After Rounds
A surgeon wearing a medical mask

Should Physician Compensation Influence Your Specialty Choice?

Physician compensation is an important consideration for medical students choosing a specialty and planning their financial future.

When I was applying to medical school, and then residency, it was common for advisers to remind applicants not to focus on money as a goal. It occurred to me later that many of those giving this advice were academics in secure jobs with benefits. It was easy for them to dismiss financial imperatives.

While avoiding discussions of money may have been a noble idea, it was also wildly unrealistic. Medical students must consider physician compensation when choosing a specialty. The costs of medical education aren’t often discussed but have to be factored in. Those costs include money spent on undergraduate and medical school: According to the Association of American Medical Colleges, many students graduate with a median debt load of $200,000. But the real cost of medical education also has to take into account the income lost by deferring one’s job until around age 30. Our general assumption that medicine is a key to great financial gain has some baggage attached.

Where Does Salary Fit Into Choosing a Specialty?

Every student choosing a specialty has to decide how much training they’re willing to endure, what sort of lifestyle they expect and ultimately, how important money is to them beyond merely reducing debts.

While it’s certainly an option to “chase the money,” personal calculations about money and choice of specialty begin with the training process itself. A surgical subspecialist, such as a neurosurgeon or interventional radiologist, can easily earn $600,000 a year — probably more depending on how busy they wish to be. However, this comes at the personal cost of high academic performance to be accepted into those training programs, and it requires a longer residency, one that’s more arduous than others and will further defer ultimate income.

On the other hand, a pediatrician who makes $200,000 or less (and doesn’t pursue a fellowship) will finish training in three years. However, depending on location, amount of time at work and the income of the local patient population, that pediatrician may make less than some nurse practitioners or physician assistants in other specialties.

The Bigger Picture: What Do You Want?

Do you want a primary care practice in a remote location? That’s certainly a valid lifestyle choice, and practitioners in such settings make a huge difference in their patients’ lives. However, it’s unlikely that such a life will be very lucrative, although admittedly the cost of living will be lower than that of more urban areas. Physicians who want to work in an underserved area are probably less likely to have expectations for early retirement, multiple homes or other markers of wealth. Such physicians need to make every effort, early on, to reduce student loan debt.

At the same time, a physician who manages to train in a lucrative specialty like ophthalmology, dermatology or plastic surgery can expect to earn a high income — and this income may be necessary since those fields generally require more populous practice locations with higher costs of living (and of practice).

The type of practice can also affect physician compensation. An academic physician may make less than their private practice colleague; however, the academician may be protected from fluctuations in the medical economy and local market. They’ll also likely have options for benefits such as insurance and retirement — things that add to the private practitioner’s costs and reduce take-home pay. But the private practitioner can sometimes have more control over practice choices and will often have more options for increasing income as needed.

When considering physician compensation and choice of specialty, it’s important to do your homework. Talk to physicians in your potential specialty and look realistically at job projections in terms of future shortages (or excesses) of physicians in that field. Perhaps more important, assess your debt load and balance it against the kind of lifestyle you want to lead, where you hope to live and the kind of family and personal life you hope to have. Then, speak to a mentor about a plan.

Less Than You Think … More Than You Need

A wise instructor once told my residency, “You can live where you want, you can work as much or as little as you want and you can make as much as you want, but you can only have two.” So far, I’ve observed that to be true. But equally important, physicians have to bear in mind a couple of things.

First, while $500,000 seems like a “King’s Ransom” in medical school, it’s rapidly reduced by taxes, mortgages, insurance, licensing, board exams, children, bad decisions and a long list of other things that conspire to take money away. So whatever path you choose, try to live as cheaply as possible for as long as possible, and avoid adding extra debt.

Second, research has suggested that people are no happier when their incomes rise above $75,000, as Money reports. In a way, this makes sense because maintaining high incomes can be time-consuming and can take us away from things that give us joy, like family and leisure time.

Decisions about physician compensation and choice of specialty are increasingly complicated. However, with thoughtful planning, honest expectations and a careful balance of needs and desires, you can have a happy, rewarding career.

Edwin Leap

Edwin Leap

I am an emergency physician and have been in practice for 29 years since finishing residency. I live with my wife and children in rural South Carolina. I have been writing op-ed columns since 1995, starting with the Greenville News, Greenville, SC. I have also written a monthly column for Emergency Medicine News, titled Life in Emergistan, since 2000. Additionally, I write a monthly health column for our SC Baptist newspaper, the Baptist Courier. My work regularly appears at the popular websites KevinMD and MedPage today. My columns have also been published in various other publications including the Huffington Post, Politico, the Atlanta Constitution and USA Today. I have a special interest in rural healthcare, physician wellness, faith and family. I serve on the editorial board of Emergency Medicine News and MedPage Today.

Add comment

Follow us

Don't be shy, get in touch. We love meeting interesting people and making new friends.