Becoming a physician requires an extensive education. After earning a bachelor's degree, aspiring physicians spend four years in medical school and then an additional three to eight years in residency and fellowship programs, depending on the specialty. The financial rewards can be substantial, however. Although physicians tend to be well paid, determining the gross income of an average physician is difficult. Numerous factors influence earnings, such as specialty, location, nature of practice, experience and professional reputation. National Statistics The U.S. Bureau of Labor Statistics tracks earnings for many medical specialists in separate categories. About the closest one can come to the "average" physician salary is the "Physicians and Surgeons, All Other" category. As of 2012, the BLS reported an average annual income of $184,820 for this category. Even within the category, however, there were significant variations in average salaries when analyzing earnings by employer type. For example, physicians employed by postsecondary institutions averaged $113,230 a year, while those employed in dental offices averaged $243,830. General hospitals provided an average salary of $140,060, but outpatient care facilities reported an average annual salary of $214,240. The federal government paid physicians an average of $187,560, while physicians' offices paid an average of $215,650. State Statistics The state in which a physician practices affects earnings dramatically. According to the BLS, in 2012, physicians and surgeons averaged the highest earnings -- $236,470 a year -- in Mississippi. Annual incomes in Minnesota, Maine and South Dakota were also well above the national average at $235,730, $235,620 and $235,230, respectively. In contrast, physicians in Oklahoma and Nebraska did not fare as well. The average salary in Oklahoma was $136,250 a year, while it was $141,370 in Nebraska. Physicians and surgeons in Massachusetts averaged $155,470 a year. In Illinois, the average was $163,050. Highest Average Salaries for Specialists According to the BLS, physicians with medical specialties earned significantly more than those without. This was largely supported by a survey conducted in 2011 by "Modern Healthcare" and released by the American Medical Association. Again, however, there were exceptions. According to an article in "Time," doctors specializing in radiology and orthopedics had the highest average earnings in 2011, at $315,000 per year. Cardiologists averaged $314,000 a year, while plastic surgeons averaged $270,000 annually. The "Modern Healthcare" survey reported salary ranges, rather than averages. The survey gave a range of $400,000 to $562,500 for radiologists and $378,062 to $576,350 for orthopedic surgeons. The salary range for cardiologists was $346,266 to $532,000. It was $360,000 to $450,000 for plastic surgeons. Lowest Average Salaries for Specialists The "Time" article stated that pediatrics and family practice were the two lowest-paying specialties. Pediatricians averaged $156,000 annually, and family practitioners averaged $158,000. General internists earned approximately $165,000 a year, while psychiatrists averaged $170,000. The "Modern Healthcare" survey supported the data, giving an annual salary range of $161,732 to $229,041 for pediatricians, $162,908 to $221,196 for family practitioners, $188,500 to $236,544 for internists, and $182,240 to $237,330 for plastic surgeons. Source