Salary vs. Experience

[mstpgrind]

In my past life as a software engineer, salaries heavily depended on years of experience (yoe). For example, at my company I started at x, while my senior engineers with 10 yoe were making 2x.

As far as I've seen in medicine, this isn't really the case.

Sure, there may be correlations, such as if you've been working longer you may be more likely to be a partner, meaning you make more.

But other than that, I don't see any increase in pay based on yoe... the only other meaningful increase in salary docs receive is your institution's annual cost of living increase, but just tracks with inflation (or even sometimes below inflation), so in real dollars you're making about the same.

Is this assessment accurate?

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[Mad Jack]

Pretty much accurate, unless you're in the increasingly less common arrangement of private practice. Often a PP will have a buy-in for junior physicians to make partner, after which they will get a substantially larger compensation package. You can also pick up additional salary from taking on additional responsibilities- unit director, executive medical officer, etc- but these tend to be small boosts to pay unless you're very high up a very large organizational structure (CMO/CEO in a large system, for example).

 

[operaman]

Agree with the above -definitely happens in PP with partnership track. Often this is because the practice may have ancillary revenue streams or other assets. So for ENT, that might be a hearing aid business, imaging, surgery center, etc. Often new associates will be paid a lot less than their earnings (<$200k) and a certain number of years count as buy-in to the practice as a partner.

The other situation would be academic medicine where well established highly regarded faculty can generate some generous compensation packages. And in academia there is the progression from assistant to associate to full professor that usually comes with increased comp.

Otherwise there does tend to be a growth in income as you establish your practice and build a reputation. I'm in my second full year of attending practice and my volume per month is double what it was a year ago (and I was busy then). I've gotten more efficient and get better referrals as well. In my comp model I do see that my earnings will probably plateau at some point, but I think that happens in many other fields as well.

 

[wamcp]

In my past life as a software engineer, salaries heavily depended on years of experience (yoe). For example, at my company I started at x, while my senior engineers with 10 yoe were making 2x.

As far as I've seen in medicine, this isn't really the case.

Sure, there may be correlations, such as if you've been working longer you may be more likely to be a partner, meaning you make more.

But other than that, I don't see any increase in pay based on yoe... the only other meaningful increase in salary docs receive is your institution's annual cost of living increase, but just tracks with inflation (or even sometimes below inflation), so in real dollars you're making about the same.

Is this assessment accurate?

The answer is you are generally correct, although “it depends”. Too many variables.

What specialty..what practice setting..what compensation model..etc

My N=1 experience as a W2 employee (internal med trained, no fellowship, hospitalist who works mostly evening or night shifts):

My base rate has increased since year 1 through 5. At first, I was at 150/hr.
Today, I am at 200/hr.
But don’t let that fool you - the extra moonlighting pay rates have been incredible, at on average 250/hr to 300/hr (if there is urgent need) since year 1.

This means, fresh out of residency, with taking on extra shifts, I was making +500K/yr.
For 2023, I will likely clear +700K/yr.

Pretty good deal for someone who only did 3 years of training after med school - not everyone has to do orthopedics, derm, or neurosurg to make this kind of coin.

Here is a shot of my latest biweekly check:



Note in my paycheck: says 150/hr base rate for 80 hours of two weeks. But my true base rate is more, at $200/hr due to my contracted hours is fewer as a nocturnist. I am contracted to work 66 hours every two weeks

 

[Lost in Translation]

The answer is you are generally correct, although “it depends”. Too many variables.

What specialty..what practice setting..what compensation model..etc

My N=1 experience as a W2 employee (internal med trained, no fellowship, hospitalist who works mostly evening or night shifts):

My base rate has increased since year 1 through 5. At first, I was at 150/hr.
Today, I am at 200/hr.
But don’t let that fool you - the extra moonlighting pay rates have been incredible, at on average 250/hr to 300/hr (if there is urgent need) since year 1.

