How many hours do you work

[pathslides]

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For practicing pathologists, how many hours a week do you work on average and what is your practice setting?

For me, 45-50 hrs/week. Community practice.

 

[BU Pathology]

55-60 academics

 

[octopusprime]

35-45 PP

 

[coroner]

40, PP (hospital based)

 

[deleted314957]

40, PP (hospital based)

40-45 community hospital solo medical director (retired 31/2 years ago.)

 

[icpshootyz]

Around 45, PP, hospital based

 

[stickyshift]

40-45 hours.
You guys are all making $500K+, right?

 

[pathslides]

You guys are all making $500K+, right?

I am not

 

[octopusprime]

40-45 hours.
You guys are all making $500K+, right?

yes

 

[icpshootyz]

40-45 hours.
You guys are all making $500K+, right?

Yes.

 

[coroner]

40-45 hours.
You guys are all making $500K+, right?

Are you?

 

[stickyshift]

Are you?

Um, no.

 

[coroner]

Yeah, me neither...haha. I would've thought $500K would qualify one for the top 10%, but it's actually closer to the mean according to MGMA. Their data has the top 10% at about $840K If you asked me beforehand, I would've been shocked the mean is roughly $500K and would've guessed that would be good enough to be in the top 10%.

I don't get it. I know, there are pathologists out there making mad bank. But MGMA's top 10% figure seems super high as does their mean of nearly 500K. Who are these underground pathologists and where are they? I know of a few of them, but from whom I've come across, they neither represent the mean nor top 10%...

 

[Dave CX]

500K?
Used to be all the money in the world. Now its a days pay.

 

[Autopsy101]

60 -70 - and not even close.

 

[stickyshift]

To be honest with you, I've found the MGMA surveys wildly unreliable from year to year: the average incomes and range of incomes swing a lot. I'm not sure if they survey the same practices from year to year, and the number of practices surveyed isn't all that large.

 

[coroner]

60 -70 - and not even close.

You've got everybody beat here. Doing...Forensics?

I've found the MGMA surveys wildly unreliable from year to year: the average incomes and range of incomes swing a lot.

That may be the case. But it's the gold standard by many hospitals nationwide to determine salaries for employed physicians. I'm sure many a pathologist would be satisfied being in the bottom 25th %ile making mid 300's...

 

[stickyshift]

You've got everybody beat here. Doing...Forensics?

That may be the case. But it's the gold standard by many hospitals nationwide to determine salaries for employed physicians. I'm sure many a pathologist would be satisfied being in the bottom 25th %ile making mid 300's...

So, I'm looking at the MGMA report for 2016 (using 2015 data) right now. Total compensation for Pathology: Anatomic and Clinical is $350K median and $383K mean for all practice types (28 groups/165 practitioners). The Midwest practices in the survey (all 7 of them, accounting for 26 of the 165 practitioners surveyed nationally) do the best regionally, with a median of $451K and a 90%ile of $828K. But that's data from a very small number of practitioners in the Midwest. In contrast, practices in the East have a median of $322K and a 90%ile of $626.

Maybe hospitals use the MGMA report as a gold standard, but the numbers vary wildly and are based on a small number of practices/practitioners. And I seem to recall that they vary a lot from year to year, too. I just find it hard to draw many firm conclusions from it.

 

[gbwillner]

These numbers are pretty crazy IMHO. Only people who own their own practice (or part of it) can make this much, and at this point, that appears to be a minority of pathologists. It also likely represents practices without significant competition.

A survey of 7 practices to represent an entire region?

 

[SEpathguy]

So, I'm looking at the MGMA report for 2016 (using 2015 data) right now. Total compensation for Pathology: Anatomic and Clinical is $350K median and $383K mean for all practice types (28 groups/165 practitioners). The Midwest practices in the survey (all 7 of them, accounting for 26 of the 165 practitioners surveyed nationally) do the best regionally, with a median of $451K and a 90%ile of $828K. But that's data from a very small number of practitioners in the Midwest. In contrast, practices in the East have a median of $322K and a 90%ile of $626.

Maybe hospitals use the MGMA report as a gold standard, but the numbers vary wildly and are based on a small number of practices/practitioners. And I seem to recall that they vary a lot from year to year, too. I just find it hard to draw many firm conclusions from it.

