13 ms·

How much money doctors actually make

49 points by atrudeau 10y ago

aanm1988 10y ago
> Despite having the same training and experience as their white peers, physicians who identified as Asian, Latino, or black received significantly less What does this mean? The averaged all doctors by race? They averaged by profession and race then combined to form some sort of weighted average by race?
- phren0logy 10y ago
  It looks like a lot of this is variance by specialty: http://www.medscape.com/viewarticle/878129_5 http://www.medscape.com/viewarticle/878129_5
  - spcelzrd 10y ago
    >And white doctors take home significantly more than their equally qualified peers of color, regardless of specialty.
- gingerbread-man 10y ago
  "We found that African American, Latino, and Pacific Islanders were more likely to work in medically underserved areas than were white physicians (adjusted odds ratio, 1.22-2.25; p < .05)." [1] Though I'm sure bias has a part in the income disparity, I suspect it is less so, relative to other professions, as the fees paid to doctors for each procedure are broadly standardized. Individual doctors' choices of where to practice and what kind of patients to serve may play a larger role. (IMHO, this is a much better justification for affirmative-action programs than other oft-cited justifications.) [1] https://www.ncbi.nlm.nih.gov/pubmed/22708247 https://www.ncbi.nlm.nih.gov/pubmed/22708247
  - deleted 10y ago
    [deleted]
- gingerbread-man 10y ago
  On a similar note, a 2016 study in JAMA[1] found gender disparities in faculty pay at US medical schools, which persisted even when correcting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue. It seems like the medical profession would actually have an easier path to pay fairness than other industries, because clinical revenue is so easy to measure. (As opposed to other fields where the financial value of an employee's work is more difficult to measure.) [1] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2532788 https://jamanetwork.com/journals/jamainternalmedicine/articl...
- shorttime 10y ago
  Thanks for asking this. I often read articles saying such things but do not provide any data or how they came to the conclusion. It makes absolutely no sense to say this without the data to back it up.
- randyrand 10y ago
  From the source: "White/Caucasian physicians earn the most ($303,000), followed by those who are Asian ($283,000), Hispanic ($271,000), and black/African American ($262,000). The gap can be partly explained by participation in primary care, which pays less. Of the four groups, black/African American doctors are most likely (30%) and white doctors least likely (20%) to be PCPs, the survey found." They continue: "A 2016 studyin BMJ[12] found an even wider gap than the new Medscape report in payment levels for black doctors. White male physicians in the United States earned as much as 35% more than black physicians, even after accounting for specialty, experience, number of hours worked, number of Medicaid patients, and whether the physician is a PCP, the study found." I can't find the BJM report. The phrase "earned as much as 35% more" is odd. Is this some maximum out of all the professions considered? a single doctor who earned more? The maximum seems like an odd number to report without reporting the average. Is there some reason they want to exaggerate the difference? It irks me. edit: I suspect another large factor they did not consider is location of practice. We should only compare doctors that practice in the same location. Location plays a big influence on the wealth of your customers, and therefore how much you are paid.
westbywest 10y ago
These data would be more informative, were they also paired with vocational costs MDs also incur, usually unavoidably. Malpractice insurance, prep for board exams, for example. Note that the latter can include having to travel to conferences, or similar events, to stay current in the field, and there may not always be an employer to reimburse such costs. Likewise, insurance rates will vary between disciplines, eg. higher for radiology vs psychiatry.
- sndean 10y ago
  Also, it's probably helpful to factor in how much debt they're in starting out. My fiancee is in (we're in) >400000 of debt. And as a resident she's effectively making ~-2 dollars/hour [0], because of the interest rate on that loan, location, and hours. I can't find it immediately, but in a recent MedScape report, some ~5% of physicians are still paying off their med school debt at 60 years old. [0] http://dotphra.se/ http://dotphra.se/
  - cpfohl 10y ago
    Don't forget malpractice insurance. As high as $200k/yr for high risk doctors like obstetricians. That significantly reduces your take home pay.
    - Gibbon1 10y ago
      When I read this 25 years ago (insane malpractice insurance for obstetricians) my thought was a good national health insurance program would probably fix that. If the US took better care of families with sick/special needs children they wouldn't have to go after the doctors when stuff goes wrong.
