Physician's REAL salary?

[gerido]

Everyone talk about how much they're looking forward to the big bucks, but in reality, how much does a physician really take home? I see all these numbers (~200K) for various specialty, but isn't that before tax and malpractice insurance (i know it varies by state).

I figure with all the tax and malpractice, doctors are probably not making much more than other professionals with the same time commitment who might be at a lower tax bracket. I know I know, medicine is not all about the money, don't jump down my throat... it's just a curiosity.

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[DieselPetrolGrl]

Everyone talk about how much they're looking forward to the big bucks, but in reality, how much does a physician really take home? I see all these numbers (~200K) for various specialty, but isn't that before tax and malpractice insurance (i know it varies by state).

I figure with all the tax and malpractice, doctors are probably not making much more than other professionals with the same time commitment who might be at a lower tax bracket. I know I know, medicine is not all about the money, don't jump down my throat... it's just a curiosity.

32% tax bracket
i cant tell you bc it hurts my body to think about this stuff
i know on my tution i paid around 10k taxes all college. i say we all move to russia but i suck at new languages so maybe not

 

[gerido]

32% tax bracket

😱
200K - .32*200K - malpractice = 😱

 

[Brav989]

Well are you talking salaried doctor or a private practice?

 

[gerido]

Well are you talking salaried doctor or a private practice?

salaried

 

[Brav989]

Well being salaried, would the hospital your working for not pay for malpractice? I'm not a physican so I can't really speak first hand, but my uncle was offered a job as the 'town doc' and they were going to pay for his entire malpractice insurance plus pay him very well ($450,000/yr)

 

[blz]

The salaries posted on sites are after malpractice insurance.

 

[gerido]

The salaries posted on sites are after malpractice insurance.

I did not know that. Are those figures before or after tax?

 

[Ross434]

I did not know that. Are those figures before or after tax?

before

Generally dont worry about malpractice. If you are on your own, it will be taken out of your revenues (practice revenues are in the high hundreds of thousands, if not 1M+) before you really count it as your take home pay. If you are an employee of a group, it will usually be paid for you.

 

[ChuckRock]

before

Generally dont worry about malpractice. If you are on your own, it will be taken out of your revenues (practice revenues are in the high hundreds of thousands, if not 1M+) before you really count it as your take home pay. If you are an employee of a group, it will usually be paid for you.

Is this done to pool risk and thereby reduce individual risk for each doctor? I've heard of this practice, but I haven't put the pieced together untill now. That'd be pretty clever if that is why they do it. This isn't really relevant, but I'd be interested to find out. I'm not even sure if this is the right place to ask, but what the hell.

 

[Beau Geste]

I imagine it gets a little complicated, too, on reporting what the final salary is if you take into account tax-deductible things as well. Malpractice is one of those, as well as license fees, CMEs, etc. IF you don't have a group or hospital paying for it for you.

 

[fantasty]

The salaries posted on sites are after malpractice insurance.

Really? I thought that the differences in malpractice was what drove some of the differences in wages. Ob/gyn and neurosurg, for example, having high malpractice but relatively higher wages.

And, since others probably know this better... academic institutions will cover our malpractice, too, if we stay in academic medicine, right? I thought that was one of the reasons that the lower pay in academics wasn't as big of a deal.

 

[fantasty]

...

 

[synapse lapse]

The salaries are gross salaries (after malpractice/expenses, pre-tax). Yes they pay your malpractice in academics, you are salaried with benefits, so the pay is fairly competitive to private practice in the end.

 

[sscooterguy]

The salaries are gross salaries (after malpractice/expenses, pre-tax). Yes they pay your malpractice in academics, you are salaried with benefits, so the pay is fairly competitive to private practice in the end.

I wouldn't really say fairly competative. There are a lot of perks of academic medicine that make it desireable, but money is not generally one of them. At least for pathology, there is a gimongo difference between private practice and academia, even minus malpractice. The nice thing about academic medicine is yes, the hospital "takes care" of the malpractice, so you don't have to negotiate with the insurance company yourself. Your peers are generally very smart, more well known in a lot of cases, and the cases are generally the interesting or difficult ones. In many cases (not all), you also have the most advanced technology. Most importantly, you have to deal with less headaches on the business side of things such as overhead, nursing staff, office staff, etc.

