Yes, we're going there. Money. The thing that we all know deep down is hugely important to our lives/careers, but for some reason in the medical field we are trained to ignore the fact that our jobs are jobs. Meaning the things we do to earn a living. As a profession we have conspired to make the topic of physician salaries somehow taboo - as if the fact that we care about making good money somehow makes us less ethical doctors.
Maybe it's unfair for me to generalize in this way. I can speak only of my own experiences in the UK, where it was ingrained into me that our career as a doctor was one of self-sacrifice, and if money became a consideration in your career decisions regarding choice of specialty or country of practice, then you had somehow forfeited moral superiority. All the while, our colleagues in dentistry, law, finance, management consultancy etc. had no qualms demanding what they considered 'fair value' for their level of training and the work they did. But we were doctors. We were different.
Well, if that describes how you feel about your own career as a physician, you may not have much interest in the rest of this article.
If, however, you love your job as a doctor, you cherish making a difference in people's lives and being there for them in their most desperate times, you've spent years making sure you have the right knowledge base and technical skills to carry the weight of responsibility of having people's lives in your hands - but you also would like to be paid according to the time that has taken, the pressure you work under, and the value of what you do... let's talk physician salaries in the U.S.
"U.S. Doctors Make So Much Money" ... or do they?
We've all heard the rumours before. U.S. physicians make these crazy sounding salaries and have holiday homes/ fancy cars. But is that actually true?
Yes. Yes it is.
I like to create some drama in these blog posts just to keep people on the egde of their sets. But the truth of the matter is, even though there are obviously huge ranges when it comes to salaries amongst U.S. doctors, on the whole they are amongst the most well-paid people in the country. Let's start out by taking a look at the below salary rankings released by the job hunting website 'Glassdoor'.
The following is the list, provided by Glassdoor, of the top-paying jobs in the US:
Glassdoor’s 25 Highest Paying Jobs in America for 2019:
Median base salary: $193,415
Number of job openings: 3,729
2. Pharmacy Manager
Median base salary: $144,768
Number of job openings: 3,042
Median base salary: $142,478
Number of job openings: 3,655
Median base salary: $126,438
Number of job openings: 1,884
5. Enterprise Architect
Median base salary: $122,585
Number of job openings: 1,555
6. Corporate Counsel
Median base salary: $117,588
Number of job openings: 907
7. Software Engineering Manager
Median base salary: $114,163
Number of job openings: 1,641
8. Physician Assistant
Median base salary: $113,855
Number of job openings: 11,008
9. Corporate Controller
Median base salary: $113,368
Number of job openings: 299
10. Software Development Manager
Median base salary: $109,809
Number of job openings: 1,663
11. Nurse Practitioner
Median base salary: $109,481
Number of job openings: 17,572
12. Applications Development Manager
Median base salary: $107,735
Number of job openings: 407
13. Solutions Architect
Median base salary: $106,436
Number of job openings: 8,215
14. Data Architect
Median base salary: $104,840
Number of job openings: 2,341
15. Plant Manager
Median base salary: $104,817
Number of job openings: 1,186
Accompanying this list was an article which you can find linked above. One fascinating line from this article is something I wanted to include here.
"Somewhat unsurprisingly, the No. 1 job on the list was physician, with a median base salary of $193,415 — more than three and a half times the US median base salary, which is currently $53,950, according to Glassdoor."
"Somewhat unsurprisingly"... I wonder how physicians in some other countries in the world would feel about the fact that doctors would clearly be higher paid than dentists, lawyers, software engineers... I think it's safe to say they wouldn't consider it a routine/ unsurprising finding! This illustrates how widely accepted a fact it is in the U.S. that being a physician is the best paid job. And it's not just something specific to physicians - the list shows that Physician's Assistants (PAs) make an average of $113k per year, while Nurse Practitioners (NPs) make $109k a year. That's over 7,550,605 Indian Rupeees per year, or £81,330 per year, for NURSES and PAs, not even doctors.
And how do they rationalise this in the article?
