2009 earnings survey: How do you compare?

According to the survey, which was administered in April and May to more than 100,000 office-based MDs and DOs in more than 16 specialties, median earnings for family physicians, internists, general practitioners, pediatricians, and ob/gyns remained roughly the same in 2008 as they were in 2007. Among them, ob/gyns were the top earners, posting a median income of $237,500.

Pediatricians averaged $187,500, followed by FPs, GPs, and internists at $162,500.

Sage notes that there was very little upward change in fee schedule reimbursement from Medicare and other third-party payers in the past year, thus adding to the challenge.

The equation is balanced to a degree, she says, by a rise in practice startups in urban and rural areas that have long experienced physician shortages, particularly in primary care. In general, she believes, "Physicians recognized the recessionary trend early and were judicious about keeping their costs under control as much as possible to avoid a loss of profitability."

Family physician Holly Abernethy practices in Farmington, New Mexico, an area with "a huge primary care physician access problem," as she puts it. She earned about the same in 2008 as she did in 2007, but doing so required working additional hours during the fall and winter months.

Soon, she'll be joining a new practice that offers her a partnership opportunity-though it comes with the tradeoff of lower starting pay.

"A partnership is more important for me and my future," says Abernethy. "The opportunity for more money will come."

Jeffrey B. Milburn, a Colorado Springs consultant with the Medical Group Management Association, says that physicians who earned more or roughly the same in 2007 and 2008 probably did so the old-fashioned way: by reducing expenses and increasing productivity. He adds, however, that the "ripple effect" of increased unemployment-with expiring healthcare benefits and less discretionary income-bodes poorly for physician earnings in 2009.

"I still like my work," he says. "I just hate the payments. Medicaid-which pays about 10 percent of billed charges for gynecological services, at best-and other third-party payers make it increasingly difficult to remain profitable."