Which specialties have the biggest variability in pay grade?

[deleted849476]

Pardon the taboo topic, but I just want to build my understanding of specialty pro/cons including salary as one aspect of that.

I'm mostly talking about primary care, but would be open to hearing answers from other specialties as well. Not looking for "which specialty pays the most," but rather "how much more can you make in a certain specialty if you do career moves X,Y,Z" (especially as compared to doing a very traditional path for the same specialty, for example: general IM, working as an employee at a hospital, working average hours, etc.).

What I'm looking for would probably sound like, "for IM you could go locum tenens, negotiate higher pay/take more shifts and earn X as compared to Y."

In other words, what are you stories for higher earnings/interesting earnings situations? These usually pop up in other threads as anecdotes but maybe we can dedicate this thread to it. Not looking for info on HPSP or PSLF.

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[DarkHorizon]

Ophthalmology

 

[Postictal Raiden]

Pathology, literally anywhere from being unemployed to sky is the limit

 

[libertyyne]

Ortho Spine
derm Mohs
Ortho Hips
these have the largest variation between 25th percentile and top performers .

 

[efle]

Here are the main MGMA specialties, sorted by their IQR divided by their median. For example, if a specialty has an IQR of 200k-400k and a median of 300k, they would be listed as 200/300 = 66%

Note this comes from the data for non-academic only

Specialty	IQR / Median
Allergy/Immuno	72.5%​
Dermatology: Mohs Surgery	72.0%​
Ophthalmology	64.9%​
Orthopedic Surgery: Spine	64.0%​
Orthopedic Surgery: Sports Medicine	63.9%​
Nephrology	61.1%​
Pain Management (Non-Anesthesia)	59.7%​
Anesthesia: Pain Management	57.8%​
OBGYN (Gynecological Oncology)	56.9%​
Dermatology	56.2%​
Orthopedic Surgery: Hip and Joints	54.0%​
Surgery: Plastic Recon (Plastic Surgery)	53.3%​
Pulmonary Medicine (General)	52.7%​
Orthopedic Surgery: Hand	52.6%​
Otorhinolaryngology	52.4%​
Pediatrics: Neonatal Medicine	52.4%​
OBGYN (Gynecology ONLY)	51.7%​
Hematology/Oncology	50.9%​
Orthopedic Surgery (General)	50.1%​
Physical Medicine and Rehab (Physiatry)	49.8%​
Surgery: Oncology	48.8%​
Surgery: Thoracic	48.7%​
Gastroenterology	48.4%​
Podiatry (General)	48.3%​
Obstetrics/Gynecology (General)	48.1%​
Urology	48.0%​
OBGYN (Urogynecology)	47.5%​
Internal Medicine (Ambulatory Only)	46.8%​
Surgery: Neurological (Neurosurgery)	46.4%​
Infectious Disease	46.3%​
Surgery (General)	46.0%​
Surgery: Colon and Rectal	45.8%​
Pediatrics: General	45.5%​
Podiatry: Foot and Ankle Surgery	45.1%​
Cardiology: Noninvasive	45.1%​
Family Medicine (with OB)	45.0%​
Pediatrics: Cardiology	44.8%​
Pulmonary Medicine: Critical Care	44.1%​
Surgery: Cardiovascular	43.9%​
Radiology (Diagnostic)	43.1%​
Hospitalist: Family Medicine	43.0%​
Internal Medicine (General)	43.0%​
Neurology	42.4%​
Surgery: Vascular (Vascular Surgery)	41.0%​
Cardiology: Electrophysiology	41.0%​
Surgery: Bariatric	41.0%​
OBGYN (Maternal Fetal Medicine)	40.4%​
Family Medicine (without OB)	39.8%​
Surgery: Breast	39.8%​
Pediatrics: Neurology	39.2%​
Radiation Oncology	39.1%​
Pediatrics: Surgery	38.9%​
Pediatrics: Hematology Oncology	38.8%​
Psychiatry (General)	38.6%​
Cardiology: Invasive	38.3%​
Cardiology: Invasive Interventional	38.0%​
Rheumatology	37.9%​
Pediatrics: Internal Medicine	37.6%​
Family Medicine - Ambulatory Only	37.3%​
Geriatrics	37.1%​
Endocrinology/Metabolism	36.9%​
Urgent Care	36.2%​
Anesthesia	35.7%​
Pathology: Anatomic and Clinical	35.0%​
Orthopedic Surgery: Trauma	34.9%​
Pediatrics: Critical Care/Intensivist	34.7%​
Emergency Medicine	33.9%​
Pulmonary Medicine: General + CC	33.8%​
Family Medicine - Sports Medicine	33.8%​
Psychiatry: Child and Adolescent	33.6%​
Pediatrics: Gastroenterology	33.6%​
Critical Care Intensivist	31.6%​
Pediatrics: Hospitalist	31.2%​
Surgery: Trauma	30.4%​
Hospitalist: Internal Medicine	29.8%​
Occupational Medicine	29.7%​
Hospice/Palliative Care	24.0%​

 

[deleted849476]

Here are the main MGMA specialties...

