Medscape Comp Report 2018

[Mt Kilimanjaro]

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Anyone have good sources on the gender pay gap? That’s always discussed on these surveys, but I’ve yet to see one that clearly accounts for the fact that a portion of female physicians just work less total hours than their male counterparts.

 

[Rekt]

Doesn't EM actually make more than Gas since EM works so few hours in comparison?

You must not have seen anasthesia "work". Most of them have easy cush hours.

 

[mymembernames]

You must not have seen anasthesia "work". Most of them have easy cush hours.

I understand, but in terms of time per hour I believe they would makes less?

 

[zero0]

Because they don’t.

These surveys are BS. Most of the ones that participate are academicians/salaried/underpaid. PP physicians don’t like to report their true income (for obvious reasons).

244k for neurology. That makes me laugh. I have worked with neurologists long enough to know that this can’t be further from the truth. Same goes for GS.

I gotta agree on both counts, neuro and GS.

Who are these general surgeons anyway? Last time I checked like 70% did some kind of fellowship. So are they just lumping in transplant and trauma in with general surgery? Cuz I'll tell you right now no trauma or transplant surgeon anywhere makes less than 400k.

Medscape data tends to lowball and flat out misclassify data. MGMA is more realisitic in my exp.

 

[CliveStaples]

MGMA or bust.

I'll say this; nobody on either side of the employment game uses Medscape data in price negotiations.

 

[DexterMorganSK]

MGMA data that is used by organizations for salary estimates indicates that Anasthesia does make 30k+ more than gen surg and that 240 is within 30K of the neurologist average. this data i have is older, but follows the same trends.

Are you referring to the 2015 MGMA data drive?

 

[neurotransmitter]

I am a med student, but I have a close relative who is an anesthesiologist. From what I have seen and know, I would not necessarily say anesthesia is cush.

• It is dealing with keeping people alive during surgery. That is the basic nature of the job. A lot of people can't handle this even though they think they can, so they either choose to leave residency or are asked to leave residency when it becomes obvious they don't deal well with acute and stressful situations like anesthesia has to be able to handle. You have to know what you can and cannot handle. You can work "only" 40-50 hours per week in a mommy track job (and I have seen a lot of mommy track jobs that do not pay $300K, but more like $250-$275K, I am on the West coast however, Midwest probably does pay about $300K for mommy track jobs), but if you are not able to handle the basic nature of the job, then it will not seem "cush" to you no matter how few hours you work.
• It is sometimes working with difficult surgeons. Good anesthesiologists truly have to have no ego.
• It is often on the surgeon's schedule. That could mean staying late due to earlier cases running late, add-ons, or other issues. It could mean working weekends if that's best for the surgeons at the hospitals your group deals with.
• It is (for over half the jobs) managing and directing CRNAs who are sometimes either arrogant or ignorant. They sometimes either think they know better than you or they don't know what they don't know so they are dangerous to patients and possibly to your career if they get into trouble but don't know when to call for help or call for help too late. The majority of jobs in private practice are supervising CRNAs today and this is only going to grow in the future. You sometimes are running from room to room "putting out fires" as anesthesiologists say. You have to be okay with all this.
• It is probably taking call for most of your career if you want to make over $300K. Maybe q6-7 in private practice seems to be common from what I have seen. You can be coming into the hospital in the middle of the night in your 50s and you need to live near enough a hospital. You can take in-house call where you sleep overnight in the hospital away from your family. Taking call once per week is easy when we are young, but I have seen this take a toll on older anesthesiologists with families.
• It is a hospital-based specialty so you have to be willing to deal with hospital politics and how hospital politics can affect your job.
• But when you are done, you are done. You do not need to take work home like in other specialties. (This is also true for emergency medicine, critical care, pathology, radiology, hospitalist, and others that are more "shift-work" based.)

Some people don't mind these, but other people think these are big deals. It depends what your idea of cush is.

My idea of a cush specialty is one that fits as many of these criteria as possible: You are the boss. You control your own schedule and can work as little or as much as you like. You can have mostly regular hours (e.g. 8-6pm). You do not have to work a lot of nights or weekends unless you want to. You are not on call much, or if you are on call, you do not have to go into the hospital, but you can take call from home. You do not have a high chance for "emergencies" to suddenly occur, but can see patients the following day. You bring business to hospitals rather than hospitals seeing you as a necessary expense or cost to doing business. You have lower medico-legal risks.

 

[Atom612]

Because they don’t.

These surveys are BS. Most of the ones that participate are academicians/salaried/underpaid. PP physicians don’t like to report their true income (for obvious reasons).

244k for neurology. That makes me laugh. I have worked with neurologists long enough to know that this can’t be further from the truth. Same goes for GS.

Is that neurology figure too high, in your experience?

