Highest, Lowest Paid Specialties for 2014

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Typically, physicians who perform procedures are paid the highest and those managing chronic illnesses are at the bottom of the compensation list.

In keeping with past results, orthopedics reported the highest physician compensation, according to the annual Medscape Physician Compensation Report.

Typically, physicians who perform procedures are paid the highest and those managing chronic illnesses are at the bottom of the compensation list.

Overall, physician compensation was mostly flat, with very slight increases in some specialties and even a decrease for the second most highly compensated specialty, according to the report. Most specialties only reported a year over year salary increase of 2% or 3% in 2014. In comparison, in 2013 salaries had increased by 11% year over year for many specialties and even 29% for orthopedics.

Leslie Kane

"Compensation may not be the only reason that medicine has become a less attractive career choice than it once was," said , Director, Business of Medicine for Medscape. "Changes in the healthcare landscape, increased paperwork, more rules, less autonomy and legal woes are also having a major impact on physicians' career choices and overall satisfaction."

In this year’s report, rheumatologists reported the largest salary increase (15%) and nephrologists reported the largest salary decrease (-8%). According to the report, the small decline in compensation could reflect early changes in reimbursement resulting from the Affordable Care Act.

While female physicians still earn significantly less than their male counterparts ($204,000 and $267,000, respectively), the wage gap is shrinking. From 2010 to 2013, the salaries for male physicians increased by 19%, while women enjoyed an increase of 26%.

Overall, physicians are split 50-50 on whether or not they feel fairly compensated, though, primary care physicians are more likely to say they aren’t (52%). These responses have changed little in 3 years, according to Medscape. Dermatologists feel the most fairly compensated (64%) while plastic surgeons are the least likely to feel fairly compensated (37%).

Geographical region continues to play a major role in physician compensation, with the middle of the country still boasting the highest earners.

In the past 3 years participation in an Accountable Care Organization has jumped up from 3% in 2011 to 24% in 2013; meanwhile just 3% are participating in a concierge practice. Few physicians plan to stop taking current Medicare/Medicaid patients (3% of self-employed and 1% of employed), although 15% of self-employed physicians will stop taking new Medicare/Medicaid patients (compared to 5% of employed).

"Between coverage and reimbursement concerns, physicians are often caught between a rock and a hard place when it comes to the relationships they share with patients," said Kane. "Many doctors refuse to drop patients for insurance-related issues, primarily because they care about their patients and consider it inappropriate," Kane added, "However, others realize that 'time is money', and have made the tough decision to drop patients in order to keep their practices viable."

However, physicians could be doing a better job of discussing costs with patients. Just a third of respondents said they regularly discuss the cost of treatment with patients, while 40% said they do so occasionally, if they patients brings it up. Meanwhile 15% never discuss costs—11% because they don’t know it, and 5% because they feel it is inappropriate.

Unsurprisingly, physicians in the highest paid specialties are far more likely than those in the lowest paid specialties to say they would choose the same specialty if they could do it all over again. However, the lowest paid specialties are much more likely to say they would still choose medicine again.

See the highest paid specialties on the next page.

Highest paid specialties

5. Radiology

Mean income 2014 report: $340,000

Mean income 2013 report: $315,000

Satisfaction with compensation: 53%

Would choose same specialty: 54%

3. (tied) Gastroenterology

Mean income 2014 report: $348,000

Mean income 2013 report: $303,000

Satisfaction with compensation: 47%

Would choose same specialty: 59%