This means, fresh out of residency, with taking on extra shifts, I was making +500K/yr.
For 2023, I will likely clear +700K/yr.

Pretty good deal for someone who only did 3 years of training after med school - not everyone has to do orthopedics, derm, or neurosurg to make this kind of coin.

Here is a shot of my latest biweekly check:

View attachment 370084

Note in my paycheck: says 150/hr base rate for 80 hours of two weeks. But my true base rate is more, at $200/hr due to my contracted hours is fewer as a nocturnist. I am contracted to work 66 hours every two weeks

I went into the wrong field.

 

[wamcp]

I went into the wrong field.

What specialty? What’re the hours/income like for you?

 

[aldol16]

You should take a look at the MGMA data if you haven't already. The difference between the 10th and 90th percentiles by specialty is there. It's not big, but it's there. That can be accounted for by years in the field mostly.

Also, salary doesn't take into account other important intangibles that come with years in practice. When you're in any practice, academic or private, you're going to be taking more of the call and more of the ****ty cases that other people don't want in your first years in practice. Sure, you might not make much less than them but you're doing more work that's is probably less enjoyable than them.

 

[mstpgrind]

You should take a look at the MGMA data if you haven't already. The difference between the 10th and 90th percentiles by specialty is there. It's not big, but it's there. That can be accounted for by years in the field mostly.

Also, salary doesn't take into account other important intangibles that come with years in practice. When you're in any practice, academic or private, you're going to be taking more of the call and more of the ****ty cases that other people don't want in your first years in practice. Sure, you might not make much less than them but you're doing more work that's is probably less enjoyable than them.

I guess then my question would be why do you think physicians who are more experienced make more?

 

[voxveritatisetlucis]

Physicians aren’t paid nearly enough. My girlfriend who went to a below average stage school recently graduated and works in finance recently just got a bonus that brings her up to nearly 100k. No way some doctors should only be making 3x that

 

[guytakingboards]

Physicians aren’t paid nearly enough. My girlfriend who went to a below average stage school recently graduated and works in finance recently just got a bonus that brings her up to nearly 100k. No way some doctors should only be making 3x that

The golden age of physician salaries is long past. My dad, as a pulm crit doc, made in the mid-90's roughly what i made as a fresh attending in radiology in 2019. When you account for 25-30 years of inflation, the purchasing power of my salary was a fraction of what he made.

The double doozies of reimbursement cuts and lack of inflation-adjustment have signficantly gutted the financial upside of healthcare.

 

[Kierkegaard's Bud]

I guess then my question would be why do you think physicians who are more experienced make more?

In fields like rads, at least, experience lends itself to better clinical predictions. Look at the literature.

 

[Splenda88]

The answer is you are generally correct, although “it depends”. Too many variables.

What specialty..what practice setting..what compensation model..etc

My N=1 experience as a W2 employee (internal med trained, no fellowship, hospitalist who works mostly evening or night shifts):

My base rate has increased since year 1 through 5. At first, I was at 150/hr.
Today, I am at 200/hr.
But don’t let that fool you - the extra moonlighting pay rates have been incredible, at on average 250/hr to 300/hr (if there is urgent need) since year 1.

This means, fresh out of residency, with taking on extra shifts, I was making +500K/yr.
For 2023, I will likely clear +700K/yr.

Pretty good deal for someone who only did 3 years of training after med school - not everyone has to do orthopedics, derm, or neurosurg to make this kind of coin.

Here is a shot of my latest biweekly check:

View attachment 370084

Note in my paycheck: says 150/hr base rate for 80 hours of two weeks. But my true base rate is more, at $200/hr due to my contracted hours is fewer as a nocturnist. I am contracted to work 66 hours every two weeks

Projection shows about 650k, which is still impressive.

As a hospitalist, I hope that gravy train does not end any time soon.

 

[wamcp]

Projection shows about 650k, which is still impressive.

As a hospitalist, I hope that gravy train does not end any time soon.

