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How important is a specialty's median salary?

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  • #16
    I went into IM, started 20+ years ago. For years I felt underpaid, compared to medians of other specialties. Never worked a night, weekend or holiday, so sometimes life is not that bad. Never missed one of my kids games or recitals, which I value more than working. I started out around 100 , last year I was at 550. You need to find the right practice that fits you from a financial point and also a personal point. Life is short and it is not all about the money.

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    • #17
      I am not a physician, but curious to know the spread in different specialties.
      In dentistry, it can be enormous. ADA says average dentist income is around $200K. I've looked at many practices where the owner was taking home under $150K, and I know quite a few people making $1M+. I thought much of the variability came from the fact that most dentists own their own practices, and their income depends much more on their business acumen than clinical skills.
      With MDs largely working as employees/ICs, I would think the spread is less - not so?

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      • #18
        Originally posted by molar roller View Post
        I am not a physician, but curious to know the spread in different specialties.
        In dentistry, it can be enormous. ADA says average dentist income is around $200K. I've looked at many practices where the owner was taking home under $150K, and I know quite a few people making $1M+. I thought much of the variability came from the fact that most dentists own their own practices, and their income depends much more on their business acumen than clinical skills.
        With MDs largely working as employees/ICs, I would think the spread is less - not so?
        Data is SOLD, much is available but mostly limited to a region or national. So, there is an art to this by population size and employment type.

        https://info.practicelink.com/blog/a...sation-surveys

        Outdated (2017) info that would give you an overview. 25th, mean, median, and 75th paint a picture in Table 4 (page 20).

        http://www.medpac.gov/docs/default-s...actor_sec.pdf?
        Last edited by Tim; 02-20-2021, 03:47 PM. Reason: Forgot Comp link

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        • #19
          I think the variability with physician income , as an employee is less , but still related to supply and demand for services. I see ads for IM jobs all over the US , with different rates, whether physicians make those rates , I dont know. But at least the advertised rate being 25% higher in one location probably has to do with the local market conditions , ie insurance mix, population growth and a whole lot of other factors. I was in solo practice for most of the time, so I can control how much I work, and how much my overhead was. I could be more efficient in the way I delegate work. But what I could not do effectively is negotiate higher reimbursement rates which is a significant driver of how well you do.

          What I can say is that my take home pay , was significantly higher than the advertised physician rates for the hospital system in my area. I attribute this to good business habits, being efficient and also seeing on average more patients.

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          • #20
            It's worth looking at, just realize the intraspecialty differences dwarf the interspecialty differences. But it's going to be a lot easier to make bank in ENT than preventive medicine.
            Helping those who wear the white coat get a fair shake on Wall Street since 2011

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            • #21
              Focus on salary is overrated, focus on the ratio of spend/salary.

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              • #22
                Thanks a lot people. Seems like you can't just look at medians since like everyone says, there's a big variability. That said, my current plan is to kind of start looking at specialties that are traditionally "good gigs" - if I like one of them, great; if not, then I can look for something else.

                Originally posted by molar roller View Post
                I am not a physician, but curious to know the spread in different specialties.
                In dentistry, it can be enormous. ADA says average dentist income is around $200K. I've looked at many practices where the owner was taking home under $150K, and I know quite a few people making $1M+. I thought much of the variability came from the fact that most dentists own their own practices, and their income depends much more on their business acumen than clinical skills.
                With MDs largely working as employees/ICs, I would think the spread is less - not so?
                I'd imagine that being an employee is far more likely to get you closer to the median than far above it and that's getting a lot more common in medicine, unfortunately. I think it's also true in dentistry. Actually, while I'm concerned by the corporate path that medicine is on, I think I'd be even more concerned to be in dentistry considering the tuition is (even more?) insane, and my understanding is that most desirable places to live are pretty saturated and cutthroat and the jobs aren't that great.

