The crippling student loans that burden many medical students may dissuade them from becoming family practitioners or pediatricians. Instead, foreseeing that they will owe about $140,000 at graduation, they might opt to pursue more lucrative specialties like cardiology or urology. With a base pay offer of $189,000 a year, on average, family practitioners, pediatricians, and psychiatrists are offered the lowest pay of all physicians, according to the medical search and consulting firm Merritt Hawkins & Associates’ 2012 Review of Physician Recruiting Incentives. That might seem like serious money, but it pales in comparison an orthopedic surgeon’s $519,000 paycheck. Cardiologists make an awful lot, too. They are guaranteed an average base salary of $512,000, according to the Merritt Hawkins data. The third highest-paying specialty: Urology. These specialists earn an average of $461,000, not including production bonuses or benefits. Why are specialists offered so much more than primary care physicians? One reason is they simply bring in more revenue per doctor. “Primary care may monopolize the headlines, but, by in large, specialists still monopolize physician compensation,” says Travis Singleton, senior vice president of Merritt Hawkins. “Specialists still far out produced their primary care counter parts in terms of guarantees offered by an average of over $150,000.” That’s probably because in medicine today, more value is placed on procedures than on diagnosis and preventive care—but Singleton says, “we’re making progress.” For example, a primary care physician who spends 45 minutes consulting with a diabetic may be paid less than an orthopedic surgeon who spends ten minutes repairing a knee. “Even with recent efforts to pay primary care physicians more, cardiologists and other specialists still are able to generate considerably more revenue than family physicians and other primary care doctors, and hence are paid more,” Singleton says. “I think people will suggest that it costs more to develop a specialist to justify higher salaries, and to an extent that’s correct. However, the primary driver remains the revenue capacity and reimbursement.” The disparity in pay has contributed to a declining interest in primary care and has created a shortage of these doctors. In the 1990s, many medical school graduates were drawn to primary care residencies, enhancing supply, but today many are avoiding the field. “The truth is that medical students have long been deterred from going into primary care not only for economic reasons but for reasons connected to professional prestige,” Singleton says. “Many primary care physicians have told us that during medical school they were counseled by their professors to go into a medical specialty rather than into primary care, because the ‘best students’ specialize,” he adds. But things are starting to look up for primary care physicians this year. Their compensation guarantees, for the first year in several, increased significantly in this past survey. In fact, since 2007, family practitioner salary offers have increased over 10%, or approximately $17,000. In that time period, pediatrics was the single biggest winner of the primary care specialties with an almost 20% gain. “One of the most overlooked reasons for this sudden boom in primary care offers is the rise of employment,” he says. “With more hospitals employing primary care physicians, we are seeing a greater ability to pay larger guaranteed salaries that better reflect the demanding market.” He says it’s expected that this trend will carry on as employment percentages continue to increase—thus reducing the shortage of primary care doctors. Glen Stream, MD, MBI, president of the American Academy of Family Physicians (AAFP), says it’s already happening. Stream says that after two consecutive years of increased medical student interest in family medicine, the AAFP has seen the number of graduates entering these residencies plateau in 2012. "The provisions of the Affordable Care Act that place added value on primary care are a good beginning, but we can't lose momentum,” Stream says. “We need to double down on programs that generate student interest. Now is the time to reform the medical education infrastructure, tear down the barriers to students who want to become primary care physicians, and establish a practice environment that ensures that young primary care physicians can build successful practices that serve the needs of their communities." Singleton concludes, “Though we’ve made strides, we have a ways to go. Politicians may urge medical students that primary care is the route to pursue, but the money still suggests otherwise.” Here’s how much doctors in the top recruited specialties are offered, according to consulting firm Merritt Hawkins & Associates' 2012 Review of Physician Recruiting Incentives. These are the average offered base salaries or guaranteed income, not including production bonus or benefits. 1. Orthopedic Surgeon Average: $519,000 2. Cardiology (invasive) Average: $512,000 3. Urology Average: $461,000 4. Gastroenterology Average: $433,000 5. Otolaryngology Average: $412,000 6. Cardiology (non-invasive) Average: $396,000 7. Dermatology Average: $364,000 8. Hematology/Oncology Average: $360,000 9. Radiology Average: $358,000 10. General Surgery Average: $343,000 11. Pulmonology Average: $321,000 12. Ophthalmology Average: $295,000 13. Neurology Average: $280,000 14. OB/GYN Average: $268,000 15. Emergency medicine Average: $264,000 16. Endocrinology Average: $248,000 17. Hospitalist Average: $221,000 18. Internal medicine Average: $203,000 19. (tie) Psychiatry Average: $189,000 19. (tie) Family practice Average: $189,000 19. (tie) Pediatrics Average: $189,000 Source