I've been curious where my salary matches up with the national averages for a while (which is how I ended up on this thread; actually I joined SDN just so I could write this). After talking with friends in private practice these numbers actually seem to be about right for private practice pathology. I'm hemepath trained, working in a quasi-academic setting in the southeast. I'm employed by a fairly large academic medical center, but work in a community hospital based setting. Most of my effort is in signing out cases, with some fairly minor teaching responsibilities (couple hours a month) and some minor research stuff. Looking back at last year I signed out just over 5700 cases, including about 85 bone marrows (I also split reading the professional side of flow and hemeFISH with another hempath in our group). I have good communication skills (non-PC translation - I'm a white American male who gets along well with the surgeons, gastroenterologists, oncologists, etc). I've been asked to interview for a few other jobs since starting this one (I'm coming up on my 3rd year out of fellowship) but am overall pretty happy with my current job and my family likes where we live so I just haven't pursued other possibilities. Currently I make low 200's (with benefits, closer to mid 200's).
With all that in mind what are people's thoughts on this salary - should I just be happy with this level of pay or am I making way less than I should? I have no idea what my billing and collection numbers are (even though I have asked for this info on more than one occasion).
PS - if any of my colleagues are reading this and know its me writing it, I'm not planning on leaving...that is unless someone on here tells me I'm really getting screwed 🙂

 

[gbwillner]

I've been curious where my salary matches up with the national averages for a while (which is how I ended up on this thread; actually I joined SDN just so I could write this). After talking with friends in private practice these numbers actually seem to be about right for private practice pathology. I'm hemepath trained, working in a quasi-academic setting in the southeast. I'm employed by a fairly large academic medical center, but work in a community hospital based setting. Most of my effort is in signing out cases, with some fairly minor teaching responsibilities (couple hours a month) and some minor research stuff. Looking back at last year I signed out just over 5700 cases, including about 85 bone marrows (I also split reading the professional side of flow and hemeFISH with another hempath in our group). I have good communication skills (non-PC translation - I'm a white American male who gets along well with the surgeons, gastroenterologists, oncologists, etc). I've been asked to interview for a few other jobs since starting this one (I'm coming up on my 3rd year out of fellowship) but am overall pretty happy with my current job and my family likes where we live so I just haven't pursued other possibilities. Currently I make low 200's (with benefits, closer to mid 200's).
With all that in mind what are people's thoughts on this salary - should I just be happy with this level of pay or am I making way less than I should? I have no idea what my billing and collection numbers are (even though I have asked for this info on more than one occasion).
PS - if any of my colleagues are reading this and know its me writing it, I'm not planning on leaving...that is unless someone on here tells me I'm really getting screwed 🙂

I think this is pretty normal for a young employee in PP or academia in a non-super competitive institution in a "non-desirable" location. I think the most important thing you say is that you are happy. Of course you could make more money, but that may come with serious compromises elsewhere.

 

[pathslides]

Looking back at last year I signed out just over 5700 cases, including about 85 bone marrows (I also split reading the professional side of flow and hemeFISH with another hempath in our group). Currently I make low 200's (with benefits, closer to mid 200's).

Because it is an academic place paying you, your salary appears on par from my experience in interviews for jobs. If it was a community hospital without academic affiliation, with those workload numbers, I think your salary would seem to be a bit low for 3 yrs post training.

 

[coroner]

I signed out just over 5700 cases, including about 85 bone marrows...Currently I make low 200's (with benefits, closer to mid 200's).

As far as revenue, you are generating at least 450 - 500K depending on location, case & payor mix. If you were an equal partner in pp with your workload being the average, you'd be making upper 300's or more i.e. what your friends in pp said they're at.

Given that you are doing “some minor” teaching and research, I’m guessing your pay structure is pretty similar to the academic model despite being in a community hospital. You’re income level is about on par being < 3 yrs out. If you’re considering fair market value, the first question would be: What is the ceiling for potential income growth? Given your job setting, if you’re in a big city and/or desirable area, you’re doing ok if you reach 250+ (not 10 yrs later though) imo.

I have no idea what my billing and collection numbers are (even though I have asked for this info on more than one occasion).

The fact that you asked your billing info (depending on whom) after being there close to 3 yrs and haven't gotten feedback is a little uncouth to me. But it doesn't surprise me that academic or employed places would be tight-lipped about this. If you want to find out that info, you don't need to ask anyone in the first place. This can be easily figured out by looking at CMS reimbursements for your area and CPT codes for the cases you sign out, and if you really want to get to down to it, patients' insurance.

