What are the Highest Paid Medical Specialties in the US?
Calculating a physician’s income can be difficult due to the number of factors involved, such as specialty, which state they practice in, and if they own their own practice or are employed by a medical facility. So, when it comes to which doctor makes the most money, the answer isn’t as simple as one might think.
We have compiled a list of medical specialties in the United States with the highest yearly income. The income data is based on several sources, including Medscape, Indeed, and LinkedIn.
|Allergy and Immunology||$301,000|
|Diabetes and Endocrinology||$236,000|
|Physical Medicine and Rehabilitation||$308,000|
|Public Health and Preventative Medicine||$232,000|
How Do Doctors in the United States Get Paid?
Determining and articulating how doctors in the US get paid is almost as difficult as determining how much they earn annually. As we’ve already mentioned, calculating how much a physician earns is dependent on many factors. The healthcare landscape in the United States is constantly changing and evolving due to the introduction of new bills, laws, and other institutional changes.
Let’s review the different factors that affect a doctor’s income.
Private Practice vs. Employed
Statistics show that self-employed physicians earn more than employed physicians. Self-employed physicians earn an average of $395k per year, while employed physicians earn an average of $298k per year. According to a report by the AMA, American Medical Association, the main difference in how doctors get paid lies in their employment status—employed vs. private practice. The difference between the two is not their income per se but rather how they earn their living. Physicians who work in medical facilities like hospitals and medical centers cite their salary as their main mode of compensation. Private professionals can also be paid a salary, but the number of self-employed doctors who earn a salary is lower. According to the AMA report, over 46% of employed physicians reported that more than half of their income is salary-based, while only 25.6% of self-employed doctors reported the same.
Private physicians’ compensation relies on their personal productivity. This is not to say that the compensation of employed doctors does not rely on their productivity—it does, but less so than their private practice counterparts. Financial performance was only important in the compensation of private practice physicians, but only 10% of private practice owners cited that it was the sole factor in determining their income.
Pie chart indicating 47.1%
How do private practice physicians get paid? Much like any private business owner, a self-employed doctor’s income can be determined after all other business expenses and bills are paid. The physician’s office sees patients, documents their visit, bills the patient or the insurance company and receives revenue. Let’s say a doctor’s office made $350k in one year. If the cost of running the business is $200k (rent, lease, supplies, employee salaries, etc.), then the owner or owners are left with $150k to divide amongst them.
It is in the best interest of a private practice to serve as many patients as possible per day. The revenue of the business heavily depends on how many patients they see and bill each day. If the number of patients decreases, so does the revenue.
In recent years, private practices have become less common among physicians in the United States. Per recent data from the AMA, only 47.1% of doctors in America remain in a private practice setting. In contrast, the number of employed physicians is on the rise. Per data from AMA, 50.2% of physicians in the United States were employed in 2020. The percentage of employed doctors has been on the rise for the last decade, with 41.8% of physicians employed in 2012 and 47.4% employed in 2018. Let’s discuss the reasons for this growth in employed physicians and the decrease in self-employed physicians.
As with any business, running a private practice is no easy task. Many doctors grow tired and frustrated with the regulations and responsibilities of managing such an enterprise. On top of dealing with rent and employees, they have to deal with insurance companies and Medicare, and malpractice insurance. For many doctors, being an employee of a hospital or other medical facility provides peace of mind and a stable income. Even though employed doctors are expected to demonstrate a high productivity level, their income is not solely reliant on their productivity.
Although, this is too overly simplistic. Hospitals within the United States have created a protection for reduced physician productivity. Many hospitals throughout the US have created pay packages for their physicians. These pay packages reward physicians who put in hard work. The work relative value unit, commonly referred to as the wRVU, is a system that attempts to reward and compensate doctors for demonstrated enthusiasm and extra work, like seeing additional patients. In this aspect, the revenue model and income of private practices are also present in larger medical institutions—the more patients a doctor serves, the higher they are paid.
Many healthcare systems in the US are looking to change their pay structure to adapt to certain rules put in place by Medicare. However, it is hard to imagine that the US healthcare system would move away from rewarding physicians based on the number of patients they serve. A lot of attention is being paid to both the quality and efficiency, meaning the value of the care will consider more than the number of patients served. As one can imagine, it is hard to find the right balance between the two. With all business models, pay in the healthcare industry is reliant on productivity, but the shift in the structure of healthcare compensation seeks to align productivity and quality of care.