      - cpfohl 10y ago
        I think it's a more complex issue than either medicine, insurance, or the legal system can address alone.
nickgrosvenor 10y ago
It's funny that list almost seems like the pay scale should be inverted. The most important doctors get paid the least and the least important doctors get paid the most.
- magic_beans 10y ago
  That logic also seems to be true in most major corporations...
  - rbcgerard 10y ago
    "important" might be one adjective, but typically less specialized, less competitive, and more common
- snarf21 10y ago
  Well a lot of it is supply and demand plus a little for elective procedures. Orthopedics is so high because there aren't enough doctors. These days all elderly get hip and knee replacements. In the past, they would have just used a wheelchair. Add to that all the sports injuries when chronic over training has 12 year olds getting MCL and rotator cuff surgeries. Also, if you look at Pediatrics and Family Medicine, one could argue that 99% of what they do should be done by CPRN or other highly trained nurses. We don't need MDs to look in a kids ear for three seconds to diagnose an ear infection and prescribe an anti-biotic. This is also one of the things we should be doing to help remove cost from our health care system. MDs in this setting should be at a 10x1 ratio and be there for difficult cases and to oversee.
cocoa19 10y ago
I've wondered why everyone and their moms are pushing people to study computer science and STEM, but you don't see the same push for physicians.
- deleted 10y ago
  [deleted]
- burkemw3 10y ago
  I consider health professions as STEM, under Science specifically. US ICE has a list of degrees that includes a number of health related degrees: https://www.ice.gov/sites/default/files/documents/Document/2014/stem-list.pdf https://www.ice.gov/sites/default/files/documents/Document/2...
- ikeyany 10y ago
  Because it takes 0-4 years of schooling to get your foot in the STEM door, but 8-12 years of schooling for medicine. That pretty much bars access for anyone interested in having money in their 20s/30s, and those without a strong support system. There is a reason why only those from affluent/foreign backgrounds go into medicine. They're the only ones who can "afford" to not make money right out of college.
  - cantankerous 10y ago
    Realistically, it takes 4 years to attempt to get your foot in the door at a medical school unless you have pre-admittance or you're looking at a special case like UMKC's 6-year program. Getting into an MD or a DO program isn't a guaranteed thing. It's a substantial downside risk. Also, you can have a STEM-based undergraduate education as your pre-med, even math and computer science can count if you take the right additional electives. The two aren't mutually exclusive. It's a good fallback if you bomb out of getting into med school (or decide 3 years into ugrad that you don't want to apply).
    - ikeyany 10y ago
      4 years of undergrad and 4 years of med school at least. And I agree that a tech related bachelor's is a good idea for a med school backup.
aabajian 10y ago
I'm a graduating medical student with a master's in computer science. In a lot of ways CS is the polar opposite of medicine; one values derivation and automation while the other emphasizes memorization and one-on-one interactions. Surprisingly, teamwork is one area where CS wins out. I've found that despite the professed importance of the healthcare team, healthcare often doesn't function like a team at all. Doctors, nurses, PAs, patient care assistants, administrative staff, can make or break your life by providing support or creating obstacles. I think it's a result of a inherently tiered system with a single person (e.g. the attending) on top who decides the treatment plan. In CS you almost never have a single person who is overly-trained relative to peers. Maybe you'll have a better developer, UI designer or manager, but none of these attributes makes that person the sole decider. The pay structure in medicine reflects its hierarchical system: software managers don't earn 10x what software developer make, whereas attendings easily make 10x a nurse's salary.
- vikascoder 10y ago
  You would be surprised how this doesn't apply to many software companies out there and how the hospital environment is exactly the kind of culture existing. There is no one thing fits all fact.
- alpha_squared 10y ago
  > I'm a graduating medical student with a master's in computer science. That's... actually really neat. What made you go for a graduate degree then on to med school, if you don't mind me asking?
  - sjg007 10y ago
    I would guess that doctors have better career stability.
  - aabajian 10y ago
