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

Leigh Page

Disclosures

August 12, 2019

In 2015, only a minority of physicians was still expanding their ancillary services, according to the Medscape survey on physician compensation for that year, the last year Medscape measured this category.[26]

Specialists were somewhat more likely to offer new services, according to that survey. Whereas about 23% of family physicians, 20% of internists, and 18% of pediatricians offered new services in the past 3 years, 27%-31% of orthopedic surgeons, anesthesiologists, gastroenterologists, ophthalmologists, and urologists did so.

What has changed? For one thing, states have been tightening existing regulations on the use of ancillary services. In 2013, for example, Pennsylvania imposed prohibitions on physician financial arrangements with labs, according to a 2014 report by a Pennsylvania law firm.[27]

Also, with more doctors employed at hospitals, hospitals typically don't provide these physicians with payments for ancillary services. "Hospitals are maintaining control of ancillary services performed by employed physicians," stated a 2011 issue brief by the Center for Studying Health System Change.[28]

In any case, making money doesn't seem to be the chief reason why physicians are adding ancillary services. The main reason stems from a belief that they are effective, according to a 2015 working paper published by National Bureau of Economic Research.[29]

10. You Negotiated a Better Salary Deal

Male physicians earn more than their female counterparts—even after adjustment for such factors as productivity, part-time status, and years of experience, according to a 2016 study in JAMA Internal Medicine.[30]

The study, which was limited to academic physicians because payment information for them is easier to obtain, found a payment gap of $20,000 between the sexes even after the adjustments were made.

What causes this pay gap? In an interview[31] with Time magazine, the lead author of the study surmised that women tend to negotiate payment less aggressively than men and are less likely to pressure employers into giving them a raise by soliciting outside job offers.

A key problem is that women don't ask for what they want, according to Linda Babcock, an economics professor at Carnegie Mellon University in Pittsburgh who has coauthored several books on negotiation and the gender divide.

Men initiate negotiations about four times more often than women and tend to describe the negotiating process as "winning a ball game" or "a wrestling match," whereas women tend to equate it with "going to the dentist," she wrote.[32]

Another, more obvious factor may account for the pay gap: Some employers have a bias against women that may not even be conscious, the lead author of the JAMA Internal Medicine study said. For example, one study found that when the authors of a scientific paper were identified as women, people rated the overall quality lower, he wrote.

Conclusions

Successful entrepreneurs, superstar clinicians, and physician-CEOs have always been fairly unattainable positions for most doctors, and these levels may be even harder to attain as more physicians move toward employment and accept standard salaries.

However, there are still ways physicians can make a somewhat better living, such as seeing more patients, joining a single-specialty group practice, or moving to a small city. Physicians can also avoid making even less money by dropping lower-paying venues, limiting the number of Medicaid patients they see, or opening a concierge practice.

Each of these choices involves trade-offs, though. Some physicians may decide that research and teaching are worth the lower pay of academia, or that they might prefer clinical work rather than become a higher-earning administrator in their organization.

Finding the best job might mean following your own compass rather than the money trail. "The main payback is that I enjoy my work," Portis says of his job.

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