With the annual full year bonus it will definitely be >700k (they are guaranteed for nocturnists, but quality and production-based for day hospitalists)

 

[Splenda88]

With the annual full year bonus it will definitely be >700k (they are guaranteed for nocturnists, but quality and production-based for day hospitalists)

I thought I had a solid hospitalist job; yours is definitely a heck of a lot better in term of salary.

 

[voxveritatisetlucis]

The golden age of physician salaries is long past. My dad, as a pulm crit doc, made in the mid-90's roughly what i made as a fresh attending in radiology in 2019. When you account for 25-30 years of inflation, the purchasing power of my salary was a fraction of what he made.

The double doozies of reimbursement cuts and lack of inflation-adjustment have signficantly gutted the financial upside of healthcare.

Any way it could ever go back to that without some sort of collective action

 

[aldol16]

I guess then my question would be why do you think physicians who are more experienced make more?

It's not a phenomenon unique to physicians. In any field, the more senior you get, the more you make. Because people are paying for that expertise. It's just less with physicians.

 

[mstpgrind]

It's not a phenomenon unique to physicians. In any field, the more senior you get, the more you make. Because people are paying for that expertise. It's just less with physicians.

Hmm interesting - aren’t insurance reimbursements the same code by code?
How does that change with experience?

 

[aldol16]

Hmm interesting - aren’t insurance reimbursements the same code by code?

That's not the only way physicians are paid. Professional fees are the same, sure. But when you're part of a group practice, you're splitting the pie and the senior people get a bigger slice. And better call schedules. Also, the more senior people are more likely to have a stake in owning practices, ASCs, etc.

 

[ChordaEpiphany]

I've gotten more efficient and get better referrals as well.

When you say better referrals, do you mean you've carved out a referral base that pays better on an RVU/time basis? I imagine it would be very wise to do an analysis at the start of your career as an attending (or even a fellow) and figure out which diagnoses/procedures pay the best in RVU/time and establish a reputation as the best person for that diagnosis/procedure.

It's not a phenomenon unique to physicians. In any field, the more senior you get, the more you make. Because people are paying for that expertise. It's just less with physicians.

It's less with physicians because physicians aren't really paid based on proficiency. Sure, you'll get fewer referrals as a specialist if the PCPs all see you as a liability, but overall you're paid because of the license you hold and then it's just "eat what you kill" for reimbursement. If you get paid more with seniority it's because you are more efficient, generate more RVUs, or have been established for a long enough time to get into a privileged position. As others have mentioned, buying into a surgicenter, dialysis unit, etc... brings in more income. Usually you need to have spent a few years as an attending building up cash reserves to buy into something like that, but investments like that can be most of your income for private practice docs.

 

[ChordaEpiphany]

The golden age of physician salaries is long past. My dad, as a pulm crit doc, made in the mid-90's roughly what i made as a fresh attending in radiology in 2019. When you account for 25-30 years of inflation, the purchasing power of my salary was a fraction of what he made.

The double doozies of reimbursement cuts and lack of inflation-adjustment have signficantly gutted the financial upside of healthcare.

I hear this sentiment all the time on here, but I've yet to see data backing it up. While I believe some physicians were among society's wealthiest, physicians have long held status as top 1-5% earners and have never had a reputation as being ludicrously wealthy like folks in finance. It's hard to believe physicians were ever raking in the equivalent $1M+ or even $500K+. Attending incomes have largely kept up with inflation. What's changed is training length, cost of education, and a consolidation of people into urban/metro areas, which has made housing equivalent to what you probably grew up with incredibly difficult to come by, even if you're making 2x what your parents did, adjusted for inflation.