With all that in mind what are people's thoughts on this salary - should I just be happy with this level of pay...

I don't think anyone can say if you should be happy other than yourself. Others can only relate their level of satisfaction based on their own personal wants and needs including their family's as well as what their financial goals are. And, no one but yourself can tell you what you should feel your net worth is given the other advantages you spoke of being in your current job. You've already expressed you are happy with your current situation because you've passed on other interviews, haven't looked around for other jobs, and not planning on leaving. Sounds to me like you're mind is pretty much already made up. Having said that, if you're posting on here for the first time to inquire about this, I think it'd be worth testing the waters and at least having a conversation with some of the other places that wanted to interview you the next time it comes up and see what they're offering. You may end up being happier...

 

[Diana Prince]

I accepted a position in a rural hospital as a staff pathologist as my first job out of fellowship training. My starting salary was over $300K.
I currently work 50-60 hours per week and I sign-out approximately 4,000 surgical, cyto and hemepath cases per year.
I realized that I needed to move to a larger city where I would be surrounded by friends and family and therefore the amount of money that I make is not worth it.
I have had four jobs interviews with three offers with different regions of the U.S. in a private practice type setting. The starting salaries have ranged from $200K to $250K after one year of work experience and multiple board certifications.
I am willing to take the pay-cut so that I can be more supportive of my family and have a better quality of life outside of work.
Bottom line: Do not live just to work. Life is too short.

 

[coroner]

I have had four jobs interviews with three offers...The starting salaries have ranged from $200K to $250K...I am willing to take the pay-cut

If these new jobs offer partnership/income ceilings higher than where your rural job is at, you're only losing out for a couple of years and may even surpass you're total career earnings in the next 5-10 yrs. So, taking a 50-100K pay cut in the short run may not be as bad as it seems...

 

[SEpathguy]

As far as revenue, you are generating at least 450 - 500K depending on location, case & payor mix. If you were an equal partner in pp with your workload being the average, you'd be making upper 300's or more i.e. what your friends in pp said they're at.

Given that you are doing “some minor” teaching and research, I’m guessing your pay structure is pretty similar to the academic model despite being in a community hospital. You’re income level is about on par being < 3 yrs out. If you’re considering fair market value, the first question would be: What is the ceiling for potential income growth? Given your job setting, if you’re in a big city and/or desirable area, you’re doing ok if you reach 250+ (not 10 yrs later though) imo.


The fact that you asked your billing info (depending on whom) after being there close to 3 yrs and haven't gotten feedback is a little uncouth to me. But it doesn't surprise me that academic or employed places would be tight-lipped about this. If you want to find out that info, you don't need to ask anyone in the first place. This can be easily figured out by looking at CMS reimbursements for your area and CPT codes for the cases you sign out, and if you really want to get to down to it, patients' insurance.


I don't think anyone can say if you should be happy other than yourself. Others can only relate their level of satisfaction based on their own personal wants and needs including their family's as well as what their financial goals are. And, no one but yourself can tell you what you should feel your net worth is given the other advantages you spoke of being in your current job. You've already expressed you are happy with your current situation because you've passed on other interviews, haven't looked around for other jobs, and not planning on leaving. Sounds to me like you're mind is pretty much already made up. Having said that, if you're posting on here for the first time to inquire about this, I think it'd be worth testing the waters and at least having a conversation with some of the other places that wanted to interview you the next time it comes up and see what they're offering. You may end up being happier...

Thanks for your comments (and those from the others who have commented also). A few months ago I did try to figure out what I thought I'd probably be collecting per year and estimated around 400-500k. I thought maybe I'd overestimated though (couldn't imaging they'd be paying me half or potentially less than half of the amounts I collect). The position was supposed to be a "hybrid" between academics and private practice. From what I can tell it seems like the reimbursement is closer to the academic level than the private practice level. All that to say, 200k+ is still a good amount of money for any sane person, I just kind of hate the idea that half the money I collect is probably going into someone else's pocket.

