US Physicians Highest Paid Globally, but Spend Most for Training

Physicians in the United States make almost twice as much as German physicians, who are the next highest paid, and more than 14 times as much as Mexican physicians, who are the lowest paid, results from a Medscape survey that compared training, costs, and value assessments for seven countries show.

US physicians also spend much more time and money in training, according to Medscape's International Physician Compensation Report 2019.

The highest annual salaries were $313,000 for US physicians; $163,000 for German physicians; and $138,000 for doctors in the United Kingdom.

Mexico had the lowest-paid doctors ($22,000), followed by Brazil ($58,000).

For the report, compensation for employed doctors included salary, bonuses, and profit sharing. Pay for self-employed physicians included earnings after taxes and business expenses before income tax. All amounts were converted to US dollars.

The authors note that expenses differ greatly among the countries.

"For example, average rent in Mexico is about 75% less than in the United States," they write. In Mexico, there is no tuition for medical school, but graduates must work in a government service hospital or medical center for a set time in return for receiving their education.

Public medical school education, if not free, was much less expensive in countries other than in the United States. Public medical school in the United States (in-state tuition) averaged $35,000, compared with $11,000 in the United Kingdom, $800 in France, and $600 in Germany. Costs do not include room and board.

Private school medical education cost the same as public school education in France, but in all the other countries, the cost was much higher in private schools than in public schools.

The United States requires the most years of school – 8 years plus 3 to 7 more years, depending on the specialty. Mexico requires the least, with 4 to 5 years plus 2 years of internship and practical training. In most of the European countries in the survey, medical school lasts 6 years plus specialty training.

Stark Gender Differences in Specialists' Pay

Male physicians in primary care made more than female primary care physicians in all the countries that reported pay differences. The gender pay gaps were similar: United States, 25%; United Kingdom, 26%; Germany, 20%; France, 21%; Brazil, 29%; Mexico, 23%.

Gender gaps were even more glaring among specialists. In Germany, female specialists make a little more than half of what their male colleagues make (men make 47% more). The next-largest gap was in France (43%), followed by the United Kingdom (38%), the United States (33%), Brazil (32%), Mexico (24%), and Spain (19%).

Primary care physicians in France on average spend the most hours with patients (45 hours per week for male physicians and 43 hours per week for women). US male physicians were next, with 40 hours spent with patients for male physicians and 36 hours for female physicians.

The authors say that one explanation for the high number in France may be reductions in staff. This year, emergency department physicians and nurses at dozens of hospitals protested cuts in funding and in the number of hospital beds, as well as staff, the authors note.

In addition to time spent with patients, at least half of the physicians in most of the countries spent from 10 to 24 hours per week on paperwork or administrative tasks.

Table. Number of Hours Spent on Paperwork by Country

Country	1–9 Hours, %	0–24 Hours, %	25+ Hours, %
Brazil	33	44	23
France	37	52	11
Germany	18	59	24
Mexico	33	42	25
Spain	36	50	15
United Kingdom	26	57	17
United States	26	56	18

The survey also asked how happy respondents were with their pay. Physicians who made the most (those in the United States and Germany) were naturally the happiest, with income satisfaction rates from 56% to 44%. Although physicians in Spain did not earn the least compared to those of other countries, their rates of satisfaction with income were the lowest (only 16% in primary care and 13% in specialty care were satisfied.)

Satisfaction rates were fairly low in the United Kingdom as well (33% satisfaction in primary care and 41% for specialists).

"In the UK, increasing patient workloads and an increasing number of hours spent at work to accommodate this — but without a corresponding increase in earnings — is probably the main reason why physicians don't feel fairly compensated," Rob Hicks, MD, a general practitioner and media personality in the United Kingdom, told Medscape.

When asked about the most rewarding part of their job, physicians in all the countries rated at the top gratitude for and relationships with patients and being good at what they do/finding answers.

France was a bit of an outlier regarding comparisons of how much being good at what they do and finding answers mattered with respect to the rewards of their job. Sixty-two percent of doctors in France said it was the most rewarding part, whereas in other countries, the percentage of doctors who said it was the most rewarding ranged from 24% to 36%.

Physicians' answers varied as to what they found most challenging. Only 14% in the United States and 8% in the United Kingdom said long hours were the biggest challenge; in France, Spain, Brazil, and Mexico, 25% to 36% said that that was the biggest challenge.

Rules and regulations were the biggest challenges in German and France, whereas in Mexico and Brazil, only 9% to 11% answered that way.

Overall, most physicians in all the countries said they would choose medicine again. The rate ranged from 77% in the United States and Germany to 61% in the United Kingdom.

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