I think the market was a little wilder and allowed for greater variation. So there are tons of stories of cardiac surgeons doing CABG after CABG and making $1M+ back in 1993. But overall it seems like data and anecdotes point towards steady pay. My dad graduated from medical school in 1982, and he told me he considered taking a position in EM after his IM residency for ~$100K/year, and that was considered a lot of money ($312K in 2023 dollars, so about what EM makes now). He was in private practice and made ~$350K average as a nephrologist with pretty consistent increases (and I think $250K of that was clinical income, as in not from ancillary investments like dialysis centers or medical director fees from hospitals) from 1995-2015.

The average internist was making ~$140K in 1995 according to this article, which is $277K in 2023 dollars. Radiologists were making $250K ($495K in today's dollars), and orthopedists were making $300K ($595K in today's dollars). Seems pretty consistent with today. That makes sense, because physician's incomes have always been sort of made up. It's a fake "free market" deciding reimbursements that's really just CMS testing physicians' leverage and pain tolerance and private payers following along. It's not surprising that very little has changed in the last 30 years.

 

[Splenda88]

The average internist was making ~$140K in 1995 according to this article, which is $277K in 2023 dollars. Radiologists were making $250K ($495K in today's dollars), and orthopedists were making $300K ($495K in today's dollars). Seems pretty consistent with today. That makes sense, because physician's incomes have always been sort of made up. It's a fake "free market" deciding reimbursements that's really just CMS testing physicians' leverage and pain tolerance and private payers following along. It's not surprising that very little has changed in the last 30 years.

These salaries appear to keep up w/ inflation

CPI Inflation Calculator

 

[whoknows2012]

These salaries appear to keep up w/ inflation

CPI Inflation Calculator

The “golden age” salaries lore that for >15 years (I joined sdn back in 2008) has percolated on this forum is largely a myth. Other external factors have dictated changes to the lifestyle of a physician in 2023 vs 1988 (as mentioned above, education cost, cost of living, as well as administrative burdens emr etc) that largely explain the the differences.

 

[yeetus]

https://www.washingtonpost.com/archive/politics/1992/05/21/doctors-average-income-164300/a53f3355-43dd-46d0-85d1-bdc501f117cf/

I found a 1992 WaPo article about physician salaries in 1990. I made a table adjusting them for inflation.

Specialty	1990 Salary	Adjusted for Inflation (2023)
Median US Doctor	$130K	$300K
Average US Doctor	$164K	$379K
Average Surgery	$236K	$545K
Average Radiology	$219K	$505K
Average Anesthesiology	$207K	$478K
Average OBGYN	$207K	$478K
Average Family Medicine	$103K	$238K
Average Pediatrician	$107K	$247K

 

[aldol16]

It's less with physicians because physicians aren't really paid based on proficiency. Sure, you'll get fewer referrals as a specialist if the PCPs all see you as a liability, but overall you're paid because of the license you hold and then it's just "eat what you kill" for reimbursement. If you get paid more with seniority it's because you are more efficient, generate more RVUs, or have been established for a long enough time to get into a privileged position. As others have mentioned, buying into a surgicenter, dialysis unit, etc... brings in more income. Usually you need to have spent a few years as an attending building up cash reserves to buy into something like that, but investments like that can be most of your income for private practice docs.

The key is the "established for a long enough time." When you're more established in a group practice, you're not doing the crappy cases with small RVUs relative to the amount of actual work you put in (RVUs are supposed to be an indicator of difficulty/amount of work but in reality just reflect lobbying efforts - just talk to any Mohs surgeon) - you can offload those onto your newer partners who are building their practices (to an extent). Also, as I stated in my subsequent comment, you're getting the benefits of buying into the group, into ASCs, etc.

 

[operaman]

When you say better referrals, do you mean you've carved out a referral base that pays better on an RVU/time basis? I imagine it would be very wise to do an analysis at the start of your career as an attending (or even a fellow) and figure out which diagnoses/procedures pay the best in RVU/time and establish a reputation as the best person for that diagnosis/procedure.