 

[Man o War]

Interesting that Gas makes more on average than Optho, Urology and ENT?? Guessing the ceiling is much higher in those 3 specialties compared to gas

I see a lot of people on this forum saying the gas job market is bad....I’m not sure why, it’s not at all. I write a lot of letters for graduating fellows and residents, and they’re all getting great jobs without much issue. Now, if one insists on being in NYC or Denver for example salaries are doing to be lower, but that’s true for almost all specialties.
You have to remember also that fellowships after anesthesia offer pretty high comp, cardiac and pain mostly. Those are pretty competitive to obtain though.

 

[Chibucks15]

Just wondering...the AAMC has the "Careers in Medicine" thing that gives some data on specialties and gives average salaries on some. It has neuro at 305 for example and IM at 215 medians for 1-2 years in specialty. Is that closer?

EDIT: Just saw they get than data from the latest MGMA data so I'm inclined to believe it more than medscape

 

[Man o War]

I am a med student, but I have a close relative who is an anesthesiologist. From what I have seen and know, I would not necessarily say anesthesia is cush.

• It is dealing with keeping people alive during surgery. That is the basic nature of the job. A lot of people can't handle this even though they think they can, so they either choose to leave residency or are asked to leave residency when it becomes obvious they don't deal well with acute and stressful situations like anesthesia has to be able to handle. You have to know what you can and cannot handle. You can work "only" 40-50 hours per week in a mommy track job (and I have seen a lot of mommy track jobs that do not pay $300K, but more like $250-$275K, I am on the West coast however, Midwest probably does pay about $300K for mommy track jobs), but if you are not able to handle the basic nature of the job, then it will not seem "cush" to you no matter how few hours you work.
• It is sometimes working with difficult surgeons. Good anesthesiologists truly have to have no ego.
• It is often on the surgeon's schedule. That could mean staying late due to earlier cases running late, add-ons, or other issues. It could mean working weekends if that's best for the surgeons at the hospitals your group deals with.
• It is (for over half the jobs) managing and directing CRNAs who are sometimes either arrogant or ignorant. They sometimes either think they know better than you or they don't know what they don't know so they are dangerous to patients and possibly to your career if they get into trouble but don't know when to call for help or call for help too late. The majority of jobs in private practice are supervising CRNAs today and this is only going to grow in the future. You sometimes are running from room to room "putting out fires" as anesthesiologists say. You have to be okay with all this.
• It is probably taking call for most of your career if you want to make over $300K. Maybe q6-7 in private practice seems to be common from what I have seen. You can be coming into the hospital in the middle of the night in your 50s and you need to live near enough a hospital. You can take in-house call where you sleep overnight in the hospital away from your family. Taking call once per week is easy when we are young, but I have seen this take a toll on older anesthesiologists with families.
• It is a hospital-based specialty so you have to be willing to deal with hospital politics and how hospital politics can affect your job.
• But when you are done, you are done. You do not need to take work home like in other specialties. (This is also true for emergency medicine, critical care, pathology, radiology, hospitalist, and others that are more "shift-work" based.)

Some people don't mind these, but other people think these are big deals. It depends what your idea of cush is.

My idea of a cush specialty is one that fits as many of these criteria as possible: You are the boss. You control your own schedule and can work as little or as much as you like. You can have mostly regular hours (e.g. 8-6pm). You do not have to work a lot of nights or weekends unless you want to. You are not on call much, or if you are on call, you do not have to go into the hospital, but you can take call from home. You do not have a high chance for "emergencies" to suddenly occur, but can see patients the following day. You bring business to hospitals rather than hospitals seeing you as a necessary expense or cost to doing business. You have lower medico-legal risks.

This is a good post.

 

[Dr. Bruce Banner]

wonder why pm&r physicians don't feel fairly compensated... any ideas?

 

[Postictal Raiden]

Is that neurology figure too high, in your experience?

Much lower.

 

[DubbiDoctor]

wonder why pm&r physicians don't feel fairly compensated... any ideas?

Read on reddit that they're lumping in pain management specialists, who deal with very difficult patients and have had their reimbursement slashed.

 

[House D.O.]

Much lower.

Can we get an anectodal salary range for neurology? Im trying to see how the salary compares to the numerous articles saying neurology will work your ass off.

 

[Winged Scapula]

Like most surveys, without knowing how the datapoints were calculated, its relatively meaningless.

I suspect that one reason GS is lower is the significant decrease in the number in PP; newer grads are favoring employed positions which historically pay less. Also these surveys only include salary, not benefits, not money for call, ASC ownership, etc. so don't represent total income.

 

[Postictal Raiden]

Can we get an anectodal salary range for neurology? Im trying to see how the salary compares to the numerous articles saying neurology will work your ass off.

Neurology compensation

 

[spacegun]

Can we get an anectodal salary range for neurology? Im trying to see how the salary compares to the numerous articles saying neurology will work your ass off.

