Allright, cough it up: How much do surgeons *really* make?

[Toadkiller Dog]

For the last two or three years, I have been hearing several horror stories about how poorly surgery (especially GS) is being paid these days. Quite frankly, I don't buy it.

First, all of the income surveys are skewed, and most of them are grossly low. Second, payment in general is heavily weighted toward procedures (surgery being one of them).

Some of the surgeons on our faculty are disgustingly rich (a small US MD school). And just to drive home a point, a good friend of mine just finished a rotation in CT surgery, and swears that the surgeons he worked with are making 1-1.5 million, net, working 50 or so hours a week.

So I challenge anyone out there who really knows: how much are surgeons (especially GS, but others too) making? and I don't mean at only at first, but after "buy-in" to a group practice in a moderate area in anytown, USA.

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[ana]

"Surgeons" is a pretty board term. CT surgeons do an additonal 2-3 years fellowship in addition to 5 or more years training as a general surgeon. Also, I do not know of any CT surgeon who works less than 80 hrs per week and is pullling 7 figures (I live in Los Angeles).

A vascular surgeon (additional 2 years fellowship post g-surg residency) I know who has been out for 5 years and doing private practice in the So. Cal area earns between $150-190k after expenses but before taxes; he also has to do some general surgery stuff (hernias, appys, etc). He works pretty hard -- does a lot of surgeries on weekends.

ENTs make about the same, but have a better lifestyle. Plastics earns slightly more than my friend, but they still have a lot of patients willing to pay out of pocket for cosmetic stuff.

Anyway, "surgeons" is too broad a term. What type of surgery are you interested in?

 

[droliver]

Ana,

a lot of that depends upon where you practice. Here in Louisville, a metropolitan area ~ 1,000,000 people, I think partners in the general surgery groups in private practice make b/w 250-400K pretty routinely. There may be some slightly more than that & some bariatric guys are doing very well. If you survey the recruitment flyers, offers of 200-250K to start seem to be pretty common in most areas with some of the more desperate rural areas guarenteing salaries of 350-450K.

I think the vascular surgeons we work with are prob in the 300-400K range.

The CT surgeons are prob in the upper 6 figures for partners.
The Spine surgeons are upper 6 figure lower 7 figures
Plastic surgery varies the most I guess from 200K to $1,000,000+ (with very few in that upper end & most clustered around 350-500k range)
Surgical oncologists & colo-rectal surgerons in private practice usually make about 10-15% more than the average general surgeon in whatever market you're in.



As far as hours, I think most of these surgeons put in 70+ hours a week to keep up their practices @ these levels. I don't think you could effectively limit yourself to say 50 hrs. with these kind of referrral based practices

 

[DocWagner]

A reliable source to invesitgate trends is "Medical Economics" Magazine, published monthly.

 

[southerndoc]

I think the problem with the "poor incomes" of surgeons is because of the enormous costs of malpractice insurance.

 

[droliver]

ACtually it has more to do with declining reimbursement per procedure with rising overhead & administrative costs. General surgery malpractice coverage is not prohibitivly expensive in most places as compared to say OBGYN or Neurosurgery. A notable exception to this is if you wish to do bariatric surgery (a pretty hot field right now) for which coverage can be an additional $100,000 assuming you can get it (many companies will no longer write policies for it)

 

[ana]

dr oliver,
thanks for your reply. The figures I was quoting for my MD friends and acquaintances in Los Angeles is after expenses (including overhead and malpractice) but before taxes. As SoCal is highly competitive for positions, I am sure salaries will be higher in other places.

The general surgeons I know pay $30K-50K in malpractice per year assuming they have not been sued. OB/Gyn and CTsurgery malpractice in L.A. ranges $50K-$80K (again, assuming no successful lawsuits). The rates for primary care and psych are low (my psychiatrist friend pays $10K!!!).

 

[southerndoc]

An IM doc I know pays $6,000/yr for malpractice. Gotta love it.

 

[droliver]

I'm surprised that you've heard the malpractice premiums are that high in California. It is one of the most-friendly environments for malpractice in the nation because of legislated caps on pain & suffering damages. It is actually held up as one of the states with the cheapest insurance because of this when the issue is discussed @ meetings & such. The worst places are supposed to be in Nevada, Pennsylvania, West Virginia, Mississippi, & Florida. Each of those states has had well publicized consequences of the tort system especially Nevada, where the only level one trauma center in the state @ UNLV was about to close to trauma and Mississippi where large parts of the state have no obstetric coverage.

 

[Toadkiller Dog]

A few points:

1. University Medical Center in Las Vegas DID close (the trauma center only), as the orthopedic surgeons took themselves off the rotation schedule due to an inability to negotiate a malpractice related issue with the hospital. It was down for 2-3 weeks, I believe.

2. A friend of mine just did a rotation there, and said that the surgery chief, a plastic surgeon named Zamboni, owns a mult-million dollar mansion on the same street as Celine Deion! (who recently go some insane amount of money to perform at a casino in Vegas. Heresay, but still fun).

3. I have a hard time believing that any surgeon in SoCal is making that little unless he/she is working entirely on MediCal patients or 3rd rate HMO patients. California has *very* low malpractice premiums, but MediCal payments supposedly stink.

 

[ana]

The rates I quoted ARE considered LOW malpractice premiums. These are what my friends who are in practice tell me they are paying. Considering the salaries I also mentioned are after expenses (including malpractice), they are not bad (an primary care doc out for less than 5 years in the L.A. area may make about that much before expenses).

As for reimbursement from 3rd rate HMOs, you have to remember the HMO penetration in California is about 80%. The best paying customers are the Medi-Medi patients (they have BOTH medicare and medicaid) and are the favorites of all docs both surgical and primary care.

 

[fourthyear]

Totally off the subject, but, Toadkiller - I learned somethign interesting at a hockey game once - Zamboni is actually the family name of the guy who invented the ice-rink Zamboni machine. I have no clue if your doctor is related, but how many Zamboni's can there be? So maybe he has some family money too. But I do beleive you can make millions in plastic surgery if the patients are the ones who can afford to pay cash for a surgeon who has a great record of making people beautiful.

 

[Voxel]

According to one salary survey in 2001,
Average GS salary: East: ~235K , Midwest: ~255K , South: ~300K , West: ~221K. This is net salary (adjusted gross - expenses) and before taxes. I have spoke to some private practice surgeons who say they used to make twice that in inflation adjusted dollars in the 80s.

 

[dr.evil]

What's sad is that they made twice that amount of money in the 80's but did half the amount of actual surgery.

A study from the Univ. of Michigan Dep. of Surgery in 1997 showed that the number of operations performed in one year increased from 7000 in 1982 to more than 17,000 in 1995 (a 249% increase). There was little change in the workload of OB/Gyn, Otolaryngologists, or ophthalmologists during the same period.

Kind of helps explain the reason why GS apps are down. More work (for attendings and especially residents) and less pay per case.

 

[womansurg]

Hey, my first post....and it's on the subject of money...

Those figures (from Voxel) are pretty accurate for general surgeons. A lot depends on the your patient base too. The real issue is not how much work you do, or how much you bill, but rather how much you COLLECT. Sometimes collection rates can be only 30% or so of what you actually bill. If you are in a suburban private practice, not taking care of trauma patients, uninsured folks, and so forth, it seems to be fairly easy to hit about 500K.

Heck, it's all good. Surgery is hands-down the funnest, most interesting job in the world. I'd probably do it for free.

Wait, that's basically what I've been doing the past 5 years. It's call 'residency'.