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[deleted973577]

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[M&L]

oh thats a great question... I want to know too. For example, i want to be a pathologist, i am assuming i will have better career opportunities if i do residency in Hopkins or Harvard, for example, vs a community hospital in midwest... Just because there is more money invested in those places, more high-tech stuff, more research. And in pathology residency that translates into more in-depth training, - for example, how could you consider molecular pathology as a specialty if your residency is not even equipped for it, you know? Plus connections, etc.
That being said, i wonder if that would translate in a higher pay.... GREAT question

 

[Beans203]

I feel like the only context in which I've heard about varying salaries for doctors in the same specialty is by type of practice (academic or private) or regional, with NE usually being the lowest. Both of these would seem to stack the cards against doctors who trained in top programs, who are more likely to get academic positions and who are more likely to practice in large cities (where top teaching hospitals are disproportionately located) where the salary is lower.

But to be honest, I know very little about how salaries are determined for doctors in private practice since there are several different models of reimbursement, so I'm not qualified to say whether, for example, a practice looking to recruit a Harvard-trained doc will offer them a larger base salary.

 

[M&L]

I feel like the only context in which I've heard about varying salaries for doctors in the same specialty is by type of practice (academic or private) or regional, with NE usually being the lowest. Both of these would seem to stack the cards against doctors who trained in top programs, who are more likely to get academic positions and who are more likely to practice in large cities (where top teaching hospitals are disproportionately located) where the salary is lower.

But to be honest, I know very little about how salaries are determined for doctors in private practice since there are several different models of reimbursement, so I'm not qualified to say whether, for example, a practice looking to recruit a Harvard-trained doc will offer them a larger base salary.

YOu are my new favorite person, - i love that you honestly said that you are not qualified to answer the question. I love it so much. This forum is sometimes full of ppl who will BS their way through life to avoid admitting they are not perfect in everything.

For some reason i am getting an impression that getting to the best residencies translates more into more opportunities, vs higher salaries, you know what i mean? maybe i am wrong.

 

[SunBakedTrash]

Pathologist here. A well-known and prestigious residency is helpful in the job hunt, no doubt. This is especially true for a first job but over time as experience is gained, it begins to matter less and less where you trained since you have proven yourself competent to practice. A caveat is that the fancy places don't necessarily have the best training or teachers. Grossing 500 Whipples or looking at nothing but transplant biopsies doesn't prepare you for the real world, unless you plan on staying at that academic place. As a matter of fact, some of the hyperacademic places are known for putting out subpar diagnosticians. Hard to learn pathology when you spent your residency being a research monkey. My advice, go to a location that makes you happy with people you feel comfortable working with. Obviously it should be a place people have heard of, but your life will not be over if you go to UCSD for residency instead of Hopkins.

 

[M&L]

Pathologist here. A well-known and prestigious residency is helpful in the job hunt, no doubt. This is especially true for a first job but over time as experience is gained, it begins to matter less and less where you trained since you have proven yourself competent to practice. A caveat is that the fancy places don't necessarily have the best training or teachers. Grossing 500 Whipples or looking at nothing but transplant biopsies doesn't prepare you for the real world, unless you plan on staying at that academic place. As a matter of fact, some of the hyperacademic places are known for putting out subpar diagnosticians. Hard to learn pathology when you spent your residency being a research monkey. My advice, go to a location that makes you happy with people you feel comfortable working with. Obviously it should be a place people have heard of, but your life will not be over if you go to UCSD for residency instead of Hopkins.

Do you mind if i PM you? i could use insight in the matter.

 

[Angus Avagadro]

I think your specialty and region of practice, and clinical setting, i.e., community vs urban vs academics vs private practice vs employed vs salaried play the greatest factor in determining W2 income. An established rural FM doc in the midwest may make more than an urban salaried gen surgeon starting out in the Northeast.

 

[M&L]

Pathologist here. A well-known and prestigious residency is helpful in the job hunt, no doubt. This is especially true for a first job but over time as experience is gained, it begins to matter less and less where you trained since you have proven yourself competent to practice. A caveat is that the fancy places don't necessarily have the best training or teachers. Grossing 500 Whipples or looking at nothing but transplant biopsies doesn't prepare you for the real world, unless you plan on staying at that academic place. As a matter of fact, some of the hyperacademic places are known for putting out subpar diagnosticians. Hard to learn pathology when you spent your residency being a research monkey. My advice, go to a location that makes you happy with people you feel comfortable working with. Obviously it should be a place people have heard of, but your life will not be over if you go to UCSD for residency instead of Hopkins.

it doesnt let me PM you. would you mind messaging me please?