    I actually got my master's in the middle of medical school (I took a leave of absence). My undergrad degree is in computer science as well. It's my long-term goal to start a radiology informatics company.
gumby 10y ago
Quite surprised Dermatology and Plastic Surgery aren't the top two. Those specialities are almost unique in being the only remaining ones in which most practitioners are not in managed care programs so can and do charge what the market will bear. If you go to an oncology conference you see a lot of paper presentations and poster sessions. If you go to the annual Derm conference there's a whole "scene" in the corridors and the trade show floor is really little different from the trade show floor of, say, a car show, or the AVN awards. Maybe GDC, or maybe that's a bit over the top. If you aren't an unabashed fan of capitalism (which I am), you'd likely call it crass. One year I was walking the show floor and stopped to look at a display of liposuction tubes -- it was beautifully laid out, like a cross between a bunch of Cala Lilies and an pipe organ rank. The salesdroid came over and said only two things: - "Hello, Doctor! Do you do liposuction in your clinic?" (I shook my head) - "Well you can easily get an additional $3000/day from these babies." I'm also surprised radiologists score so high because a lot of the analysis has been farmed out to India. And since that entailed a fully digital stack, those Indian MDs are about to be the first physicians to be replaced with DL. Perhaps the large number reflects a small residual 'n', or perhaps the radiologists have been able to hang on even though part of the job is outsourced -- presumably by them.
- clavalle 10y ago
  >Those specialities are almost unique in being the only remaining ones in which most practitioners are not in managed care programs so can and do charge what the market will bear. I think you've hit upon the reason. Turns out when the customer is paying directly and feels the pinch directly the market will not bear as much.
- nugget 10y ago
  Plastics is likely dragged down by a significant number of academic surgeons. Anyone doing a high volume of elective cosmetic procedures would laugh at these numbers. Derm likely reflects the number of hours worked, which is lower than other specialties. If you looked at a chart of earnings per hour, derm and ortho would be much closer together. NSG isn't mentioned but it should be the same or higher than ortho (with vascular and CT maybe a bit lower). Overall these numbers are low and represent a lot of physicians who are optimizing for lifestyle rather than income. There is still a lot of money in medicine if you know where to look.
plg 10y ago
The doctors who live on my street drive Porsches, Mercedes-Benz and Audis. Two docs on our street own multiple Porsches each (summer, winter, racing). Maybe it's family money. Then again maybe it's taxpayers paying their salaries. (location: mid-sized city in Canada)
- maxxxxx 10y ago
  German doctors have nice sports cars too. Same in the US.
czbond 10y ago
These pay scales are insane for the fact that doctors essentially just have to show up. This doesn't even include management of others (aka Director roles, etc). Just literally showing up.
- jboogie77 10y ago
  if you think all doctors do is "just show up", i'd be curious to know what you think programmers do. Do they just "type stuff"?
  - czbond 10y ago
    I meant ... normally for a pay scale above $200k in the non-coastal areas, someone has to manage staff, lead a team, run a business unit, and make strategic decisions. Literally, doctors "do their specialty" - no teams, no 'winning clients' and closing deals to bring in business. They don't have to have any other skills but their specialty at those ranges.
    - Fomite 10y ago
      ...I know a number of doctors who manage staff, lead teams, provide cost justifications to their hospital's C-suite, and make strategic decisions.
- beisner 10y ago
  An employee at a company is likely responsible for a small piece of a product that will affect the lives of some number of people by a very small amount. A doctor will affect the lives of some number of people by an enormous amount. The responsibility is much higher in the medical profession, so doctors may "just show up" but when they don't, people suffer dramatically; when a regular employee doesn't "show up", nobody bats and eyelash.
qudat 10y ago
This article is extremely misleading. Even though these salaries might be high, they aren't adjusting for number of hours worked. When we think of a typical "salaried" job, we think 40 hours/week. This is almost certainly not the case, even for the cushiest physician specialties. My girlfriend is a critical care physician about to enter attending-hood working at a university hospital. She will be working a minimum of 50 hours/week and with all the administrative tasks she's being asked to do, it'll probably be more like 60+. Really we need to see hourly rates to get a better idea of what physicians actually make.