It's less with physicians because physicians aren't really paid based on proficiency. Sure, you'll get fewer referrals as a specialist if the PCPs all see you as a liability, but overall you're paid because of the license you hold and then it's just "eat what you kill" for reimbursement. If you get paid more with seniority it's because you are more efficient, generate more RVUs, or have been established for a long enough time to get into a privileged position. As others have mentioned, buying into a surgicenter, dialysis unit, etc... brings in more income. Usually you need to have spent a few years as an attending building up cash reserves to buy into something like that, but investments like that can be most of your income for private practice docs.

That’s exactly what I did in fellowship- figured out how billing and rvus worked so I could optimize my practice. And yes better referrals tend to be ones with diagnoses that need procedures which is typically where rvus lie, both clinic and OR based procedures.

For me as a subspecialty doc, those referrals typically come from other ENTs. They tend to be higher levels of medical decision making which boosts E&M coding and then they typically require a number of diagnostic procedures which further add up.

I definitely recommend that trainees make a point to learn about billing and coding. This is probably best done near the end of training when you’re close to starting and already have a good grasp of the medical stuff. And talk to recent grads and pick their brain about how they’re doing it in practice. I’m amazed at how little new grads know of the basics - like some don’t even know what a modifier is! Hopefully their coders are catching things and educating them, but many leave a bunch of money on the table.

 

[GadRads]

I hear this sentiment all the time on here, but I've yet to see data backing it up. While I believe some physicians were among society's wealthiest, physicians have long held status as top 1-5% earners and have never had a reputation as being ludicrously wealthy like folks in finance. It's hard to believe physicians were ever raking in the equivalent $1M+ or even $500K+. Attending incomes have largely kept up with inflation. What's changed is training length, cost of education, and a consolidation of people into urban/metro areas, which has made housing equivalent to what you probably grew up with incredibly difficult to come by, even if you're making 2x what your parents did, adjusted for inflation.

I think the market was a little wilder and allowed for greater variation. So there are tons of stories of cardiac surgeons doing CABG after CABG and making $1M+ back in 1993. But overall it seems like data and anecdotes point towards steady pay. My dad graduated from medical school in 1982, and he told me he considered taking a position in EM after his IM residency for ~$100K/year, and that was considered a lot of money ($312K in 2023 dollars, so about what EM makes now). He was in private practice and made ~$350K average as a nephrologist with pretty consistent increases (and I think $250K of that was clinical income, as in not from ancillary investments like dialysis centers or medical director fees from hospitals) from 1995-2015.

The average internist was making ~$140K in 1995 according to this article, which is $277K in 2023 dollars. Radiologists were making $250K ($495K in today's dollars), and orthopedists were making $300K ($595K in today's dollars). Seems pretty consistent with today. That makes sense, because physician's incomes have always been sort of made up. It's a fake "free market" deciding reimbursements that's really just CMS testing physicians' leverage and pain tolerance and private payers following along. It's not surprising that very little has changed in the last 30 years.

Salaries may be equivalent accounting for inflation, but the effort required per dollar has gone up significantly. Reimbursement per RVU has also gone down. This is true across specialties. Take a look at the medicare conversion factor over the last 20 years to see the problem. The older radiologists in my practice had a good amount of work downtime in the 90s and early 2000s, now they are working harder. Volumes are much higher these days and we are reading imaging studies at a frenetic pace.

 

[SurfingDoctor]

https://www.washingtonpost.com/archive/politics/1992/05/21/doctors-average-income-164300/a53f3355-43dd-46d0-85d1-bdc501f117cf/

I found a 1992 WaPo article about physician salaries in 1990. I made a table adjusting them for inflation.

Specialty	1990 Salary	Adjusted for Inflation (2023)
Median US Doctor	$130K	$300K
Average US Doctor	$164K	$379K
Average Surgery	$236K	$545K
Average Radiology	$219K	$505K
Average Anesthesiology	$207K	$478K
Average OBGYN	$207K	$478K
Average Family Medicine	$103K	$238K
Average Pediatrician	$107K	$247K

Man, I need to become more of an average pediatrician.