 

[icpshootyz]

Thanks for your comments (and those from the others who have commented also). A few months ago I did try to figure out what I thought I'd probably be collecting per year and estimated around 400-500k. I thought maybe I'd overestimated though (couldn't imaging they'd be paying me half or potentially less than half of the amounts I collect). The position was supposed to be a "hybrid" between academics and private practice. From what I can tell it seems like the reimbursement is closer to the academic level than the private practice level. All that to say, 200k+ is still a good amount of money for any sane person, I just kind of hate the idea that half the money I collect is probably going into someone else's pocket.

Could be even less than half going to you if you did primarily in-office path work.

 

[jupiterianvibe]

Since I'm paid flat rate per day I limit my hours to eight per day. No more, no less.

 

[octopusprime]

... All that to say, 200k+ is still a good amount of money for any sane person, I just kind of hate the idea that half the money I collect is probably going into someone else's pocket.

Disagree entirely with the first part of that statement because it's entirely reliant on the second part: NO ONE making 200k in pathology, who is signing out an appropriate number of cases, is being appropriately compensated because all that money is being siphoned off to someone else. This is the inherent problem with our field--we've accepted the notion that such poor compensation is not only to be expected but appropriate.
Sure, 200k compared to your national median household income is great, but add on top $250k of med school debt (which is avg nowadays), the complete lack of any sort of loan repayment programs to otherwise offset that debt (the kind that is common for primary care gigs) and the undeniable fact that signing out 5000 cases / yr should guarantee you at a MINIMUM 300k, and 200k is insulting.

Hospitals, like academic institutions and nat'l lab outfits, redistribute the money you make to areas that are needed to either a.) bring in more business / grease the machine, or b.) bring in more business / grease the machine. Our field if plagued by meek, passive aggressive idiots without one iota of business sense, let alone self respect, who think 200k is acceptable.

 

[coroner]

But he is referring to standard of living, for which 200K puts someone in the top 3-5% household income in the US. And it is satisfactory to support one's family and retire comfortably. I don't think anyone he's saying his income is fair or appropriate for the amount of work he's doing. He's just saying he enjoys where he lives and his income is more than enough for his family's lifestyle and to live within their means.

Yes, making low 200's while generating 450-500K of revenue is highway robbery. But hello, welcome to corporate America. No successful business model thrives off narrowing the margin between labor costs and profits from productivity. It's the same concept as farmers hiring illegal immigrants to work for 1/3 of the costs as Americans would. As long as there's a steady supply of illegals to pick fruit for 12 hrs/day under the scorching sun, the farmers will keep using them. Just like a Quest or Ameripath is going to pay someone 200 vs 300 to push glass as long as there's someone willing to accept, which unfortunately due to the market, there's plenty who will...

 

[octopusprime]

But he is referring to standard of living, for which 200K puts someone in the top 3-5% household income in the US. And it is satisfactory to support one's family and retire comfortably. I don't think anyone he's saying his income is fair or appropriate for the amount of work he's doing. He's just saying he enjoys where he lives and his income is more than enough for his family's lifestyle and to live within their means.

Yes, making low 200's while generating 450-500K of revenue is highway robbery. But hello, welcome to corporate America. No successful business model thrives off narrowing the margin between labor costs and profits from productivity. It's the same concept as farmers hiring illegal immigrants to work for 1/3 of the costs as Americans would. As long as there's a steady supply of illegals to pick fruit for 12 hrs/day under the scorching sun, the farmers will keep using them. Just like a Quest or Ameripath is going to pay someone 200 vs 300 to push glass as long as there's someone willing to accept, which unfortunately due to the market, there's plenty who will...

LMAO. Again, the source of the problem...some pathologists function as the migrant labor force of medicine...and not because they have no other choice and their families are being ruined by drugs & crime, but because they CHOOSE to for convenience sake...while a whole separate population of equally trained persons has worked diligently to ensure scarcity of product, high demand and low trainee output.
There's a difference between surviving in corporate america and complacency allowing for such situations to exist in the first place.

And you can't look at 200k in the medical field compared to household income any more than you can look at US household income compared to world household income...apples to oranges. Sure as a general abstraction 200k is good. Just like living in the US, water and shelter are good.