49 points by atrudeau 10y ago

aanm1988 10y ago

> Despite having the same training and experience as their white peers, physicians who identified as Asian, Latino, or black received significantly less What does this mean? The averaged all doctors by race? They averaged by profession and race then combined to form some sort of weighted average by race?

phren0logy 10y ago
It looks like a lot of this is variance by specialty: http://www.medscape.com/viewarticle/878129_5 http://www.medscape.com/viewarticle/878129_5
- spcelzrd 10y ago
  >And white doctors take home significantly more than their equally qualified peers of color, regardless of specialty.
gingerbread-man 10y ago
"We found that African American, Latino, and Pacific Islanders were more likely to work in medically underserved areas than were white physicians (adjusted odds ratio, 1.22-2.25; p < .05)." [1] Though I'm sure bias has a part in the income disparity, I suspect it is less so, relative to other professions, as the fees paid to doctors for each procedure are broadly standardized. Individual doctors' choices of where to practice and what kind of patients to serve may play a larger role. (IMHO, this is a much better justification for affirmative-action programs than other oft-cited justifications.) [1] https://www.ncbi.nlm.nih.gov/pubmed/22708247 https://www.ncbi.nlm.nih.gov/pubmed/22708247
- deleted 10y ago
  [deleted]
gingerbread-man 10y ago
On a similar note, a 2016 study in JAMA[1] found gender disparities in faculty pay at US medical schools, which persisted even when correcting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue. It seems like the medical profession would actually have an easier path to pay fairness than other industries, because clinical revenue is so easy to measure. (As opposed to other fields where the financial value of an employee's work is more difficult to measure.) [1] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2532788 https://jamanetwork.com/journals/jamainternalmedicine/articl...
shorttime 10y ago
Thanks for asking this. I often read articles saying such things but do not provide any data or how they came to the conclusion. It makes absolutely no sense to say this without the data to back it up.
randyrand 10y ago
From the source: "White/Caucasian physicians earn the most ($303,000), followed by those who are Asian ($283,000), Hispanic ($271,000), and black/African American ($262,000). The gap can be partly explained by participation in primary care, which pays less. Of the four groups, black/African American doctors are most likely (30%) and white doctors least likely (20%) to be PCPs, the survey found." They continue: "A 2016 studyin BMJ[12] found an even wider gap than the new Medscape report in payment levels for black doctors. White male physicians in the United States earned as much as 35% more than black physicians, even after accounting for specialty, experience, number of hours worked, number of Medicaid patients, and whether the physician is a PCP, the study found." I can't find the BJM report. The phrase "earned as much as 35% more" is odd. Is this some maximum out of all the professions considered? a single doctor who earned more? The maximum seems like an odd number to report without reporting the average. Is there some reason they want to exaggerate the difference? It irks me. edit: I suspect another large factor they did not consider is location of practice. We should only compare doctors that practice in the same location. Location plays a big influence on the wealth of your customers, and therefore how much you are paid.

westbywest 10y ago

These data would be more informative, were they also paired with vocational costs MDs also incur, usually unavoidably. Malpractice insurance, prep for board exams, for example. Note that the latter can include having to travel to conferences, or similar events, to stay current in the field, and there may not always be an employer to reimburse such costs. Likewise, insurance rates will vary between disciplines, eg. higher for radiology vs psychiatry.

sndean 10y ago
Also, it's probably helpful to factor in how much debt they're in starting out. My fiancee is in (we're in) >400000 of debt. And as a resident she's effectively making ~-2 dollars/hour [0], because of the interest rate on that loan, location, and hours. I can't find it immediately, but in a recent MedScape report, some ~5% of physicians are still paying off their med school debt at 60 years old. [0] http://dotphra.se/ http://dotphra.se/
- cpfohl 10y ago
  Don't forget malpractice insurance. As high as $200k/yr for high risk doctors like obstetricians. That significantly reduces your take home pay.
  - Gibbon1 10y ago
    When I read this 25 years ago (insane malpractice insurance for obstetricians) my thought was a good national health insurance program would probably fix that. If the US took better care of families with sick/special needs children they wouldn't have to go after the doctors when stuff goes wrong.
    - cpfohl 10y ago
      I think it's a more complex issue than either medicine, insurance, or the legal system can address alone.