Very interesting data, thank you!

 

[Tenk]

Pathology, literally anywhere from being unemployed to sky is the limit

You’re like on a street corner with a microscope and a cardboard sign saying: will read slides for food.

 

[CidHighwind]

Ophthalmology

/thread. Have some making 150k or less, while others making 10s of millions a year.

 

[The Knife & Gun Club]

The academic pay in some of the surgical subs is astronomically slow. Some could net close to a mil in the community

 

[Mass Effect]

Psychiatry. You can make as little as $170K in academics to as much as $500/hour in private practice. I recently got an ad for a job in the midwest with base salary of $400K.

 

[Mad Jack]

Pardon the taboo topic, but I just want to build my understanding of specialty pro/cons including salary as one aspect of that.

I'm mostly talking about primary care, but would be open to hearing answers from other specialties as well. Not looking for "which specialty pays the most," but rather "how much more can you make in a certain specialty if you do career moves X,Y,Z" (especially as compared to doing a very traditional path for the same specialty, for example: general IM, working as an employee at a hospital, working average hours, etc.).

What I'm looking for would probably sound like, "for IM you could go locum tenens, negotiate higher pay/take more shifts and earn X as compared to Y."

In other words, what are you stories for higher earnings/interesting earnings situations? These usually pop up in other threads as anecdotes but maybe we can dedicate this thread to it. Not looking for info on HPSP or PSLF.

Psych can make $200k/yr in community mental health or $500/hr in cash-only private practice in the right area.

 

[CidHighwind]

Psych can make $200k/yr in community mental health or $500/hr in cash-only private practice in the right area.

Don’t you usually have to have the right credentials to work in places like that (come from a residency with name brand prestige)

 

[Doctor Strange]

I interviewed for internal medicine primary care jobs last year so can speak to this.

Salaries can range pretty widely, and a lot of it has to do with location and academic vs community/private practice. I would say that you're going to make the least at an urban academic center and the most at a private practice/community practice out in the middle of nowhere (think "fly over" states). When I was applying, I would get phone calls and e-mails on a daily basis from practices in places like Wyoming, North Dakota, etc. that were offering base salaries of upwards of 300-500K on top of signing bonuses, loan repayment, relocation reimbursement, generous CME stipend, and residency stipends. The drawback, obviously, is that you have to live there. In speaking with colleagues that interviewed for academic primary care jobs in the city (I didn't), the salary range was usually towards the 150-200K range and offered little beyond a signing bonus in terms of benefits.

Aside from the base salary, you often can make more if you are meeting your RVU targets. Most contracts will specify that the base salary is in place for X-amount of years, after which time you will move to the RVU-based compensation plan. Oftentimes, you will automatically migrate to the RVU-based compensation plan if you outpace your base salary earlier than the number of years specified in the contract.

I ended up signing with a practice somewhere in the middle at a rural/suburban practice in my hometown with a base salary in the low 200Ks and income potential closer to 300K. I also got a signing bonus and a residency stipend with an additional retention bonus that will be paid at the end of every year I am there for three years. CME stipend is also quite generous.

Feel free to reach out to me with any further questions, though as a medical student, I anticipate that it will be awhile before this becomes fully relevant to you.

 

[Mad Jack]

Don’t you usually have to have the right credentials to work in places like that (come from a residency with name brand prestige)

No, but it helps. I've seen NPs that charge $350 for initial evals and $200 for follow-ups, to give you an idea. Even a DO could pull that kind of money by marketing themselves as a "holistic psychiatrist" and insisting that they focus on nutrition a d what not in addition to regular psychiatric treatment.

 

[efle]

Don’t you usually have to have the right credentials to work in places like that (come from a residency with name brand prestige)

No, but it helps. I've seen NPs that charge $350 for initial evals and $200 for follow-ups, to give you an idea. Even a DO could pull that kind of money by marketing themselves as a "holistic psychiatrist" and insisting that they focus on nutrition a d what not in addition to regular psychiatric treatment.

I think it's more about where you practice than where you trained. Plenty of crazies with daddy's or hubby's credit card along the west coast. These are states where you can run a successful solo practice as an ND, hard to have worse credentials than that.

 

[CidHighwind]

I think it's more about where you practice than where you trained. Plenty of crazies with daddy's or hubby's credit card along the west coast. These are states where you can run a successful solo practice as an ND, hard to have worse credentials than that.