                I'd be very surprised if new dentists are going to try and break into the market and be successful with the debt loads that are becoming more and more common.

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                • #23
                  Originally posted by Turf Doc View Post
                  Thanks a lot people. Seems like you can't just look at medians since like everyone says, there's a big variability. That said, my current plan is to kind of start looking at specialties that are traditionally "good gigs" - if I like one of them, great; if not, then I can look for something else.



                  I'd imagine that being an employee is far more likely to get you closer to the median than far above it and that's getting a lot more common in medicine, unfortunately. I think it's also true in dentistry. Actually, while I'm concerned by the corporate path that medicine is on, I think I'd be even more concerned to be in dentistry considering the tuition is (even more?) insane, and my understanding is that most desirable places to live are pretty saturated and cutthroat and the jobs aren't that great.

                  I'd be very surprised if new dentists are going to try and break into the market and be successful with the debt loads that are becoming more and more common.
                  Lots of variability in dentistry. Average for GP is $200K, a little more for owners, around $250K. New grads mostly work for corps these days, $125-175K is decent pay from what I understand. Considering some of these kids have $500k in loans, not sure how they can survive on that. I was getting that 20 yrs ago, and my loans were 5 times less.

                  That said, most "successful" practice owners are probably in $300-400K range. $1M is rare but not impossible. $2M+ - has to be a very niche practice or running a very profitable chain.

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                  • #24
                    I have a somewhat different take. When I was in med school, the compensation in the specialties I was considering was a major factor in my decision. I systematically researched this as best I could (data are better and more available now than they were). I also tried to predict where the fields were headed in the future, speculating about government take over, corporatization and overall demand by specialty. I was no expert in these areas, so my ideas were wrong as often as they were right. But I hardly ignored the financial future.
                    My field, which I like well enough, has changed dramatically since I entered it. Fortunately, the relative compensation has not changed. I found, to my disappointment, that while I could have perfectly logical discussions about career choice with my college roommate, who was getting a JD and MBA, I could not discuss it with med students. So many of them self-righteously proclaimed that one should ignore income that I found it best not to engage.

                    People who say they can only do well what they love are being indulgent. The vast majority of people in the world work because they have to. They may not love what they do, but the try to do it well because that is how responsible people behave. I don't love what I do, but I try to be very good at it. I know plenty of docs who don't seem happy with their jobs but who I think are outstanding at them.

                    I also know plenty of docs in low paying specialties who complain constantly about their low pay. The one time I made the mistake of asking what they though the compensation would be when they chose their field, I got an aggressive, angry lecture about how they picked the job without regard to pay, but that they should be paid a lot more. It made no sense but I had no reason to continue the conversation.

                    Absent some very good reason to think otherwise, med students should plan on being about average at their fields in terms of clinical ability and compensation. Maybe if you are really exceptionally good in school you can think you will be above average. But what you need to be an above average doc is so different from what you need to be an exceptional student that accomplishment in the classroom does not predict much. If you assume you will be average in income then the median income is the most robust measure of central tendency. Use it.

                    I have known a handful of docs who came from so much family money that it did not matter what they made in their practices, or whether they worked at all. For them, ignoring the money and picking something they thought they would like was reasonable. For the rest of us, it would be like picking an asset allocation with no thought of the likely returns or risk.

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                    • #25
                      I agree. The stigma re: discussing money/finances in med school that frankly persists throughout most careers is annoying... but maybe even more than that the lack of discussing impact of work conditions on your life and the lack of any discussion re: how inhumane some are

                      Personally I tell med students the following:

                      1. If possible eliminate any specialty that works nights or that has significant call— ESPECIALLY ones that aren’t shift based and are expected to just work all day the next day.. no amount of money is worth it. It will ruin your life and will take years off your life.

                      2. Pick an under the radar specialty that makes a lot of money but won’t be large enough to come under attack (ie ortho/cards).. my “hidden gems” are something like urology.