nickgrosvenor 10y ago

It's funny that list almost seems like the pay scale should be inverted. The most important doctors get paid the least and the least important doctors get paid the most.

magic_beans 10y ago
That logic also seems to be true in most major corporations...
- rbcgerard 10y ago
  "important" might be one adjective, but typically less specialized, less competitive, and more common
snarf21 10y ago
Well a lot of it is supply and demand plus a little for elective procedures. Orthopedics is so high because there aren't enough doctors. These days all elderly get hip and knee replacements. In the past, they would have just used a wheelchair. Add to that all the sports injuries when chronic over training has 12 year olds getting MCL and rotator cuff surgeries. Also, if you look at Pediatrics and Family Medicine, one could argue that 99% of what they do should be done by CPRN or other highly trained nurses. We don't need MDs to look in a kids ear for three seconds to diagnose an ear infection and prescribe an anti-biotic. This is also one of the things we should be doing to help remove cost from our health care system. MDs in this setting should be at a 10x1 ratio and be there for difficult cases and to oversee.

cocoa19 10y ago

I've wondered why everyone and their moms are pushing people to study computer science and STEM, but you don't see the same push for physicians.

deleted 10y ago
[deleted]
burkemw3 10y ago
I consider health professions as STEM, under Science specifically. US ICE has a list of degrees that includes a number of health related degrees: https://www.ice.gov/sites/default/files/documents/Document/2014/stem-list.pdf https://www.ice.gov/sites/default/files/documents/Document/2...
ikeyany 10y ago
Because it takes 0-4 years of schooling to get your foot in the STEM door, but 8-12 years of schooling for medicine. That pretty much bars access for anyone interested in having money in their 20s/30s, and those without a strong support system. There is a reason why only those from affluent/foreign backgrounds go into medicine. They're the only ones who can "afford" to not make money right out of college.
- cantankerous 10y ago
  Realistically, it takes 4 years to attempt to get your foot in the door at a medical school unless you have pre-admittance or you're looking at a special case like UMKC's 6-year program. Getting into an MD or a DO program isn't a guaranteed thing. It's a substantial downside risk. Also, you can have a STEM-based undergraduate education as your pre-med, even math and computer science can count if you take the right additional electives. The two aren't mutually exclusive. It's a good fallback if you bomb out of getting into med school (or decide 3 years into ugrad that you don't want to apply).
  - ikeyany 10y ago
    4 years of undergrad and 4 years of med school at least. And I agree that a tech related bachelor's is a good idea for a med school backup.

aabajian 10y ago

I'm a graduating medical student with a master's in computer science. In a lot of ways CS is the polar opposite of medicine; one values derivation and automation while the other emphasizes memorization and one-on-one interactions. Surprisingly, teamwork is one area where CS wins out. I've found that despite the professed importance of the healthcare team, healthcare often doesn't function like a team at all. Doctors, nurses, PAs, patient care assistants, administrative staff, can make or break your life by providing support or creating obstacles. I think it's a result of a inherently tiered system with a single person (e.g. the attending) on top who decides the treatment plan. In CS you almost never have a single person who is overly-trained relative to peers. Maybe you'll have a better developer, UI designer or manager, but none of these attributes makes that person the sole decider. The pay structure in medicine reflects its hierarchical system: software managers don't earn 10x what software developer make, whereas attendings easily make 10x a nurse's salary.

vikascoder 10y ago
You would be surprised how this doesn't apply to many software companies out there and how the hospital environment is exactly the kind of culture existing. There is no one thing fits all fact.
alpha_squared 10y ago
> I'm a graduating medical student with a master's in computer science. That's... actually really neat. What made you go for a graduate degree then on to med school, if you don't mind me asking?
- sjg007 10y ago
  I would guess that doctors have better career stability.
- aabajian 10y ago
  I actually got my master's in the middle of medical school (I took a leave of absence). My undergrad degree is in computer science as well. It's my long-term goal to start a radiology informatics company.