“Some of these high paying jobs, such as healthcare-related roles, require many years of advanced education, while other jobs require years of experience gained over time, such as technology and finance roles,” an analysis from Glassdoor says. “Workers with these extensive knowledge and experience skill sets are in short supply, and employers are willing to pay top dollar to attract and retain talent.”
That sounds kind of refreshing, right? Hearing that your many years of advanced education are being recognised and appreciated. Being described as having 'extensive' knowledge and skill sets which should be compensated well to make sure we feel valued... What a revolutionary concept to so many of us, who have been taught (tricked) into thinking that as physicians we are uniquely expected to accept less than the value our work provides, because that's the moral thing for us to do. When there's a pandemic, it's clear that our work is the most essential - the bankers can day trade from home, the dentists can delay their scales/polishes, the management consultants can close their PowerPoint slides for a few months (sorry for the shade non-doctors, I'm just trying to make a point here, we know you do valuable work). And yet, in so many countries, we're on stagnant wages, less than our colleagues in nearly all of those other fields, and STILL having to fight new contracts to make sure our pay isn't made worse...
What are the average salaries for U.S. physicians?
RANT OVER. Back to the point of physician salaries in the U.S.! So yes, they do make a lot of money in America. Whilst the Glassdoor article above mentions the average of around $190,000 per year, this is actually an underrestimate when compared with other data sources we have for these figures.
The "gold standard" when it comes to doctor salary reports is the Medscape Physician Compensation Report (the 2020 report is atttached at that link). They surveyed over 17,000 physicians from 30 specialies to help them reach their conclusions. And the results for average annual salaries...?
- Primary Care Physicians: $243,000
- Specialist Physicians: $346,000
Not bad, huh? These numbers are of course averages, so not every doctor is earning that much (but it means half of them are earning more than this too...) Also, these numbers are before tax, so you have to keep that in mind. But unless you're living/working in certain Arab countries, taxes are a fact of life for us all (and are actually more in Europe than in the U.S.... but that's for another article).
Are the salaries going down yearly?
In many other countries, it's almost become an accepted fact that the 'glory days' of physician compensation are in the past, and that our generation of doctors is generally earning less and less each year. So is this the same case in the U.S.?
Not according to the numbers. That same Medscape Physician Compensation report which first became widespread in 2015 found that at that time, the average PCP physician salary was $195,000, and the average specialist made $284,000. This shows that physician salaries have been increasing in the U.S., a trend that has persisted for over 10 years.
Which specialties make the most money?
Not that this is going to be the most important part in anyone's decision making regarding what they want to practice for next 50 years of their lives! But it is always interesting to see which of your colleagues are making the most so that you know to throw shade at them when they get something wrong...
Below is a screenshot taken from the Physician Compensation Report 2020 showing salaries broken down by specialty.
So, as you can see, even if the average was in the $300k range, a lot of specialties average significantly more than this. Spare a thought for the poor pediatrics doctors who have to somehow survive on $232k a year...
I've included the below graph just because I think it's quite funny. It shows which percentage of respondents from different specialties think they are 'fairly compensated'.
So the orthopedic surgeons, true to orthopedic surgeon stereotypes, get paid the most but somehow almost half of them still think they should be paid more. Can't blame them for the hustle - respect. Out of interest, what percentage of UK doctors do you think would feel like they are 'fairly compensated' for their work...?
Which states pay the most money to doctors?
Once again, this shouldn't be the MAIN thing you consider when deciding where to settle down in the U.S. (*cough* politics, racial composition, gun ownership...) but for those interested, the top 5 best paying average states in the U.S. are listed below.
It's unfortunately not a coincidence that some of the more rural, Southern, less diverse, more Republican states are the best paying... the rules of supply and demand are such that, to incentivise more people to relocate to these states, they have to pay more. Whereas hospitals/practices know that doctors want to typically live in NY, California, San Francisco etc. so they don't need to provide as generous a financial package to attract them. It's also worth bearing in mind that 'red states' (Republican run states) do tend to have less income tax as well as paying more... so just keep it in mind!
How much do residents get paid during training?