However, for pathology (I know first hand), academic medicine starts attendings off at around 165-180K, and maxes around 230-240k, even for the big names...the only person making more would be the chairperson. In private practice, the AVERAGE for a pathologist working in private practice is around 320K and can move up to 600-800k (if you make partner after 5-10 years), thats after malpractice (which is comparatively low for pathologists), overhead, etc. So the overall picture may even out in the business headaches and academic interests of medicine, but not financially.

A lot of people complain that "doctors make so much" and thats why juries give so much compensation so easily. Unfortunately many laypersons don't understand or don't care that physicians put in over 30 years of education and training, tons of work hours (no such thing as 40 hr weeks), and have the awesome responsibilities for people's lives. They also don't understand that pensions are few and far in between for physician, even in acedemics, as few stay at one institution long enough. Oh well though, thats why physicans make big bucks.

sscooterguy

 

[gschl1234]

32% tax bracket
i cant tell you bc it hurts my body to think about this stuff
i know on my tution i paid around 10k taxes all college. i say we all move to russia but i suck at new languages so maybe not

I'm not sure I correctly understand federal income tax but as far as I know, being in the "32% bracket" means that the first $7000 or so you make, you pay 10%, the next $23000 on top of the $7000 you've already made, you pay 15% etc...etc...so you're not paying 32% of your total income, jsut the portion above $90000 or so. Sorry if my numbers are off. As far as malpractice, if you're salaried, your employers take care of that but I've heard of people being "let go" if they're not bringing in enough profit for the practice.

 

[synapse lapse]

I wouldn't really say fairly competative. There are a lot of perks of academic medicine that make it desireable, but money is not generally one of them. At least for pathology, there is a gimongo difference between private practice and academia, even minus malpractice. The nice thing about academic medicine is yes, the hospital "takes care" of the malpractice, so you don't have to negotiate with the insurance company yourself. Your peers are generally very smart, more well known in a lot of cases, and the cases are generally the interesting or difficult ones. In many cases (not all), you also have the most advanced technology. Most importantly, you have to deal with less headaches on the business side of things such as overhead, nursing staff, office staff, etc.

However, for pathology (I know first hand), academic medicine starts attendings off at around 165-180K, and maxes around 230-240k, even for the big names...the only person making more would be the chairperson. In private practice, the AVERAGE for a pathologist working in private practice is around 320K and can move up to 600-800k (if you make partner after 5-10 years), thats after malpractice (which is comparatively low for pathologists), overhead, etc. So the overall picture may even out in the business headaches and academic interests of medicine, but not financially.

A lot of people complain that "doctors make so much" and thats why juries give so much compensation so easily. Unfortunately many laypersons don't understand or don't care that physicians put in over 30 years of education and training, tons of work hours (no such thing as 40 hr weeks), and have the awesome responsibilities for people's lives. They also don't understand that pensions are few and far in between for physician, even in acedemics, as few stay at one institution long enough. Oh well though, thats why physicans make big bucks.

sscooterguy

You are forgetting about all the other benefits in academic medicine, including no operating expenses, payed vacation time, health/dental insurance, retirement plans, and shorter work hours. I agree with you that the income potential is much higher in private practice and it is a more lucrative option, but in many ways when benefits are factored in and hours equalized the salaries are comparable.

 

[robh]

Everyone talk about how much they're looking forward to the big bucks, but in reality, how much does a physician really take home? I see all these numbers (~200K) for various specialty, but isn't that before tax and malpractice insurance (i know it varies by state).

I figure with all the tax and malpractice, doctors are probably not making much more than other professionals with the same time commitment who might be at a lower tax bracket. I know I know, medicine is not all about the money, don't jump down my throat... it's just a curiosity.

I don't know if this is accurate but have a look here if you haven't already:

http://www.physicianssearch.com/physician/salary1.html
http://www.physicianssearch.com/physician/salary2.html

 

[NunoBR]

I don't know if this is accurate but have a look here if you haven't already:

http://www.physicianssearch.com/physician/salary1.html
http://www.physicianssearch.com/physician/salary2.html

I don't know if this is accurate, but I've seen other site surveys that shows salaries much bigger than these (2-3x).

 

[robh]

I don't know if this is accurate, but I've seen other site surveys that shows salaries much bigger than these (2-3x).

Would you post links to those sites? I would be interested in looking at them.

I think one should take these things with a huge grain of salt. The two links I posted were from a physician search firm. They obviously have a stake in matching physicians with open jobs. It might be argued that it is in their best interests to inflate salaries. I have NO clue how accurately these surveys reflect the actual market. Caveat emptor I guess.

