don't seem to have that kind of draw. Young physicians work there to help pay off their debts and leave when they've completed their obligations, according to an article by Kisha Davis, MD, a family physician who worked in a CHC for 4 years after training.[18]

Davis wrote that she loved the work but left her CHC for a stint in President Obama's White House, and she never returned.

Doctors in CHCs often have excessive workloads, and this resulted in burnout for some of her colleagues, though not for her, she wrote. "Although I don't miss the headaches, I do miss serving that population," she added.

7. You Find New Practice Niches

Singleton says that in recent years, physicians have been breaking out of traditional practices and creating niches that offer more focused services.

In some cases, they are making more money than before, though their main aim is finding work they like to do, he says.

Singleton calls these physicians the new entrepreneurs. Although they don't make the kind of money that an inventor of a new device gets, they're still thinking outside of the box. For example, a niche practice might treat a certain kind of diabetes, offer diet and nutrition counseling, or provide executive wellness services, he says.

One new and promising area is offering convenience, such as starting an urgent care center or a telemedicine company, he says. Singleton knows a family physician who spends all of his time providing telehealth for all of the islands in Hawaii on a cash-only basis.

More opportunities are arising. When Massachusetts legalized medical marijuana in 2012, a variety of psychiatrists, anesthesiologists, obstetrician-gynecologists, internists, and pain specialists became medical marijuana specialists, according to a news report[19] by the Boston Globe.

Since then, many more states have made medical marijuana legal, and opportunities have expanded. The American Medical Marijuana Physicians Association now lists more than 1000 physician members.[20] However, allowing recreational marijuana, as such states as Colorado and California have done recently, may diminish demand for clinical marijuana.

Probably the biggest niche for doctors is concierge or cash-only practices, where physicians are available to patients around the clock for a monthly fee. In 2018, 2% of physicians were in concierge practices, 5% in cash-only practices, and 13% in direct primary care, according to the Medscape compensation report.[21]

However, some physicians in this model don't make a lot of money. For example, Eric Kenworthy, MD, saw earnings from his solo internal medicine practice in Brooklyn, New York, plummet in the early 2000s, according to a 2015 interview[22] in New York Magazine.


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