 

[SEpathguy]

Disagree entirely with the first part of that statement because it's entirely reliant on the second part: NO ONE making 200k in pathology, who is signing out an appropriate number of cases, is being appropriately compensated because all that money is being siphoned off to someone else. This is the inherent problem with our field--we've accepted the notion that such poor compensation is not only to be expected but appropriate.
Sure, 200k compared to your national median household income is great, but add on top $250k of med school debt (which is avg nowadays), the complete lack of any sort of loan repayment programs to otherwise offset that debt (the kind that is common for primary care gigs) and the undeniable fact that signing out 5000 cases / yr should guarantee you at a MINIMUM 300k, and 200k is insulting.

Hospitals, like academic institutions and nat'l lab outfits, redistribute the money you make to areas that are needed to either a.) bring in more business / grease the machine, or b.) bring in more business / grease the machine. Our field if plagued by meek, passive aggressive idiots without one iota of business sense, let alone self respect, who think 200k is acceptable.

Haha! I need you to re-negotiate my contract. I just meant 200k+ is a lot of money when you consider people starving to death, working 3 jobs and can't pay bills, etc. "Woe is me, I only make $200k" Would I take more money if offered? Of course. Does the amount of money I make define my life? Thankfully - hell no 🙂

 

[SEpathguy]

Haha! I need you to re-negotiate my contract. I just meant 200k+ is a lot of money when you consider people starving to death, working 3 jobs and can't pay bills, etc. "Woe is me, I only make $200k" Would I take more money if offered? Of course. Does the amount of money I make define my life? Thankfully - hell no 🙂

On a side note while we're talking money. About how much do we get reimbursed for professional side of reading FISH (for example we review a ton of BCR/ABL FISH tests sent from the cancer center)? I know I could try look it up, but I have "not one iota of business sense" so would probably read it wrong 🙂

 

[coroner]

some pathologists function as the migrant labor force of medicine...and not because they have no other choice and their families are being ruined by drugs & crime, but because they CHOOSE to for convenience sake

Most illegals who come here to work on farms do so to send money back home, not to avoid drugs & crime. Because making $5/hr here is more than they'd make back home given their skills. If anything, pathologists have less of a choice because there's less of a demand for us than people willing to do manual/cheap labor. But whether it's illegal immigrants or pathologists, there's always a choice...

If the market is oversaturated with pathologists, don't blame them for "settling" for lower wages than they are worth out of convenience sake. They are merely adapting to market forces out of their control. Refusing to not accept anything less than 2/3 income of the revenue you're generating just means next man up...

And you can't look at 200k in the medical field compared to household income any more than you can look at US household income compared to world household income...apples to oranges.

Partially correct because the opportunity cost to reach 200K for a physician in the US is greater than someone in investment banking who reached that same income level in their late 20's with only a four year degree. But a dollar earned by someone making 200K in investment banking or any other field has the same purchasing power as a dollar earned by a physician making that same amount. i.e. a single earner making 200K in the medical field vs a family with a household income of 200K still has to pay the same amount for a 2,000 sq. ft house and a Prius in San Bernadino, CA or whatever city in America they're living in.

Sure as a general abstraction 200k is good

That's what he meant

I just meant 200k+ is a lot of money when you consider people starving to death, working 3 jobs and can't pay bills, etc.

 

[octopusprime]

Haha! I need you to re-negotiate my contract. I just meant 200k+ is a lot of money when you consider people starving to death, working 3 jobs and can't pay bills, etc. "Woe is me, I only make $200k" Would I take more money if offered? Of course. Does the amount of money I make define my life? Thankfully - hell no 🙂

Again, I'm not minimizing the fact that 200k in the grand scheme of life is "good", I'm just saying if you take some utilitarian generic view of your career as a comparison to starving people in Africa, why don't we work for even less --say $100k? $100k is still better off than most. Why not $85k?
Because the paltry ~$200k you're making is what the powers-that-be deem is a level that will still garner willing applicants...it's a threshold that we keep lowering and lowering every year. The damn point is that WE have taken negotiation off the table because we've relinquished the ability to control our own profession.

 

[octopusprime]

That's what he meant

He came on to see where his "...salary matches up with the national averages ... (which is how I ended up on this thread; actually I joined SDN just so I could write this)"...not to compare his salary to the median household income.

 

[jupiterianvibe]

Untruths from the CAP:

There is a shortage.
There will be a shortage.
Pathologists are groovy.

