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

Leigh Page

Disclosures

August 12, 2019

In 2010, Kenworthy switched to a hybrid concierge model, in which only some of his patients paid the concierge fees. By 2014, one quarter of his patients and two thirds of his revenues were in concierge. His net income was at $190,000, still far short of his best year but above what he earned in his worst year, he told the magazine.

8. You Have Moved to a New Locale

How much you earn depends a great deal on where you practice.

On the basis of average pay by locality, a neurosurgeon could earn 11% more by moving from Maryland to South Carolina, and an anesthesiologist could earn fully 61% more by moving from Massachusetts to Wisconsin, according to a 2015 analysis[23] in the Atlantic.

In general, income is higher in less populated areas, where there are relative shortages of physicians. In the 2019 Medscape compensation report, the top-earning states for physicians were Oklahoma, Alabama, Nevada, Arkansas, and Florida.[11]

Physicians tend to flock to the big cities where they did their training, avoiding smaller cities that can offer higher incomes, lower expenses, and a pleasant lifestyle. Taking home life as well as work life into account, Medscape selected the following communities as the best places to practice in 2018: Grand Forks, North Dakota; Kailua, Hawaii; Lincoln, Nebraska; Shelburne, Vermont; and Iowa City, Iowa.[24]

The dynamics of supply and demand affect the salaries of employed physicians, but self-employed practices deal with reimbursements, and reimbursements actually favor urban areas. Medicare reimbursements are adjusted upward in urban areas to account for higher practice expenses.

In 2003, Iowa physician Michael Kitchell, MD, told the US Senate Finance Committee that the Medicare geographic adjustment for his state set reimbursements unfairly low compared with some large cities.

For example, he noted that reimbursement for the procedure code 99213 varied by as much as 30%—with San Francisco and New York City at the high end and Iowa and rural Missouri at the low end, according to his presentation to the committee. The spread can be even wider for other codes, he added.[25]

Today, this system remains basically the same, with more than 100 geographic payment areas across the country. Within each area, physician pay tends to be quite uniform, except for lower pay in such venues as CHCs, Greenwald says.

He says salary levels in the Minneapolis area, where most doctors are employed by systems, tend to be uniform, keeping most physicians from constantly moving among employers.

But Singleton says that this is not the case in other areas, such as Boston, where reimbursements can vary even between neighborhoods. He also notes that doctors charge markedly higher fees in a wealthy suburb, such as Westchester County, New York, than they do just a few miles away in the Bronx.

9. Your Practice Offers More Ancillary Services

Offering ancillary services used to be a key driver of physician income, but opportunities have declined.

In the survey of family physicians, the second strongest predictor of income was offering a full scope of services, including making rounds on the hospital and providing obstetric services.[7]

Similarly, physicians in family medicine and some other specialties offer such ancillaries as simple surgery, EKGs, and stress tests, Singleton says. "These procedures are almost 10 times more lucrative than office visits," he says, "but you don't see much of that anymore."

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