 

[tsthethird]

My friend's father is a dermatologist is Oklahoma making 400,000 a year. He owns a small private practice.

 

[thackl]

My brother, who's a Dr, has also told me these sites only include base salaries...... not aditional perks, bonuses, etc.

 

[Law2Doc]

My friend's father is a dermatologist is Oklahoma making 400,000 a year. He owns a small private practice.

Medicine has changed a ton in the last decade or so. So pretty much anyone's "father" will not be earning a salary likely obtainable by anyone going into medicine today. Not to mention that the average med student doesn't get into the most competitive residency specialty anyhow.

 

[WatchingWaiting]

You are forgetting about all the other benefits in academic medicine, including no operating expenses, payed vacation time, health/dental insurance, retirement plans, and shorter work hours. I agree with you that the income potential is much higher in private practice and it is a more lucrative option, but in many ways when benefits are factored in and hours equalized the salaries are comparable.

Generally speaking, people in academics, especially at high prestige institutions, are going to be working as much or more than people in private practice. Having attending committments + research and teaching obligations leads to lots of work. Do you seriously think that a physician in private practice isn't going to set up a 401k plan, health insurance, a vacation policy, and the like? People go into academics for the increased prestige (at least within the medical community), the intellectual environment, love of research and being on the cutting edge. Also, once you're in the 6-figures, is there really a huge difference between making $180K versus $280K? I mean, it's certainly nicer to make $280K, but even at $180K you're still post-taxes making triple the median worker's income. Many people are willing to take the reduced salary in exchange for the intellectual/interpersonal benefits of academics. But, to summarize, the financial benefits most assuredly do not compensate for the reduced salary.

 

[synapse lapse]

Generally speaking, people in academics, especially at high prestige institutions, are going to be working as much or more than people in private practice. Having attending committments + research and teaching obligations leads to lots of work. Do you seriously think that a physician in private practice isn't going to set up a 401k plan, health insurance, a vacation policy, and the like? People go into academics for the increased prestige (at least within the medical community), the intellectual environment, love of research and being on the cutting edge. Also, once you're in the 6-figures, is there really a huge difference between making $180K versus $280K? I mean, it's certainly nicer to make $280K, but even at $180K you're still post-taxes making triple the median worker's income. Many people are willing to take the reduced salary in exchange for the intellectual/interpersonal benefits of academics. But, to summarize, the financial benefits most assuredly do not compensate for the reduced salary.

The point was that you have 401k matching, paid health and dental insurance, paid life insurance in some cases, paid vacation time, and other benefits. I stand by the fact that academics is comparably salaried when benefits are considered, though it does still have a slightly lower salary after they are accounted for. Obviously you are going to set up a 401k, buy health and life insurance etc, but all of that comes out of your salary. And noone said that physicians in academia don't work long hours, though I did say the hours are shorter since their income is not tied directly to patient load, though you are correct that many work as much as private practice physicians.

 

[WatchingWaiting]

The point was that you have 401k matching, paid health and dental insurance, paid life insurance in some cases, paid vacation time, and other benefits. I stand by the fact that academics is comparably salaried when benefits are considered, though it does still have a slightly lower salary after they are accounted for. Obviously you are going to set up a 401k, buy health and life insurance etc, but all of that comes out of your salary. And noone said that physicians in academia don't work long hours, though I did say the hours are shorter since their income is not tied directly to patient load, though you are correct that many work as much as private practice physicians.

You seem confused about what is taken out of net versus gross income. As a private practitioner, your gross income (total billings) are going to be between half a million and a couple of million per year depending on your speciality. Health insurance premiums for a family (maybe $20K per year), 401k matching ($7k at maximum), paid vacation and the like are generally coming out of that gross total, not out of your reported salary. In other words, the salary figures you see reported on most websites are after vacation, insurance, retirement plan, malpractice insurance, and other benefits. Seriously, go talk to some residents or fellows in the last year of their training, especially if they're in lucrative specialties, about the financial calculus of academics versus private practice. Maybe for family practice or internal medicine there isn't that much of a difference, but for surgery and subspecialties, rads, gas, any of the higher-paid specialties, the difference is usually 50%-100% more in private practice.