Not salaries exactly but this is relevant:

Life as a Neurologist: Notes from the Field

 

[libertyyne]

Neurology compensation

What is really funny is that you ignored this thread that doesn't correspond with the ranges you claiming
Starting Salary

 

[Postictal Raiden]

What is really funny is that you ignored this thread that doesn't correspond with the ranges you claiming
Starting Salary

What's funnier is that you didn't bother to read the thread you're referencing.

Let me summarize it for you:
1. 150-400k.
2. A job in metro area is paying 500K+.
3. 150-200k
4. 250k
5. 230-375k in CA.
6. 300-350k

All of the above posters were referring to starting salary. Couple of them mentioned the potential to make much more eventually.

Collectively, it seems to me that the starting salary for neurology is in the mid-high 200's, with a very realistic potential to make 350k+ down the road. But hey, all this is anecdotal and meaningless when compared to your indisputable Medscape data.

 

[DrfluffyMD]

What's funnier is that you didn't bother to read the thread you're referencing.

Let me summarize it for you:
1. 150-400k.
2. A job in metro area is paying 500K+.
3. 150-200k
4. 250k
5. 230-375k in CA.
6. 300-350k

All of the above posters were referring to starting salary. Couple of them mentioned the potential to make much more eventually.

Collectively, it seems to me that the starting salary for neurology is in the mid-high 200's, with a very realistic potential to make 350k+ down the road. But hey, all this is anecdotal and meaningless when compared to your indisputable Medscape data.

What does MGMA say?

 

[Postictal Raiden]

What does MGMA say?

The report from 2016 shows 285k.

 

[ButterButter]

I am a med student, but I have a close relative who is an anesthesiologist. From what I have seen and know, I would not necessarily say anesthesia is cush.

• It is dealing with keeping people alive during surgery. That is the basic nature of the job. A lot of people can't handle this even though they think they can, so they either choose to leave residency or are asked to leave residency when it becomes obvious they don't deal well with acute and stressful situations like anesthesia has to be able to handle. You have to know what you can and cannot handle. You can work "only" 40-50 hours per week in a mommy track job (and I have seen a lot of mommy track jobs that do not pay $300K, but more like $250-$275K, I am on the West coast however, Midwest probably does pay about $300K for mommy track jobs), but if you are not able to handle the basic nature of the job, then it will not seem "cush" to you no matter how few hours you work.
• It is sometimes working with difficult surgeons. Good anesthesiologists truly have to have no ego.
• It is often on the surgeon's schedule. That could mean staying late due to earlier cases running late, add-ons, or other issues. It could mean working weekends if that's best for the surgeons at the hospitals your group deals with.

A few comments: where are you "seeing" all these jobs that list compensation so low? If we're talking gaswork, then that's not at all indicative of true market value for anesthesiologists. Also, there's no equivalency between a mommy track job, a non-partner track position and a partner-track position (much less an actual partner). That being said, anyone who's taking $250-275k as an anesthesiologist is a sucker (unless they are, in fact, working part time or fresh out).

The idea that "good anesthesiologists truly have to have no ego" is false and for some reason, gets propagated on these forums quite often. Try posting that one in the anesthesia forum and see how that goes over. The job of the anesthesiologist is to keep the patient alive and to optimize surgical conditions for the surgeon. Sure, working well with surgeons and being pragmatic is extremely important, but to say that anesthesiologists are gas-wielding buddhas behind the curtain is false. I've been in a few instances where an anesthesiologist standing up to a surgeon kept a patient alive.

 

[libertyyne]

What's funnier is that you didn't bother to read the thread you're referencing.

Let me summarize it for you:
1. 150-400k.
2. A job in metro area is paying 500K+.
3. 150-200k
4. 250k
5. 230-375k in CA.
6. 300-350k

All of the above posters were referring to starting salary. Couple of them mentioned the potential to make much more eventually.

Collectively, it seems to me that the starting salary for neurology is in the mid-high 200's, with a very realistic potential to make 350k+ down the road. But hey, all this is anecdotal and meaningless when compared to your indisputable Medscape data.

A job that is paying 500 that no one else wants to take.

Mid 200s is what medscape says and what mgma says. But hey more power to you if you want to live in an rural area to get 50k more .
If you are gonna work twice the hours of an average job you are going to make close to twice the money. But the point is you are not average at that point. If hospitalists worked everyday of the year they could pull 600k plus. But you won't find many doing that.

 

[neurotransmitter]

A few comments: where are you "seeing" all these jobs that list compensation so low? If we're talking gaswork, then that's not at all indicative of true market value for anesthesiologists. Also, there's no equivalency between a mommy track job, a non-partner track position and a partner-track position (much less an actual partner). That being said, anyone who's taking $250-275k as an anesthesiologist is a sucker (unless they are, in fact, working part time or fresh out).

One of my parents is an anesthesiologist. I'm talking about Seattle. But yes there are some bad jobs out there especially on gaswork. The good jobs are usually by word of mouth.