Right, but typically the rich, snobby communities will research their doctors and will want someone that trained at an elite program. Or at least one with name recognition like UCLA. That said, the best hair transplant surgeon is a DO, and that didn’t stop him from doing well in LA

No, but it helps. I've seen NPs that charge $350 for initial evals and $200 for follow-ups, to give you an idea. Even a DO could pull that kind of money by marketing themselves as a "holistic psychiatrist" and insisting that they focus on nutrition a d what not in addition to regular psychiatric treatment.

True, the holistic stuff is a huge hustle. That said I would want a holistic doc to at least have an MD. But I guess with wait times as they are for psychiatry people will pay more to skip the line

 

[Mad Jack]

Right, but typically the rich, snobby communities will research their doctors and will want someone that trained at an elite program. Or at least one with name recognition like UCLA. That said, the best hair transplant surgeon is a DO, and that didn’t stop him from doing well in LA



True, the holistic stuff is a huge hustle. That said I would want a holistic doc to at least have an MD. But I guess with wait times as they are for psychiatry people will pay more to skip the line

MDs have basically zero training in nutrition and health science, it's not really a good indicator one way or the other with regard to holistic anything. DOs can at least say their education is based around a holistic model and most of us get some training in nutrition and diet beyond "DASH and Mediterranean diets good, American diet bad."

 

[ace_inhibitor111]

MDs have basically zero training in nutrition and health science, it's not really a good indicator one way or the other with regard to holistic anything. DOs can at least say their education is based around a holistic model and most of us get some training in nutrition and diet beyond "DASH and Mediterranean diets good, American diet bad."

There’s a lot of poor quality research or conflicting evidence out there on nutrition. People are just too emotionally involved with their food. DASH and Mediterranean diets are recommended so much because they have probably the best evidence compared to the rest.

 

[Ganon]

MDs have basically zero training in nutrition and health science, it's not really a good indicator one way or the other with regard to holistic anything. DOs can at least say their education is based around a holistic model and most of us get some training in nutrition and diet beyond "DASH and Mediterranean diets good, American diet bad."

I got a good bit of nutritional education in my M1 year.
Unfortunately, this sentiment has become a stereotype for physicians, and I think it's very damaging.

 

[Mad Jack]

I got a good bit of nutritional education in my M1 year.
Unfortunately, this sentiment has become a stereotype for physicians, and I think it's very damaging.

It's usually a lecture or three that most students completely skip because it's low yield.

Status of nutrition education in medical schools

Numerous entreaties have been made over the past 2 decades to improve the nutrition knowledge and skills of medical students and physicians. However, most graduating medical students continue to rate their nutrition preparation as inadequate.The objective ...

www.ncbi.nlm.nih.gov

Anyway, I guess the point is one can easily sell themselves as "holistic" with the DO degree, regardless of the merit behind such statements, which can increase one's market value if you're targeting certain crowds of woo-types

 

[Mass Effect]

Don’t you usually have to have the right credentials to work in places like that (come from a residency with name brand prestige)

Nope.

 

[Mass Effect]

No, but it helps. I've seen NPs that charge $350 for initial evals and $200 for follow-ups, to give you an idea. Even a DO could pull that kind of money by marketing themselves as a "holistic psychiatrist" and insisting that they focus on nutrition a d what not in addition to regular psychiatric treatment.

A DO could pull that even without doing the "holistic psychiatrist" nonsense.

 

[deleted849476]

Psychiatry. You can make as little as $170K in academics to as much as $500/hour in private practice. I recently got an ad for a job in the midwest with base salary of $400K.

Are those $400k jobs like diamonds in the rough or just a matter of moving to the places in demand (however rural they may be, etc.)?

The ~$500/hr practice also makes me curious, are those just a matter of setting up shop or is that considering peak income after a few years, etc.? Could an entry level psychiatrist just set that rate and build a busy practice over time? Also is it just as easy to decide to start a concierge practice vs. a typical insurance-based one?

Thanks

EDIT: not like I'm expecting it to be easy but just wondering if its a matter of putting in the work vs. being a matter of more-or-less luck

 

[Mass Effect]

True, the holistic stuff is a huge hustle. That said I would want a holistic doc to at least have an MD. But I guess with wait times as they are for psychiatry people will pay more to skip the line

There is no difference in DOs and MDs when it comes to the practice of psychiatry.

 

[Mass Effect]

Are those $400k jobs like diamonds in the rough or just a matter of moving to the places in demand (however rural they may be, etc.)?

I get these ads at least once a week. They're located in rural areas all over the country.

The ~$500/hr practice also makes me curious, are those just a matter of setting up shop or is that considering peak income after a few years, etc.? Could an entry level psychiatrist just set that rate and build a busy practice over time? Also is it just as easy to decide to start a concierge practice vs. a typical insurance-based one?