 

[Faha]

The answer is no. When a specialist (or any primary care) submits a claim to Medicare, Medicaid or any private insurance they all receive the same reimbursement. The insurance companies do not pay you extra if you went to a top 10 school or residency. In my area the most popular primary care physician went to a DO school and has a 1 year wait for patients to get into his practice. The specialists who went to Harvard, Hopkins, Stanford, etc. need to be on good terms with him in order to receive referrals from his practice.

 

[Tenk]

If anything people from ultra prestigious residencies probably make less money because more of them go into academics where the pay is doodoo.

 

[jhmmd]

As a clarification, I’m not talking about different specialties, but rather, residencies within the same specialty. The common sentiment ive seen on SDN is that it’s worth it pay more for a school if it offers a substantial prestige difference (T10 vs state school for example). Many people comment saying “the T10 will allow you to pay it off anyway” and I’ve even seen one physician poster saying that you can command a greater salary coming from a stronger residency program. Is this true? Can someone doing an emergency medicine residency at Mass General get a higher starting salary than someone doing an emergency medicine residency at UMass?

I understand that a top school can make a difference in what specialty you can go into, and in that sense it can surely make a difference in income, but this is geared towards the “quality” of residency within one specialty. Match lists suggest that a top school will help get you into a top residency program within any given specialty, and I’m wondering if this actually correlates to higher pay. If it doesn’t, why pay extraordinary amounts for a top program? People don’t consider that you not only have to account for the raw amount of loans (and interest), but also that you could have been investing an amount equal to your loan repayments, which would likely lead to hundreds of thousands in gain years down the line.

Just to clarify a few points:
1. Residency programs pay YOU a salary; you don't have to pay them anything. This money comes from federal funding for Medicaid, which controls residency slots.
2. Residency program prestige doesn't really matter in the long run. There are malignant residences and good residencies. It's more important to fly under the radar and succeed at any residency than it is to go to a "T20" residency.
3. Residency progarms aren't ranked (except maybe on Scutwork, which is a very helpful website for med students applying on FREIDA); therefore you're better off going to a program that fits you best.

 

[KnightDoc]

The answer is no. When a specialist (or any primary care) submits a claim to Medicare, Medicaid or any private insurance they all receive the same reimbursement. The insurance companies do not pay you extra if you went to a top 10 school or residency. In my area the most popular primary care physician went to a DO school and has a 1 year wait for patients to get into his practice. The specialists who went to Harvard, Hopkins, Stanford, etc. need to be on good terms with him in order to receive referrals from his practice.

How does this work when the practice chooses not to be in-network, and does not accept insurance reimbursements as payment in full? Or does not accept Medicare or Medicaid at all?

Is this still a thing, and if so, does prestige of medical school or residency play a role in whether practice groups are able to do it? Do patients actually do any research before choosing a doctor, and does where the diploma comes from matter, or is everything nowadays referrals and who is or is not in-network?

My understanding is that insurance companies do indeed pay extra, depending on a practice's skill in negotiating reimbursements, competition in the area, etc. If insurance companies present take it or leave it reimbursement rates to doctors from prestigious schools with thriving practices, and there isn't a lot of competition in the area, and the doctors leave it, how do the insurance companies offer coverage to their subscribers?

Tl; dr -- is everything today really one size fits all, and, if you are not going into academic medicine, does nothing matter other than getting a residency, anywhere, in your desired specialty and not screwing up???

 

[Faha]

It would be very unusual to find a practice in adult medicine that does not accept Medicare. If an ophthalmologist did not participate in Medicare they would have a very limited practice. Very few cataract surgeries since that is the age group that needs them. OB-GYN that does not accept Medicaid ? They would lose half their patients. For practitioners,it is often take or leave it from the insurance companies and for Medicare and Medicaid their leverage is almost zero.
Patients choose their physicians based on many factors but where one attended medical school or residency is rarely one of them. If the DO who went to a low tier DO school negotiates a better deal with a private insurance company than the MD who went to a top 10 school then the DO is included in their network.