I never said ALL anesthesia jobs start at $250-$275. Re-read what I said. I said I've seen through family and friends a lot of mommy track jobs on the West coast that start that low. Obviously if you're a partner in a great practice (getting to be less and less from what I've heard) then you can make a lot of money as an anesthesiologist. But that's true for most specialties.

If you don't believe me, ask the anesthesia forum. In a previous comment, Man of War who is a private practice anesthesiologist involved in hiring anesthesiologists said my post was good.

I'm not dissuading anyone from going into anesthesiology, but to go in with eyes wide open about the politics and economics of anesthesiology today that most med schools don't really teach. That is my main point.

The idea that "good anesthesiologists truly have to have no ego" is false and for some reason, gets propagated on these forums quite often. Try posting that one in the anesthesia forum and see how that goes over. The job of the anesthesiologist is to keep the patient alive and to optimize surgical conditions for the surgeon. Sure, working well with surgeons and being pragmatic is extremely important, but to say that anesthesiologists are gas-wielding buddhas behind the curtain is false. I've been in a few instances where an anesthesiologist standing up to a surgeon kept a patient alive.

Your fallacy is equating "no ego" with being walked all over by surgeons. I never said or implied that. Rather I'm talking about arrogance. Most good anesthesiologists I know aren't arrogant. Most good anesthesiologists know when to stand up to difficult surgeons and fight for their patient versus when to let things go and realize it's not a hill to die on. That's what I'm talking about.

 

[The_Sunny_Doc]

BURN OUT.
Retail public
Drug seeking
Spotting zebras
You are always on in EM too, churning through patients. IM will afford some respite during the 12 hour shifts.

It is not all hearts and unicorns in EM. Plus if you look at MGMA data EM is 25-50K more compared to hospitalist IM. Not a huge difference considering liability for zebra's, and dealing with the public without a filter.

Adding to your list that EM is looking like a ticket to early onset dementia according to the circadian rhythm research published recently. 350k is not nearly enough to destroy your brain and feel like crap from the constant day-to-night shift changes.

 

[The_Sunny_Doc]

My interest in Psych remains high.

Considering the few students I’ve talked to about psych rotation were horrified when I said I found it “enjoyable and fascinating,” it’s no surprise there’s a shortage.

 

[DubbiDoctor]

Adding to your list that EM is looking like a ticket to early onset dementia according to the circadian rhythm research published recently. 350k is not nearly enough to destroy your brain and feel like crap from the constant day-to-night shift changes.

I'm sure susceptibility varies by person. Some people are night owls (typing this at 4:45 AM), and would likely have abnormal sleep schedules regardless. The research also shows that the APOE 4 genotype predisposes people who do shift-work to developing dementia. If you don't have that genotype (I don't), your risk of developing dementia, while higher than if you didn't do shift work, is less than 10%.

 

[Brorthopedic]

Adding to your list that EM is looking like a ticket to early onset dementia according to the circadian rhythm research published recently. 350k is not nearly enough to destroy your brain and feel like crap from the constant day-to-night shift changes.

lol

 

[Candidate2017]

My idea of a cush specialty is one that fits as many of these criteria as possible: You are the boss. You control your own schedule and can work as little or as much as you like. You can have mostly regular hours (e.g. 8-6pm). You do not have to work a lot of nights or weekends unless you want to. You are not on call much, or if you are on call, you do not have to go into the hospital, but you can take call from home. You do not have a high chance for "emergencies" to suddenly occur, but can see patients the following day. You bring business to hospitals rather than hospitals seeing you as a necessary expense or cost to doing business. You have lower medico-legal risks.

My specialty fulfills all but the part about bringing business to hospitals 🙂. That's ok because I don't want to wake up well before the crack of dawn, wear thin pajamas and work in the OR.

 

[jdh71]

Those numbers are about right, for pulmonary and critical care. At least the baseline numbers being offered as base salary in those specialties for employed physicians. Most of you will end up employed, assuming trends continue . . .

In the true private practice setting the amount you pay yourself can be a lot higher depending on your overhead, partnership status, and how much you have outstanding in business debt.

I'm not in "private practice". I'm an contractually employed physician so I can best speak about this in particular. In the last 5 years salaries for employed physicians in ALL specialties are being adjusted back to the mean/median due to legal issues related to how the government sees "inducements". If you are being paid above the "market value" for your job, you and the hospital can get into a lot of trouble, as it is seen as an inducement for use of the hospital and its services. A "bribe" if you will to the employed physicians to make sure they don't refer patients across town or work in another OR. Of course this is pretty ridiculous in most instances and I promise I understand the arguments so you don't need to tell them to me (I work in an ICU, where else I am going to "refer" the very sick patients coming out of the ED?? lol), but these are nuanced points lost on US Attorneys. Work somewhere where its hard to recruit? Like a crap hole? The US Attorneys don't care. Your hospital administrators don't like fines and jail time (yes, jail time - it's kind of nuts) and cynically they like this because it makes contract negotiations much easier and often they have been able to pay less than prior contracts for this very reason. And there is NO "negotiation" - you take it or leave it.