Income Difference by State
The state in which a doctor practices also affects their income. Many would think that states with larger populations would have higher incomes among doctors, but this is not the case. Surprisingly, heavily populated states like California and New York do not even break into the top ten states with the highest paid doctors. This may come down to several factors. Large, economically developed states have an abundance of healthcare options, meaning patients have a lot of options when it comes to choosing a healthcare provider. This would mean that, on average, there are fewer patients per doctor within these states. As previously discussed, the United States healthcare system is structured around earnings based on how many patients one serves. Fewer patients per doctor means less income, which is likely why large, populated states have lower-earning doctors.
States like Alabama, Kentucky, and Tennessee are among the top-earning states for doctors overall. In these states, healthcare options are limited, meaning there are not as many doctors, hospitals, or other medical facilities. This correlates to there being more patients per doctor in these states. In general, physicians who practice in states with lower populations fare better in terms of income than those who practice in large, populated states with an abundance of healthcare options. So a physician practicing in Kentucky would earn more than their counterpart who practices in New York.
Now, let’s go over the ten top-earning states for doctors in the United States.
Income Difference by Specialty
Primary care practitioners earn $297k on average, while specialists earn around $357k. We’ve already provided a list of the top-earning medical specialties within the US, which you can reference at the beginning of the article.
Why does a specialty affect a doctor’s income? To put it simply, some specialties require more skill than others. For example, medical specialties such as cardiology, orthopedics, and plastic surgery are some of the top paid within the United States. All of these specialties are procedure-based and require five to six years of additional residency training after graduating from medical school. The specialties mentioned also tend to demand post-residency, sub-specialty training such as fellowships.
Primary care specialties like family medicine, pediatrics, and internal medicine require less training. Aspiring physicians can become family physicians after six years of education (four years of medical school and two years of residency). While physicians practicing in these specialties earn less, there is an upside. The upside being they have a smaller debt and can enter the workforce quicker by spending less time and money on specialty training. They also accrue less debt because they can begin paying off their school debt quicker.
When it comes to choosing a specialty, you should consider the demand for that specialty within the health field. Often, higher-earning specialties are more in-demand as an increase in earnings often foreshadows a shortage in that field.
MD vs. DO Salary
We cannot avoid mentioning the salary difference between MD vs. DO physicians. DO and MD physicians make comparable income when working within the same specialty; specialty options are more limited for DO physicians. Per the latest data for the Main Residency Data Match, MD and DO graduates are equally competitive for the primary care specialties such as family medicine. However, DOs are less represented within the lucrative surgical specialties. For reference, 23 MD seniors were matched to a dermatology residence program, which is one of the most competitive residencies, but only 6 DO seniors were matched to this same specialty. Another example of this is orthopedic surgery, with 686 MDs matching vs. 112 DOs.
Although there is a discrepancy within the numbers, there has been a large increase in DO representation in competitive surgical residencies. This is primarily due to the changes in the accreditation of residency programs. Osteopathic and allopathic residencies used to be accredited by different institutions: the former by the AOA and the latter by the ACGME. Now, MD and DO programs are accredited by the ACGME, giving osteopathic programs the same status as allopathic programs. The same accreditation allows DOs to participate in MD programs and allows MDs to partake in programs with “Osteopathic Recognition” designation.
The now unified accreditation is closing the gap between MD and DO residents. Over time, the difference in numbers between the two will likely shrink. However, it is important to remember what DO stands for. DOs have a philosophy that leads them to pursue primary care and non-intrusive medical care practices. DOs are capable of becoming surgeons, but their tenets still affect their career choices, such as specialty and where they practice.
For those deciding between becoming an MD physician or a DO physician, it is best to evaluate both programs as a whole rather than based on potential income. Keep in mind when working in the same specialty DOs and MDs earned roughly the same annual income. However, there are many factors to consider when choosing between a DO and MD program. First, one must consider the philosophy of both programs and determine which best aligns with their personal values. You should also consider what medical specialty you’d like to practice. As mentioned, DOs have less representation within surgical specialties, so while this doesn’t mean you can’t be a DO and work within a surgical specialty, it may be easier to get into your preferred specialty as an MD.