One thing that may mitigate the difference that I hadn't thought of, is that docs in desirable urban areas are generally paid less than docs in medium towns and in the midwest and other less popular areas. Since academic med centers tend to be concentrated in the northeast and in large cities that have high numbers of docs, this may be making the academic-private practice gap seem a little larger than it actually would be if comparing academic versus large-city private practice doctor.

 

[LO281OK]

I don't know if this is accurate but have a look here if you haven't already:

http://www.physicianssearch.com/physician/salary1.html
http://www.physicianssearch.com/physician/salary2.html

I don't know if this is accurate, but I've seen other site surveys that shows salaries much bigger than these (2-3x).

Notice these are for 1st year and after 3 years. Clearly not your top end incomes with time to build a patient base.

The point was that you have 401k matching, paid health and dental insurance, paid life insurance in some cases, paid vacation time, and other benefits.

401k vs. Keogh ...and the Keogh Plan wins!!! Matching may mean free money, but it is always limited and I would much rather protect 40K+ per year from that 32%+ tax bracket while making 100K more than to get some "free" money that often comes limitations on investments.

FYI: Keogh Plan Description

Depending on your families health situation, you should be able to avoid 20K/yr insurance premiums. Being a MD, catastrophic insurance would be more appropriate and much less expensive (~2-5K/yr) allowing you to put some of the savings in a health account if you choose (out of which you could pay for child births, sick calls, etc).

FYI: Catastrophic Insurance

Many people are willing to take the reduced salary in exchange for the intellectual/interpersonal benefits of academics.

It may seem cliche, but most do ppl get into medicine, at least in part, with a desire to help others. So I see this argument "for" academic medicine as a wash. My opinion is this: You may get a personal benefit in ac-med from the intellectual environment and you help others through medicine and teaching, but I feel your potential for satisfying the goal of aid to others is higher in private practice (at least the way I want to help pple). Not to mention my grandmother's wisdom that having a lot of money is the best way to help others.

To clarify: Surely my time as a doctor volunteering to help those who cannot otherwise afford medical care is valuable, but what if it is a new building for a foster home that is needed. Rather than going on-site and hammering nails, I would provide more efficient help by working an extra weekend at the emergency room and donating the $280/hr that I made to the cause. I use this example b/c my dad's neighbor does just that and his weekend of work can pay 10 framers $11/hr for 3 days!! I helped a friend frame his house and I can state unequivocally that i am in the bottom 1% of framer talent on the market.

In closing: I admire those in academic medicine and the benefits we gain from their work is how those on the front lines get their education and new techniques/-ology. I see myself helping people in other ways that are more suited by private practice. Just thought I would stick up for my side. Hopefully I have helped to further the discussion. Closure on a topic is rarely profitable, but opening new avenues helps to move the pile forward.

 

[DrMojorisin]

I know 2 academic physicians really well and another as an acquaintance. Their lives are dramatically different:

#1) Works 80-100 hr weeks doing a varying combination of clinical work, academic administration, and lecture hours. Makes far less than she would make as a private pathologist, even when hours adjusted. A very strung out person who would definitely prefer to spend more time with her family and really not getting a very big payoff for sacrificing that time. Any value that the academic lifestyle would have given is lost in the stress of constant deadlines.

#2) Works 60-80 hr weeks with a combination of very successfuly clinical research and seeing patients. Has a lab full of underlings and toys for his research because he was grant funded. However, he has recently lost his funding and is crushed about that. He clearly loved his role as a research administrator of a thriving lab much more than he did seeing patients, but that has been mostly stripped from him. This man is probably the happiest of the three - but I would not call him a happy man. He is a genius though.


#3) Works 20-30 hr weeks doing a combination of teaching and unfunded research. Only performs high-yield activities. ie. He doesn't prep much for lectures and only does research when it has very high potential (financial reward). Somehow has managed to get released from having to do clinic work through the publishing of a string of papers that he talked others into working on (collecting the data for him). I do not know if his salary was adversely affected by dropping his clinical hours.


From brief conversations with each of these academic physicians there was:

1) unanimous agreement that they could make more in private practice, even if hours were adjusted. The degree of difference ranged from slightly more money to much,much more money

2) the only reason to be an academic physician is either 1) a love of teaching medicine or 2) a love of research

3) Even if you go into academic medicine for the right reasons, you may be disappointed if your research doesn't go well or the administration places too many demands on your time for someone who is already taking a paycut.


My personal concern about entering academic medicine is that I have seen firsthand how difficult it is to acquire and retain research funding and don't want to be taken off course halfway through my career.