So the future will be lots of reasonable secure jobs for employed docs around the median, or those who decide to take more of a gamble to do a true private practice (much less money than the median for years before catching up and then likely doing better than the median), or those who buy into an existing private practice (debt on top of debt). Though any of those situations may be preferable depending on the specifics involved and your level of risk/debt aversion or ability to take the initial up front costs.

Just a few things to keep in mind, and also why these numbers you see on MedScape are probably more true than not. The variance is lessening as practices are selling to hospital systems or similar when looking to retire, leaving mostly only employed opportunities in most markets.

 

[jcorpsmanMD]

How has psychiatry continued to increase each year in income? 273k is not bad, i'm just curious

 

[DubbiDoctor]

How has psychiatry continued to increase each year in income? 273k is not bad, i'm just curious

Greater demand for psychiatric services. There's a been a large (and justified) push to emphasize mental health and destigmatize mental illness and seeing help, including pharmaceutical intervention.

 

[jcorpsmanMD]

Greater demand for psychiatric services. There's a been a large (and justified) to emphasize mental health and destigmatize mental illness and seeing help, including pharmaceutical intervention.

So psychiatrists simply seeing more patients is what’s driving their salary increases?

 

[RogueUnicorn]

It's a wonder it's not more competitive than it is.

have you been in an ED? there is no amount of money you can pay me to work as a "provider" in that wretched hive of scum and villainy

 

[Money Moniker]

Those numbers are about right, for pulmonary and critical care. At least the baseline numbers being offered as base salary in those specialties for employed physicians. Most of you will end up employed, assuming trends continue . . .

In the true private practice setting the amount you pay yourself can be a lot higher depending on your overhead, partnership status, and how much you have outstanding in business debt.

I'm not in "private practice". I'm an contractually employed physician so I can best speak about this in particular. In the last 5 years salaries for employed physicians in ALL specialties are being adjusted back to the mean/median due to legal issues related to how the government sees "inducements". If you are being paid above the "market value" for your job, you and the hospital can get into a lot of trouble, as it is seen as an inducement for use of the hospital and its services. A "bribe" if you will to the employed physicians to make sure they don't refer patients across town or work in another OR. Of course this is pretty ridiculous in most instances and I promise I understand the arguments so you don't need to tell them to me (I work in an ICU, where else I am going to "refer" the very sick patients coming out of the ED?? lol), but these are nuanced points lost on US Attorneys. Work somewhere where its hard to recruit? Like a crap hole? The US Attorneys don't care. Your hospital administrators don't like fines and jail time (yes, jail time - it's kind of nuts) and cynically they like this because it makes contract negotiations much easier and often they have been able to pay less than prior contracts for this very reason. And there is NO "negotiation" - you take it or leave it.

So the future will be lots of reasonable secure jobs for employed docs around the median, or those who decide to take more of a gamble to do a true private practice (much less money than the median for years before catching up and then likely doing better than the median), or those who buy into an existing private practice (debt on top of debt). Though any of those situations may be preferable depending on the specifics involved and your level of risk/debt aversion or ability to take the initial up front costs.

Holy fvcking shlt. If this is true, it might be one of the most terrifying and outrageous things I've heard about medicine yet, and I've heard plenty already. I don't think most people reading this appreciate the true, staggering magnitude of how badly doctors are getting shafted if this is the case. It's in effect a government imposed salary cap on how much you can make. Government imposed salary caps obviously exist, if you are directly employed by the government. But in that case it was your decision to accept the government dictated salary and of course you get all the benefits that such employment entails.

What JDH is talking about here is the government imposing a de-facto salary cap on privately employed physicians as a consequence of the monstrously unjust Stark laws. The Stark laws were already unconstitutional, arbitrarily punitive fecal excrement by virtue of their original purpose to outlaw physicians from owning most types of medical facilities, but to see them now being used to dictate employed salaries is beyond infuriating. Holy ****! How can this possibly be legal? There must be basis for a lawsuit here by someone with standing, which would be either a hospital admin who gets charged under this asinine interpretation of the Stark laws or by a physician who losses out on hundreds of thousands of dollars a year in salary due to government illegaly imposing constraints on salary negotiations. There is no way that the government should be able to impose salary controls on private individuals and get away with it, this isn't the freaking Soviet Union.

 

[DubbiDoctor]

So psychiatrists simply seeing more patients is what’s driving their salary increases?

I'm certainly no expert, but yes I think it's a matter of supply and demand. Not only can psychiatrists see more patients, they can charge more and refuse insurance.

 

[The_Sunny_Doc]

So psychiatrists simply seeing more patients is what’s driving their salary increases?

There’s also a shortage. Good luck seeing a psychiatrist in a rural town. We have NPs here but as far as I know the psychiatrists are booked out for 3-6 months unless you go to the one clinic affiliated with the hospital.