 

[Beans203]

YOu are my new favorite person, - i love that you honestly said that you are not qualified to answer the question. I love it so much. This forum is sometimes full of ppl who will BS their way through life to avoid admitting they are not perfect in everything.

For some reason i am getting an impression that getting to the best residencies translates more into more opportunities, vs higher salaries, you know what i mean? maybe i am wrong.

Haha no problem, as an M1 I have no idea what the process of accepting job offers after residency looks like! It’s just that the discussions I’ve seen around doctor salaries, even on med school forums/subreddits which would probably be open about this, have never included caveats that offers vary based on prestige of your training program.

 

[Yankees27]

The answer is no. When a specialist (or any primary care) submits a claim to Medicare, Medicaid or any private insurance they all receive the same reimbursement. The insurance companies do not pay you extra if you went to a top 10 school or residency. In my area the most popular primary care physician went to a DO school and has a 1 year wait for patients to get into his practice. The specialists who went to Harvard, Hopkins, Stanford, etc. need to be on good terms with him in order to receive referrals from his practice.

One year wait for a PCP, seems like an exaggeration to be honest, since any issue would need to be resolved well before one year.

 

[Faha]

One year wait for a PCP, seems like an exaggeration to be honest, since any issue would need to be resolved well before one year.

No, the practice is full and the DO PCP would be overwhelmed with too many patients. Patients leave the practice at a very slow rate, either by moving from the region or death.

 

[Yankees27]

Just to clarify a few points:
1. Residency programs pay YOU a salary; you don't have to pay them anything. This money comes from federal funding for Medicaid, which controls residency slots.
2. Residency program prestige doesn't really matter in the long run. There are malignant residences and good residencies. It's more important to fly under the radar and succeed at any residency than it is to go to a "T20" residency.
3. Residency progarms aren't ranked (except maybe on Scutwork, which is a very helpful website for med students applying on FREIDA); therefore you're better off going to a program that fits you best.

"Residency program prestige doesn't matter in the long run", I would disagree, since a top residency program will open your job prospects more than say, a less-known one will, fact!
Residency programs are certainly ranked, whether by reputation, quality of faculty, etc.

 

[Yankees27]

No, the practice is full and the DO PCP would be overwhelmed with too many patients. Patients leave the practice at a very slow rate, either by moving from the region or death.

No, the practice is full and the DO PCP would be overwhelmed with too many patients. Patients leave the practice at a very slow rate, either by moving from the region or death.

Got it, thanks.

 

[Med Ed]

As a clarification, I’m not talking about different specialties, but rather, residencies within the same specialty. The common sentiment ive seen on SDN is that it’s worth it pay more for a school if it offers a substantial prestige difference (T10 vs state school for example). Many people comment saying “the T10 will allow you to pay it off anyway” and I’ve even seen one physician poster saying that you can command a greater salary coming from a stronger residency program. Is this true? Can someone doing an emergency medicine residency at Mass General get a higher starting salary than someone doing an emergency medicine residency at UMass?

I understand that a top school can make a difference in what specialty you can go into, and in that sense it can surely make a difference in income, but this is geared towards the “quality” of residency within one specialty. Match lists suggest that a top school will help get you into a top residency program within any given specialty, and I’m wondering if this actually correlates to higher pay. If it doesn’t, why pay extraordinary amounts for a top program? People don’t consider that you not only have to account for the raw amount of loans (and interest), but also that you could have been investing an amount equal to your loan repayments, which would likely lead to hundreds of thousands in gain years down the line.

You have to be careful in defining what makes a "top" residency, because it's not name recognition. The biggest factors that will determine one's readiness for independent practice are (1) case volume, (2) the degree to which autonomy is granted, and (3) the willingness of faculty to teach and give useful feedback. It may seem counterintuitive at first glance, but the person who trains at a mid-range university program in the midwest may see more, do more, and get taught more than someone who spends half their fellowship essentially shadowing at some world famous institution.

 

[ndafife]

You want to be the highest paid anything go to rural North Dakota after residency. Doesn't take anything prestigious to get there.