Naturally the above mentioned salaries are all referring to what fully qualfieid, board-certified, Attending physicians earn on an annual basis. Residents who are in training and practice only under supervision are certainly not making figures like these! When it comes to the average resident salary, the main variable here is geographic location. Let's use a NY based residency program and an Ohio based residency program to illustrate.
- Cleveland Clinic Internal Medicine Residency Salary
PGY 1: $57,493 PGY 2: $59,429 PGY 3: $61,350
- NYU Langone Health System Residency Salary
PGY 1: $68,247 PGY 2: $71,197 PGY 3: $74,272
Although these are only two examples, they are fairly representative of the average salary ranges you can expect in populated urban metropolitan cities like New York, versus those in more rural parts of the country such as Cleveland. It's nice to see that a reasonable 'premium' is provided for these major cities considering the multiple fold increase in cost of living in places like NY.
You can also see that the salary tends to rise by a few thousand dollars each year through residency. Most programs tend to be either 3-4 years long, but if you were to do a fellowship after residency training e.g. become a Cardiologist, your last year of training would be a 'PGY-6' year (postgraduate year 6) during which you would continue to have your pay increased yearly and end up on around $83,000 per year in NY for example.
Clearly we can see from this that residency training is certainly a less lucrative time in the medical career of U.S. doctors, as you would expect. However, even with this being said, to have a starting salary in NY as a PGY-1 of $68,000 per year (£65,000 per year) is not bad... Foundation Year 1 (FY-1) doctors in the UK, which is the equivalent point of training, start on around £28,000 per year...
The 'Opportunity Cost' Factor - why U.S. doctors are even richer...
As if all of this wasn't enough, I just wanted to point out another key aspect of the overall equation that is often overlooked. My year in business school taught me a lot of fancy words for common sense things, and one of those was 'opportunity cost'.
"The loss of potential gain from other alternatives when one alternative is chosen."
What does that mean in this context specifically? Well, let's say you're a medical student who decided to graduate and stay in the UK versus one that decided to move to the U.S. At that point, not only do you compare the exact like for like salaries at Attending/Consultant level, but you also have to factor in how much earlier you would have started to earn that money in the U.S. as compared to the UK, because the 'time to attending' tends to be so much shorter in the U.S. v the UK!
Of course, each specialty is slightly different, but let's take Dermatology as an example (my field!).
- Time to Attending in the U.S. : 1 year of Internal Medicine (/General Surgery) + 3 years of Dermatology training = 4 years
- Time to Attending in the UK: 2 years of Foundation Year training, 3 years of Core Medical Training, approx. 4 years of Specialty Training in Dermatology, plus maybe needing a PhD if you want to actually get a Consultant job in Dermatology these days (3-4 years) = 9-13 years
Not all specialties have such a huge discrepancy e.g. to become a GP is 5 years in the UK vs 3 years in the U.S., but there is basically NO specialty that has a longer 'time to attending' in the U.S. as compared to the UK, and most of them are shorter by several years. This means that, by the age of roughly 29, your theoretical colleague who moved straight to the U.S. is likely to be an Attending and making around $250k a year at least, whilst at that point you will likely still have 3-4 years of training left where you will continue to make around $60,000.
So, by the time you are both Attendings and you are still making less than them, they will actually already have headstart of around $800,000 of pre-tax earnings compared to you.
But money isn't everything!
This is 100% true. Money isn't everything. The purpose of this article is certainly not to try to tell any person reading it that this means they should clearly move their lives to another country. There are a million and one factors that people need to consider when deciding whether or not moving their entire career to the U.S. is the right move for them. Money doesn't buy happiness, and if you're entirely content knowing you won't ever go hungry as a doctor in your home country, even knowing that other professions/ doctors in other countries may make more, then that's a beautiful thing. For some people, having an established social circle, family life, familiarity etc. is worth a lot more than an extra few hundred thousand dollars a year. And those people are definitely not wrong!
We just want to provide the most detailed, up-to-date, reliable information out there for international medical students/ doctors who want help making up their mind about whether moving to the U.S. is worth it for them. That is all this article is for.
How can I find out more about moving my career to the U.S.?
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