 

[Stagg737]

Naw private practice scopers but that's how I read it so it made me chuckle

And a urologist was born.

haha no it's not. Here's a post from 2001, and nothing has changed in that 17 year time.



PMR is an old specialty - since the 40s. It's not as though it's magically on people's radar now. It's a good specialty, with good lifestyle and good pay - but the job description is also not really what most med students want to do and it will never have the same flexibility that derm has.

So...

Except it has gotten more competitive. Maybe not at an extraordinary rate, and it's certainly not derm or ortho, but you can't just waltz into PM&R anymore.

wonder why pm&r physicians don't feel fairly compensated... any ideas?

In addition to the pain docs and those specializing in workers' comp cases, it's endless paperwork. I did a PM&R rotation this spring and got to go home around 1:30 or 2 every day while my attendings were there until at least 4:30 finishing paperwork. They also did paperwork for a few hours in the morning. Of all my rotations and shadowing, it was the field with the least amount of patient contact/clinical work and the most paperwork by far. I loved the rotation and the work was pretty cool, but the sheer volume of administrative crap would have ruled the field out for me.

Doesn't EM actually make more than Gas since EM works so few hours in comparison?

Hourly rates were discussed ad nauseum in another thread, but the synopsis is that for hours rates the surgical sub-specialties and derm are still making a ton per hour. Then fields like EM, gas, psych, PM&R, hospitalists and gen surg, then all the lower paying fields that aren't "lifestyle" fields (FM, IM oupt, peds, etc). It's a lot harder to gauge hourly pay because of the variability in hours worked in certain fields.

I see a lot of people on this forum saying the gas job market is bad....I’m not sure why, it’s not at all. I write a lot of letters for graduating fellows and residents, and they’re all getting great jobs without much issue. Now, if one insists on being in NYC or Denver for example salaries are doing to be lower, but that’s true for almost all specialties.
You have to remember also that fellowships after anesthesia offer pretty high comp, cardiac and pain mostly. Those are pretty competitive to obtain though.

So are you ignoring the whole Atrium debacle going on right now or do you not think that's really common in the field? Genuinely curious as I've been loosely following the story in my spare time.

My interest in Psych remains high.

Considering the few students I’ve talked to about psych rotation were horrified when I said I found it “enjoyable and fascinating,” it’s no surprise there’s a shortage.

I've had the same general responses, typically either asking why on earth I'd ever choose that field or something along the lines of "You picked a great field and I'm glad you did because I could never do it".

So psychiatrists simply seeing more patients is what’s driving their salary increases?

It's not just that. The legitimate shortage and massive demand means we hold a lot more negotiating power than some other fields. I talked to a graduating resident the other day who was initially offered low 200's and negotiated her way up to almost 300k because the hospital was that desperate. She basically just kept telling them no and they kept coming back with better offers. Additionally, it's also one of the easiest fields to go into private practice (very significant shortage, very low overhead, opportunity for cash only, etc). Add in the recent increase to mental health awareness and skyrocketing demand and it makes it a great field for physicians (at the moment).

There’s also a shortage. Good luck seeing a psychiatrist in a rural town. We have NPs here but as far as I know the psychiatrists are booked out for 3-6 months unless you go to the one clinic affiliated with the hospital.

I'm in a medium-sized city (~500k) and we have the same problem here. The shortest wait time I've heard for new patients is 2 months and most are in the 4-6 month range. It's even worse to see a child psych here. I recently did a peds rotation and my attending said that it's a minimum 6 month wait for new patients and if you've got a kid on the spectrum it's at least a 1 year wait to see a specialist.

 

[ButterButter]

So are you ignoring the whole Atrium debacle going on right now or do you not think that's really common in the field? Genuinely curious as I've been loosely following the story in my spare time.

That is indeed a debacle, but as there are > 35,000 practicing anesthesiologists in the US, one ****-show contract renegotiation gone terribly awry can't speak for the entire field. Yes, practice models and compensation are changing (rapidly so), but the grass is still green in many places.

 

[Stagg737]

That is indeed a debacle, but as there are > 35,000 practicing anesthesiologists in the US, one ****-show contract renegotiation gone terribly awry can't speak for the entire field. Yes, practice models and compensation are changing (rapidly so), but the grass is still green in many places.

True, but I hear more about doom and gloom in the medical profession from anesthesiologists than any other field I've interacted with. Some of it just seems to be whiny personalities, but I also hear some very legitimate complaints involving mid-level encroachment, high employment and difficulty practicing independently, hospitals renegotiating contracts, and docs being fired in the name of the almighty buck. I just asked about Atrium because it seems to be the perfect storm of most of the problems anesthesiologists are facing.

 

[Man o War]

And a urologist was born.



Except it has gotten more competitive. Maybe not at an extraordinary rate, and it's certainly not derm or ortho, but you can't just waltz into PM&R anymore.