Depending on the specialty, if you want to do a fellowship or sub-specialize you need to be at a high-ranked place. If your dream is pediatric surgery, it's going to be pretty close to impossible from a community program. You need to be at an academic center, ideally one with the specific fellowship in question. REI/GYN Onc in OBGYN are next to impossible from a community program, and it's much much much easier to get urogyn/mfm from an academic/high ranked program.

Really for any competitive fellowship in any field, it's going to be a lot easier to match that fellowship if you're coming from a location that has a fellowship in that field.

 

[Chelseadagger]

The answer is no. When a specialist (or any primary care) submits a claim to Medicare, Medicaid or any private insurance they all receive the same reimbursement. The insurance companies do not pay you extra if you went to a top 10 school or residency. In my area the most popular primary care physician went to a DO school and has a 1 year wait for patients to get into his practice. The specialists who went to Harvard, Hopkins, Stanford, etc. need to be on good terms with him in order to receive referrals from his practice.

If everyone receives the same reimbursement from insurance companies, then how do regional differences in physician earnings arise? I'm only just entering medical school so I'm not very well versed in how physicians get paid. I hope that schools do a bit of education on how this all works. Sometimes it seems like it's purposefully constructed to confuse physicians and pay them less than they are worth.

 

[jhmmd]

If everyone receives the same reimbursement from insurance companies, then how do regional differences in physician earnings arise? I'm only just entering medical school so I'm not very well versed in how physicians get paid. I hope that schools do a bit of education on how this all works. Sometimes it seems like it's purposefully constructed to confuse physicians and pay them less than they are worth.

Medical billing has to do w/billing codes; this is covered briefly in medical school. A lot of places count RVUs, or relative value units, and convert them to currency; other practices are set up differently. You have to decide if you are going to accept insurance or be cash-only, and if you going to accept insurance, whether or not you want to see Medicaid/Medicare pts. Medicaid decides how much each individual code is worth, and a lot of that is based on the time spent on each patient. Procedures also generate more money than other codes, pretty much straight across the board.

 

[KnightDoc]

If everyone receives the same reimbursement from insurance companies, then how do regional differences in physician earnings arise? I'm only just entering medical school so I'm not very well versed in how physicians get paid. I hope that schools do a bit of education on how this all works. Sometimes it seems like it's purposefully constructed to confuse physicians and pay them less than they are worth.

Insurance companies definitely structure reimbursement rates based on average costs within a given region, and these definitely vary widely. I think even more important, however, is that many doctors today are paid by salary (and bonus), and this is determined by supply and demand within a given region, only loosely tied to those reimbursement rates, since they too are loosely tied to supply and demand for services in an area.

E.g., it's tough to get people to go to rural ND, using @ndafife's example, so salaries rise to attract people, and then insurance reimbursement rates rise to reflect the fact that medical care costs more there. On the other hand, lots of people in low SES inner city areas cannot afford to pay for care, and are on government programs with relatively low reimbursement rates, so it is difficult for practices to offer monetary premiums to attract talent, and that results in persistent doctor shortages (notwithstanding everyone's altruism as demonstrated by all of the volunteer hours prior to applying to med school 🙂) and relative salaries suck, especially when compared to the cost of living in the nicer parts of those metropolitan areas.

 

[EdgeTrimmer]

definitely not better pay as others said but may help getting first job since there will be fewer private groups in big and mid size cities going forward and brand name will get you the interviews like other fields.

 

[Flodaddy]

A Hopkins grad bills as much as a state school grad. No need to pay someone more. Top academic program don't always offer the best training. Top places sometimes do a lot of testing/imaging/use technology that's not realistic to use outside of academics. You may need to relearn some things when you lose those resources. You have to judge all programs on a case by case basis.

Like @ndafife said, for some fellowships in some specialties you are better off going to top programs. But it depends on the field. You can do a lot of the subspecialty surgeries in uro w/o a fellowship as long as you have the hands on exposure. If you go to a place with poor autonomy/fellows who don't share, you won't get the experience needed to do those cases w/o a fellowship. A fellowship is for those who want to do academics, get experience w/ things they didn't do in residency, or for peds.

Top places may help for PP jobs outside your region. Practices will know the quality of grads in their region and having an attending the practice personally knows vouching for you is worth much more than residency program name.