 

[octopusprime]

FWIW I couldn't live on 200k...maybe in 10 years, but not now...not when i'm paying $3k/mos to pay off med school loans (which, I'll add, are at 3.5% only after refinancing down from most being 5.5% and 6.8%...which accrued interest all through residency, whereas those that graduated 5 or 6 yrs ahead of me had interest rates of 1-2% and deferred all loans through training, no interest accrued) and $3k/mos for home loans. Sure, I could stretch that repayment plan out over 30 yrs, and my home loan out over 30 years, and drive a dodge stratus, and never go on a vacation, and not max my retirement every year. But I'm not going to be a martyr for medicine, and I'm sorry, if implicit to entering medical school was the understanding that amassing a quarter mil of debt and spending 10 yrs of training would NOT push me well above the median household income, I sure as hell wouldn't have done it. Neither would most.

 

[SEpathguy]

Again, I'm not minimizing the fact that 200k in the grand scheme of life is "good", I'm just saying if you take some utilitarian generic view of your career as a comparison to starving people in Africa, why don't we work for even less --say $100k? $100k is still better off than most. Why not $85k?
Because the paltry ~$200k you're making is what the powers-that-be deem is a level that will still garner willing applicants...it's a threshold that we keep lowering and lowering every year. The damn point is that WE have taken negotiation off the table because we've relinquished the ability to control our own profession.

All good points. The simple (and sad) answer is just that we train too many pathologists (as I think has been said on this site many, many times). I'm AOA, was near the top of my class in medical school, normal, and fairly nice (I like to think). I believe I could have probably gotten into pretty much any residency I wanted (aside from maybe derm or rad onc). I picked pathology because I liked it. I still like it but I agree it is unfortunate that we've saturated the field with so many coming out of residency that we have such a small amount of room to negotiate.

 

[SEpathguy]

FWIW I couldn't live on 200k...maybe in 10 years, but not now...not when i'm paying $3k/mos to pay off med school loans (which, I'll add, are at 3.5% only after refinancing down from most being 5.5% and 6.8%...which accrued interest all through residency, whereas those that graduated 5 or 6 yrs ahead of me had interest rates of 1-2% and deferred all loans through training, no interest accrued) and $3k/mos for home loans. Sure, I could stretch that repayment plan out over 30 yrs, and my home loan out over 30 years, and drive a dodge stratus, and never go on a vacation, and not max my retirement every year. But I'm not going to be a martyr for medicine, and I'm sorry, if implicit to entering medical school was the understanding that amassing a quarter mil of debt and spending 10 yrs of training would NOT push me well above the median household income, I sure as hell wouldn't have done it. Neither would most.

 

[octopusprime]

exactly.

 

[SEpathguy]

exactly.

Just to be clear - I don't actually drive a dodge stratus.
Sorry to whoever started this thread - seems to have been totally hijacked from its initial intent.

 

[octopusprime]

ditto

 

[Diana Prince]

I think a critical point that was made before is that new hires need to look at their long term compensation potential with the group.
Do you see yourself being a partner in the next 2-3 years? How do you make yourself a valuable commodity to the group?
I think that finding a place with a low cost of living really helps when paying off your loans. But, I learned that having a work-life balance is critical.
I am single and therefore I cannot speak for those who need to support a family.
I found it helpful to see how other people in the world have managed to live on a low salary and I learned how to budget from that.
I managed to pay off $100K from my loans and give money to my aging parents in my first year out of training. If you need help learning how to budget, shoot me a message.

 

[Unsatisfactory]

I'm here 40 hours a week but probably only working 20.

 

[LADoc00]

There is no connection between hours and pay in Medicine. That is pure mythology. I work less than I have ever worked in my life, probably 20 hours or less and make far more than the supposed 90th percentile in that data set quoted above...

 

[gbwillner]

There is no connection between hours and pay in Medicine. That is pure mythology. I work less than I have ever worked in my life, probably 20 hours or less and make far more than the supposed 90th percentile in that data set quoted above...

BUT, LA, it is clear you are not making that money from practicing medicine. You are making it from running a business that includes medical work. It is a different beast, and few are in your position to be able to build and manage such a business. That being said, I totally agree that the correlation between hours and compensation is weak at best. Our industry is built along the inequality of a coding system, not how hard you work. Those that can better manipulate the coding system to their advantage will be better compensated. It is why radiation oncologists always make more money per unit of work. It is why dermatologists always make more money. It is why pediatricians always make the least money. It it built into the system that your time is the least valuable commodity in the business.