In addition to the pain docs and those specializing in workers' comp cases, it's endless paperwork. I did a PM&R rotation this spring and got to go home around 1:30 or 2 every day while my attendings were there until at least 4:30 finishing paperwork. They also did paperwork for a few hours in the morning. Of all my rotations and shadowing, it was the field with the least amount of patient contact/clinical work and the most paperwork by far. I loved the rotation and the work was pretty cool, but the sheer volume of administrative crap would have ruled the field out for me.



Hourly rates were discussed ad nauseum in another thread, but the synopsis is that for hours rates the surgical sub-specialties and derm are still making a ton per hour. Then fields like EM, gas, psych, PM&R, hospitalists and gen surg, then all the lower paying fields that aren't "lifestyle" fields (FM, IM oupt, peds, etc). It's a lot harder to gauge hourly pay because of the variability in hours worked in certain fields.



So are you ignoring the whole Atrium debacle going on right now or do you not think that's really common in the field? Genuinely curious as I've been loosely following the story in my spare time.



I've had the same general responses, typically either asking why on earth I'd ever choose that field or something along the lines of "You picked a great field and I'm glad you did because I could never do it".



It's not just that. The legitimate shortage and massive demand means we hold a lot more negotiating power than some other fields. I talked to a graduating resident the other day who was initially offered low 200's and negotiated her way up to almost 300k because the hospital was that desperate. She basically just kept telling them no and they kept coming back with better offers. Additionally, it's also one of the easiest fields to go into private practice (very significant shortage, very low overhead, opportunity for cash only, etc). Add in the recent increase to mental health awareness and skyrocketing demand and it makes it a great field for physicians (at the moment).



I'm in a medium-sized city (~500k) and we have the same problem here. The shortest wait time I've heard for new patients is 2 months and most are in the 4-6 month range. It's even worse to see a child psych here. I recently did a peds rotation and my attending said that it's a minimum 6 month wait for new patients and if you've got a kid on the spectrum it's at least a 1 year wait to see a specialist.

You think one contract changing hands is representative of an entire field of medicine? This happens all the time in every field of medicine. Hospitals buy up practices in every specialty and earn the right to dictate working conditions to those doctors.
I guarantee you those doctors won’t make any less with Scope Aneshesia than they were with Mednax.
The SDN anesthesia forum is not representative of real world anesthesiologist feelings either. This is where many unhappy docs come to vent; and some CRNAs posing as docs. Don’t base anything off of what you read here. The reality is, it isn’t hard to make great money in anesthesia unless you insist on being geographically completely inflexible.

 

[Man o War]

True, but I hear more about doom and gloom in the medical profession from anesthesiologists than any other field I've interacted with. Some of it just seems to be whiny personalities, but I also hear some very legitimate complaints involving mid-level encroachment, high employment and difficulty practicing independently, hospitals renegotiating contracts, and docs being fired in the name of the almighty buck. I just asked about Atrium because it seems to be the perfect storm of most of the problems anesthesiologists are facing.

I don’t know of a single anesthesiologist being fired unless they did something stupid.
The Atrium/southeast anesthesia docs signed non competes that prevents them from working in the city. That was a dumb front end mistake on their part. I’ve never signed a non compete that restrictive and would never.

 

[Stagg737]

You think one contract changing hands is representative of an entire field of medicine? This happens all the time in every field of medicine. Hospitals buy up practices in every specialty and earn the right to dictate working conditions to those doctors.
I guarantee you those doctors won’t make any less with Scope Aneshesia than they were with Mednax.
The SDN anesthesia forum is not representative of real world anesthesiologist feelings either. This is where many unhappy docs come to vent; and some CRNAs posing as docs. Don’t base anything off of what you read here. The reality is, it isn’t hard to make great money in anesthesia unless you insist on being geographically completely inflexible.

I wasn't basing it off of SDN, I was basing it off of my interactions with anesthesiologists irl through clinical rotations and my shadowing/volunteering before med school. Despite having high incomes, they regularly had the gloomiest outlook on the medical field along with the gen surgeons I knew before med school. I know it happens in all fields, it just seems to pop up when I'm discussing the issue with anesthesiologists more than other fields, which is why I was curious as to whether this was an actual phenomenon or just personal experience.

I don’t know of a single anesthesiologist being fired unless they did something stupid.
The Atrium/southeast anesthesia docs signed non competes that prevents them from working in the city. That was a dumb front end mistake on their part. I’ve never signed a non compete that restrictive and would never.

I know of 2 or 3 who were fired and replaced by CRNAs supposedly because the CRNAs were cheaper. I don't doubt that the docs in the Atrium case had a hand in digging their own grave, I just wasn't sure if this was just a larger scale of a common occurrence or if it was a unique data point.

 

[Candidate2017]

So psychiatrists simply seeing more patients is what’s driving their salary increases?

Psychiatrists aren't seeing more patients. My guess for the bump in numbers is mental health parity laws, part time older psychiatrists leaving the work force (their part time incomes drag down the averages), new psychiatrists chooisng full time work over part time and academia due to large student loans and prisons driving up salaries (they have a hard time attracting psychiatrists but courts are ruling that prisoner suicides are directly caused by lack of psychiatrists, which is a constitutional violation befitting of multimillion dollar payouts).