Choosing a specialty, state to practice in, and employment status solely based on how much money you may earn is not wise. Money alone can not sustain one’s passion and dedication for their chosen career. In many ways, your personality and experiences will determine both your specialty and employment status. Some enjoy the autonomy of owning a private practice, while others prefer the steady income and stability offered by being employed at a medical facility.
Although it is difficult to make calculations about what the highest paid medical specialties or highest paid doctors are, there is no doubt that some physicians and specialties are among the top earning in the United States. When considering a doctor’s income, it is crucial to consider how long it takes to become a doctor. Earning a medical degree is a huge investment of one’s time, money, efforts, and mental health. The majority of physicians continue paying off their medical school debts long after they have graduated and begun their careers.
In addition to the debt one takes on, the vocation of a physician is not for the faint of heart. The career involves duties and responsibilities many cannot fathom. While there are a considerable amount of challenges associated with becoming a physician, one of the latest surveys done by Medscape shows that 77% of polled physicians would choose a career in medicine again if they were still deciding on their future career path.
For those of you who feel you may need additional guidance when it comes to choosing a medical specialty, we recommend seeking the assistance of residency admissions consulting. In addition to admissions consulting, taking part in a medical internship abroad may also aid in making a career path decision. The healthcare internships offered by IMA are a great opportunity to explore new, exciting areas and cultures while gaining hands-on experience in a variety of medical specialties, from cardiology and general surgery to pediatrics and internal medicine.
Frequently Asked Questions
What are the highest paid doctors in the United States?
According to the latest stats, physicians working within the orthopedics specialty are the highest paid doctors in the US. Doctors in the United States working in this specialty earn an average annual income of $511k.
What affects a doctor’s income in the US?
The primary factor that affects a doctor’s income in the United States is their employment status. Whether they are self-employed/ own a private practice or are employed by a hospital or other medical facility, other factors, such as the doctor’s specialty, affect their income. On average, surgical specialties are among the highest paid doctors in the US, while primary care is among the lowest paid. The state in which a physician practices also affects their income; reference our previously listed ten top-earning states for physicians above.
How do doctors in the United States get paid?
When it comes to getting paid as a doctor in the US, your pay primarily depends on your employment status. If you choose to become a self-employed doctor and run a private practice, your income will be heavily dependent on how many patients you serve. While the productivity of employed physicians is a factor in their salaries as well, it is not as large a factor as it is for self-employed doctors. Doctors employed by hospitals and medical centers have a more stable, steady income.
Why do doctors in the primary care field get paid less?
Although primary care physicians typically see and serve more patients than other specialized physicians, they typically charge less for their services. This reduced charge stems from the primary care field requiring less training and education than other specialties. In the United States, becoming a family medicine physician requires around six to seven years of education (four years of medical school and two years of residency), while it takes nine to ten years to become a doctor in a surgical specialty. Surgical specialties require extra skill, and therefore, the services of these physicians end up costing more than those of a primary care doctor.
Are there any advantages monetarily to becoming a primary care physician vs. a specialist?
Yes, it is true that specialists earn more. They also tend to accrue higher amounts of debt, spending both more time and money on their education. We are not here to dissuade anyone from becoming a specialist. However, money should not be the sole reason you choose to go into a medical specialty. Primary care physicians earn less but have less medical school debt due to graduating sooner and getting out into the workforce quicker. Those within the primary care field, such as family medicine physicians, spend roughly six years receiving their education as opposed to specialists who often spend ten years receiving theirs. Less time spent in medical school equates to less debt and being able to earn money sooner. Simply put, many of the highest paid doctors also have a high amount of medical school debt.
If you feel you may need additional guidance on choosing the best medical specialty for you, consider seeking the professional help of residency admissions consulting or partaking in one of IMA’s pre-med shadowing study abroad programs.
Is there an income difference between MD and DO physicians?
Yes, in the United States, there is an income difference between DOs and MDs. However, the statistics regarding this income difference tend to be misleading.
The average income of DO physicians is $164k annually within the US, while the average annual income of an MD is $202k. These average incomes are calculated while considering MDs and DOs of all specialties. This means that when these averages were calculated for MDs, the income of surgical and primary care doctors participating in the survey was added and divided by the number of MDs participating. This was done for the DO physicians as well, but DOs are less represented within the lucrative surgical specialties, leading to the lower average income of DOs vs. MDs. When DO and MD physicians practice within the same field of specialty, they have similar salaries.