                      3. but nothing wrong in at least focusing first on the higher paying specialties and weed them out from there.. if at the end of the day you land on peds than more power to you and good luck

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                      • #26
                        End of day someone has to work nights or take call, unless you want more PAs and NPs( "we weren't sure if we were in the bladder or vagina"). The problem with the under the radar specialties is students have essentially no exposure to them. Like when I was a student I never had any exposure to path, urology, ENT, heck even radiology for the most part besides after I decided I wanted to do it. You can seek them out but it's hard to get the initial spark for someone to be like " I want to be a urologist." Unless you have a personal medical issue or a family member with one related to a field and it interests you, I think its tough to acquire interest in those fields.

                        One of the things about med school that I think is stupid is you spend a month or two on the ~ 6-8 specialties that make up probably 80 % of medicine, like FM, IM and subspecialties, surgery, peds, ED, OB/GYN and then absolutely 0 time on the other 20 %. It's tough to get your foot in the door or have interest in a specialty when you barely know it exists or what it entails. By the time you can pick electives or etc you pretty much have to be committed for the more competitive things or you are already interviewing and need to obviously know what to apply for.

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                        • #27
                          Originally posted by Sundance View Post
                          I agree. The stigma re: discussing money/finances in med school that frankly persists throughout most careers is annoying... but maybe even more than that the lack of discussing impact of work conditions on your life and the lack of any discussion re: how inhumane some are

                          Personally I tell med students the following:

                          1. If possible eliminate any specialty that works nights or that has significant call— ESPECIALLY ones that aren’t shift based and are expected to just work all day the next day.. no amount of money is worth it. It will ruin your life and will take years off your life.

                          2. Pick an under the radar specialty that makes a lot of money but won’t be large enough to come under attack (ie ortho/cards).. my “hidden gems” are something like urology.

                          3. but nothing wrong in at least focusing first on the higher paying specialties and weed them out from there.. if at the end of the day you land on peds than more power to you and good luck
                          I would go into what you like

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                          • #28
                            One more thing that I think is worth considering is location demand - for many of the lower paying specialties, you can work pretty much anywhere, whereas specialist jobs are more limited and tend to be concentrated in more populated areas.

                            Some might not care about this (and in fact many on this board encourage moving to take place of arbitrage) but for others specific location is more important than money. I live in an area that is pretty saturated with primary care, yet I could go out tomorrow and get any of 10+ jobs within a half hour radius of me ranging from outpatient, inpatient, academic, etc. If I was a pediatric neurologist, I wouldn't have that kind of flexibility. Some people don't care about this, but it is at least worth noting as one non-financial benefit Take my $0.02 for what it's worth (admittedly coming from a family doc who feels underpaid...)

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                            • #29
                              Well, there is a huge shortage of pediatric neurologists. They don't make a lot of money but it is not hard for them to find jobs.

                              As for working nights- very individual. Some people are destroyed by sleep deprivation. Ruin one night and it takes them days to recover. They are still exhausted by the time the next night comes around. They should avoid jobs with a lot of off hours work. Others grab a couple of hours nap after their midnight case and feel fine by 5am rounds. For them, no reason to avoid neurosurgery.


                              People have set points of how hard they want to work and how much sleep and time off they need. No one right answer.

                              By the time you are in 3rd year you probably know where you land on the spectrum. Our neurosurgeons complain about the hours of course. But they also book elective cases for 6, 7 and 8 pm on nights they are on call. Maybe it is ego "no one else can help this person". Maybe they really want the money. Maybe they cannot think of anything they would rather be doing at night than operating. Probably a combination of factors. They complain more that there are not enough OR's, thus limiting their ability to do as many cases as they want. Everytime the hospital opens more, they fill them up.


                              Many other docs think they are crazy. But they are very good surgeons.

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                              • #30
                                Any perspectives on Ophtho vs ENT? I really like both fields but trying to look more at the financial side of the fields.

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