A friend of mine did this right out of residency in a major metro area. He charged $650 for 90 minute intake and $250 for half-hour follow-up. For more complicated cases, it's $500 for one hour follow up.

 

[You shall know the Truth]

I would say a family med PA that does Botox and CBD oil treatments is a skies the limit type of operation

 

[medhopeful82]

Pardon the taboo topic, but I just want to build my understanding of specialty pro/cons including salary as one aspect of that.

I'm mostly talking about primary care, but would be open to hearing answers from other specialties as well. Not looking for "which specialty pays the most," but rather "how much more can you make in a certain specialty if you do career moves X,Y,Z" (especially as compared to doing a very traditional path for the same specialty, for example: general IM, working as an employee at a hospital, working average hours, etc.).

What I'm looking for would probably sound like, "for IM you could go locum tenens, negotiate higher pay/take more shifts and earn X as compared to Y."

In other words, what are you stories for higher earnings/interesting earnings situations? These usually pop up in other threads as anecdotes but maybe we can dedicate this thread to it. Not looking for info on HPSP or PSLF.

One of the private hospitalist groups (~10 docs) also are medical directors for most of the SNFs in town and go see those patients on they 7d off week (usually just 1-1.5 of those days) each SNF supposedly pays 80-100k/yr for this so they really boost overall income by each having 1-2 of those under their belt.

 

[kb1900]

Are those $400k jobs like diamonds in the rough or just a matter of moving to the places in demand (however rural they may be, etc.)?

The ~$500/hr practice also makes me curious, are those just a matter of setting up shop or is that considering peak income after a few years, etc.? Could an entry level psychiatrist just set that rate and build a busy practice over time? Also is it just as easy to decide to start a concierge practice vs. a typical insurance-based one?

Thanks

EDIT: not like I'm expecting it to be easy but just wondering if its a matter of putting in the work vs. being a matter of more-or-less luck

A new psych grad could open up shop in Manhattan and be booked up in a month at cash only 300-400/hr. This is in an area with a psychiatrist every block and still more demand than supply. Many choose to have some set percent of their practice serve less wealthy patients at a discounted rate or through insurance but typically those slots are filled up immediately.

it was painful trying to set up outpatient referrals even for wealthy cash-paying patients in the city on my psych rotation. Psychiatrists can even screen out certain issues in their patient panel like violent or drug crimes, prior litigious issues etc.

Psych truly is the new derm and it’s not even close imo.

 

[Candidate2017]

it was painful trying to set up outpatient referrals even for wealthy cash-paying patients in the city on my psych rotation. Psychiatrists can even screen out certain issues in their patient panel like violent or drug crimes, prior litigious issues etc.

Why are people surprised that psychiatrists don't have to treat everyone? Psychiatrists are specialists, not primary care physicians. We reserve the right to refuse intervention just like any other specialist. Ortho won't replace hips, neurologists wont push tPA, etc if the patient is not appropriate or non-compliant with the treatment plan.

Lots of people come in wanting controlled substances, magic pills, doctor's note or psychiatric diagnosis that absolves them of any responsibility and refuse any type of behavioral change or therapies: Gimme a 3 month supply of Adderall for depression, Xanax for sleep, I ain't doing rehab, and I need a note saying molesting kids/beating my spouse was due to my bipolar. "Sorry, can't help you buddy."

 

[kb1900]

Why are people surprised that psychiatrists don't have to treat everyone? Psychiatrists are specialists, not primary care physicians. We reserve the right to refuse intervention just like any other specialist. Ortho won't replace hips, neurologists wont push tPA, etc if the patient is not appropriate or non-compliant with the treatment plan.

Lots of people come in wanting controlled substances, magic pills, doctor's note or psychiatric diagnosis that absolves them of any responsibility and refuse any type of behavioral change or therapies: Gimme a 3 month supply of Adderall for depression, Xanax for sleep, I ain't doing rehab, and I need a note saying molesting kids/beating my spouse was due to my bipolar. "Sorry, can't help you buddy."

What you’re saying is not surprising at all. My post was never about starting treatment for anyone either. I understand your need to vent on a reasonable issue, but I think you’re extrapolating out of my post

I was discussing getting standard outpatient follow up for typical inpatients for med refills and checkins etc. since our institution doesn’t have a resident clinic and PP generally screens out a lot of stuff before listening to the full story. It’s just a dispo issue that I’m highlighting exists due to the short supply of psychiatrists even in Manhattan where there’s so many of them.

my whole point was that psychiatry is in such high demand that within reason a psychiatrist can heavily pick and chose the patient population that they serve while keeping a busy practice going. it just wasn’t as drastic for other specialty referrals in my experience