gumby 10y ago

Quite surprised Dermatology and Plastic Surgery aren't the top two. Those specialities are almost unique in being the only remaining ones in which most practitioners are not in managed care programs so can and do charge what the market will bear. If you go to an oncology conference you see a lot of paper presentations and poster sessions. If you go to the annual Derm conference there's a whole "scene" in the corridors and the trade show floor is really little different from the trade show floor of, say, a car show, or the AVN awards. Maybe GDC, or maybe that's a bit over the top. If you aren't an unabashed fan of capitalism (which I am), you'd likely call it crass. One year I was walking the show floor and stopped to look at a display of liposuction tubes -- it was beautifully laid out, like a cross between a bunch of Cala Lilies and an pipe organ rank. The salesdroid came over and said only two things: - "Hello, Doctor! Do you do liposuction in your clinic?" (I shook my head) - "Well you can easily get an additional $3000/day from these babies." I'm also surprised radiologists score so high because a lot of the analysis has been farmed out to India. And since that entailed a fully digital stack, those Indian MDs are about to be the first physicians to be replaced with DL. Perhaps the large number reflects a small residual 'n', or perhaps the radiologists have been able to hang on even though part of the job is outsourced -- presumably by them.

clavalle 10y ago
>Those specialities are almost unique in being the only remaining ones in which most practitioners are not in managed care programs so can and do charge what the market will bear. I think you've hit upon the reason. Turns out when the customer is paying directly and feels the pinch directly the market will not bear as much.
nugget 10y ago
Plastics is likely dragged down by a significant number of academic surgeons. Anyone doing a high volume of elective cosmetic procedures would laugh at these numbers. Derm likely reflects the number of hours worked, which is lower than other specialties. If you looked at a chart of earnings per hour, derm and ortho would be much closer together. NSG isn't mentioned but it should be the same or higher than ortho (with vascular and CT maybe a bit lower). Overall these numbers are low and represent a lot of physicians who are optimizing for lifestyle rather than income. There is still a lot of money in medicine if you know where to look.

plg 10y ago

The doctors who live on my street drive Porsches, Mercedes-Benz and Audis. Two docs on our street own multiple Porsches each (summer, winter, racing). Maybe it's family money. Then again maybe it's taxpayers paying their salaries. (location: mid-sized city in Canada)

maxxxxx 10y ago
German doctors have nice sports cars too. Same in the US.

czbond 10y ago

These pay scales are insane for the fact that doctors essentially just have to show up. This doesn't even include management of others (aka Director roles, etc). Just literally showing up.

jboogie77 10y ago
if you think all doctors do is "just show up", i'd be curious to know what you think programmers do. Do they just "type stuff"?
- czbond 10y ago
  I meant ... normally for a pay scale above $200k in the non-coastal areas, someone has to manage staff, lead a team, run a business unit, and make strategic decisions. Literally, doctors "do their specialty" - no teams, no 'winning clients' and closing deals to bring in business. They don't have to have any other skills but their specialty at those ranges.
  - Fomite 10y ago
    ...I know a number of doctors who manage staff, lead teams, provide cost justifications to their hospital's C-suite, and make strategic decisions.
beisner 10y ago
An employee at a company is likely responsible for a small piece of a product that will affect the lives of some number of people by a very small amount. A doctor will affect the lives of some number of people by an enormous amount. The responsibility is much higher in the medical profession, so doctors may "just show up" but when they don't, people suffer dramatically; when a regular employee doesn't "show up", nobody bats and eyelash.

qudat 10y ago

This article is extremely misleading. Even though these salaries might be high, they aren't adjusting for number of hours worked. When we think of a typical "salaried" job, we think 40 hours/week. This is almost certainly not the case, even for the cushiest physician specialties. My girlfriend is a critical care physician about to enter attending-hood working at a university hospital. She will be working a minimum of 50 hours/week and with all the administrative tasks she's being asked to do, it'll probably be more like 60+. Really we need to see hourly rates to get a better idea of what physicians actually make.