 

[DoctwoB]

Keep in mind that a lot of these numbers are based on small N's and thus prone to fluctuate year to year given the inherent differences in who responds. If you look at MGMA data, one of the biggest things that pops out is the Standard deviation in the salaries. For example, Urologists in large groups mean is about 400k. SD is almost 200k. That tells you that with small N's there will be a great degree of variability.

While there are long term trends in why salaries go up or down, you won't see big fluctuations year to year in any given field unless something drastic happens that effects that particular field, like cutting reimbursement for a highly used CPT code, or getting rid of loopholes like "buy and bill" for oncologists or urologists, who used to make big $$$ administering chemo (or lupron for urologists) because you could buy the drug at wholesale and then charge a higher rate for the drug when you administer it in addititon to the charge for actually administering the dose. Absent those factors though, any big jumps or drops in salary in these surveys is likely much more noise then signal.

 

[kabooya]

I'm interested in going into infectious disease. I was told the salaries tend to be lower because there are no procedures. But why do other specialties with no procedures get paid a decent amount more (i.e. psych)?

 

[libertyyne]

I'm interested in going into infectious disease. I was told the salaries tend to be lower because there are no procedures. But why do other specialties with no procedures get paid a decent amount more (i.e. psych)?

depends on a few factors.
How much insurance and medicare pay for the services the specialty provides.
Can the hospital receive accreditation without coverage from said specialty.
Is the specialty required to keep the hospital running and allow other services to function at their full potential.
What is the supply of said specialty.

 

[LebronManning]

EM is excellent. They're working 36 hours a week (least in medicine for among the highest hourly pay), making 100k more than hospitalists who work 7on/7off (averages to 42 hours a week). They also see a diverse range of pathology, perform an interesting and exciting mix of procedures and medicine, and are able to treat trauma, particularity if they work at a level 1 or 2 trauma hospital. All that and no on call. It's a wonder it's not more competitive than it is.

Have you ever actually worked in an ED? lol. If you have, you would know that it is absolutely not a wonder why it is not more competitive. Its the most soul crushing work in all of medicine with a high rate of complete BS because 80% of your patients don't need to be there. Interesting cases get managed for about 30 mins by EM then goes up to IM. Any good trauma gets managed by surgery from start to finish, maybe the EM doc will be able to intubate if EMS hasn't done it already lol.

 

[anbuitachi]

Interesting that Gas makes more on average than Optho, Urology and ENT?? Guessing the ceiling is much higher in those 3 specialties compared to gas

Rich surgeons aren't responding to these surveys i bet. there are no rich gas docs. they are all capped by # of hours in a day

it's not about the existence of midlevel or not (eg. anesthesiologists still get paid ALOT despite CRNA, EM physicians get paid alot despite PAs), it's more about the trend towards wanting less invasive methods and spending less money on procedures. One of the gyn onc physicians I was with couple of weeks ago was telling me that all the surgeons here basically had about the same salary since late 1990s. Now salary stagnancy is not nationwide, but pretty much everyone agrees the rate of pay is NOT keeping up with the overall inflation and economy. He also told me that now there is a huge push towards spending less money on invasive procedures and surgeries to save money, and spend more money on minimally invasive or non-invasive means of treatment. On the bright side, surgery will NEVER die because there will always be a need. But with the advent of regenerative medicine, there might be a shift of which specialties might benefit more from reimbursements in the future. But don't let money stop you from doing what you love!

Anesthesiology salary is not doing well compared to the past, despite still being in the 300s. They are also doing way more casees to make that salary. And it's likely to slowly get worse.

Have you ever actually worked in an ED? lol. If you have, you would know that it is absolutely not a wonder why it is not more competitive. Its the most soul crushing work in all of medicine with a high rate of complete BS because 80% of your patients don't need to be there. Interesting cases get managed for about 30 mins by EM then goes up to IM. Any good trauma gets managed by surgery from start to finish, maybe the EM doc will be able to intubate if EMS hasn't done it already lol.

EM residency competitiveness has skyrocketted recently because people are realizing how good of a field it is. One of few fields with lots of flexibility in terms of work hours, and one the highest salaries per hour, and one of the few specialties that makes a lot and has time to spend their money.

Gas should be plan A. Top earner and not competitive at all. I think 2017 match, Gas had one of the highest IMG match rates which says a lot. Good lifestyle. Very flexible. Very much a mommy track specialty and starting at a min 300

Since your perception of gas is so off, you should visit their forums to see what it is really like and how depressing it is. (Awful life style consisting of many nights, days, weekends. One of the highest hours worked per week out of all the specialties w avg of 61hrs/week. Not flexible. Good luck finding that mommy track at a location near you) Though still a good option if your step score is garbage