Have you ever wondered why it’s so hard to get an appointment to see a primary care physician? It’s partly because many doctors don’t work in primary care. The push to specialize starts early in medical school. A physician told me as much. He wanted to be a primary care physician but his mentors in medical school told him he really didn’t. The truth was he wanted to see a variety of patients with a variety of different health problems, but his professors pushed him to specialize. From talking to him I got the impression that there was also a subtle coercion. It was like the professors were saying, “if you want me to mentor you then you will take my advice.” His professors considered specialties to be more challenging, more interesting, but it’s also that many specialties come with higher pay.
Medscape Medical News just released its physician compensation survey for 2023. It found that primary care physicians earned $265,000 on average compared to $382,000 for specialists. That’s $117,000 difference. That averages out to nearly $10,000 a month lower pay for primary care. There is an even greater pay gap depending on the type of medicine practiced. Public health & preventive medicine (a type of primary care) compensation averages $249,000 a year compared to $619,000 a year for plastic surgery. I compared 2023 to the 2022 survey and plastic surgery went up $43,000 a year compared to an increase of only $6,000 for public health & preventive medicine.
Male primary care physicians earn more than female primary care physicians, $286,000 to $239,000. Among primary care physicians, men earn $47,000 more than women, on average. That’s an improvement compared to 2022 when men earned $57,000 more. What is the cause of the primary care pay gender gap? If I had to guess, it’s probably that many female physicians want work/life balance. Many have kids at home. The gender pay gap also varies by specialty, but on average male specialists earn $88,000 more per year. Women tend to congregate in some specialties more than others. Women outnumber men in pediatrics and OB/GYN, but men outnumber women 8 to 1 in urology. Citing Becker’s Hospital Review, a physician on Twitter pointed out that 11 of the 20 lowest-paid areas of medicine included the word “pediatrics” in the job title. Female physicians are more likely to treat kids and kids don’t pay well.
Depending on the area of practice, between 35% and 68% of physicians feel fairly compensated. That means that between 32% and 65% don’t think they’re paid enough. The comparable figure from 2022 was 42% and 72%, and oddly enough the specialty that felt well compensated was the lowest paid (public health & preventive medicine).
I have often heard it said that medicine is so frustrating many doctors now advise their kids not to go into medicine. However, nearly three-fourths (73%) say they would go into medicine again. Most would go into the same specialty, ranging from 61% of internal medicine physicians to 97% of plastic surgeons.
More than half of physicians are employees rather than self-employed. However, those who work for themselves earn nearly 10% more, $374,000 vs. $344,000. Although doctors report spending a little over 15 hours per week on paperwork and administration, that varies from 9 hours (anesthesiologists) to 19 hours per week (physical medicine & rehab).
I have talked to physicians who are tired of dealing with the hassles of insurance. A relatively small proportion report dropping low paying health plans. Yet, about two-thirds (65%) of physicians accept new and current Medicare and Medicaid patients, down from 70% in 2022. One way physicians dispense with the bureaucracy of accepting insurance is by opening direct primary care practices (DPC). Although DPC physicians report enjoying their work more, they don’t always earn as much as those who take insurance.
According to Zip Recruiter, DPC physicians earn less than other physicians, from $127,019 a year in Georgia to $191,410 in Tennessee. Tennessee shares a border with Georgia. It makes me wonder why Georgia DPC physicians don’t pack up and move to Tennessee? But, then again, I’m not really sure how Zip Recruiter would know since DPC is usually a sole proprietorship. Over the years I have met doctors who earn above the average by specializing in services patients want. My wife and I have such a doctor. They don’t take Medicare, Medicaid or insurance of any kind. I have told the story of the time my physician was out of town and had another physician cover for him. His colleague who covered took cash only. He would not make appointments. It was first come, first served. I saw him and it was quick, cheap and easy. I wish he still practiced.