Although compensation is still a sore issue for many physicians, according to Medscape’s 2015 Physician Compensation Report, most saw modest to significant gains.

The top three earners in this year’s report are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000). Likewise, in 2011 — the first year Medscape conducted this survey — orthopedists topped the list, followed by radiologists and anesthesiologists.

The average compensation for a primary care physician (PCP) in 2014 was $195,000 and for a specialist it was $284,000.
The three lowest earners for patient care were pediatricians ($189,000), family physicians ($195,000), and endocrinologists and internists (both at $196,000), according to the report. The bottom earners in 2011were also pediatricians, followed by primary care physicians, and endocrinologists.

More than 19,500 physicians in 26 specialties responded to this year’s survey between December 30, 2014, and March 11, 2015, reporting their compensation, number of hours worked, and career satisfaction.

Career, Compensation Satisfaction

About half of PCPs (47%) and half of specialists (50%) are happy with their compensation. PCPs feel about the same as they did in the 2011 Medscape Compensation Report, but specialists feel slightly less fairly compensated than in 2011, when 52% of them were satisfied.

Although only 48% of family physicians and 45% of internists feel they are fairly compensated, ophthalmologists (40%), allergists, and general surgeons (both 41%) are the least happy.
Dermatologists (61%) and emergency medicine physicians and pathologists (both 60%) are the most satisfied with their compensation. Compensation increased by 12% for emergency medicine physicians and pathologists in the past year.

According to the new report, the physicians with the highest career satisfaction are dermatologists (63%), followed by pathologists and psychiatrists (both 57%). The physicians with the least career satisfaction are internists (47%) and then nephrologists and general surgeons (48% and 49%, respectively).

In the 2011 Medscape Compensation Report, most physicians (69%) reported they would choose medicine as a career again, and 61% would choose their same specialty. In the newest report, 64% would still select medicine, but only 45% would stick with the same specialty.

Nonpatient Care Activities

Orthopedists also make the most compensation from nonpatient-care activities ($29,000), including expert witness duties, product sales, and speaking engagements. Next in line are urologists, plastic surgeons, and dermatologists (all three $26,000).

Radiologists ($6000), make the least in this category, followed by pediatricians ($7000), and anesthesiologists ($8000). Physicians, especially PCPs, who are at the lower end of patient-work compensation, also tend to get less in nonpatient-care compensation.

Rheumatologists, Urologists See Decrease, Others Increase
Compared with last year’s report, this year’s compensation for rheumatologists decreased the most, by 4%, followed by urologists, whose income decreased by 1%.

Compensation increased for all other physicians, with the greatest among infectious disease physicians (22%), followed by primarily hospital-based physicians: pulmonologists (15%) and emergency medicine physicians and pathologists (both at 12%).

Notably, compensation for family physicians increased by 10%.

Compensation Varies by Geographic Region

The wide variation in cost of living in certain geographic areas of the United States is problematic for the Centers for Medicare & Medicaid Services because of the need to balance the higher cost of living in some areas with the difficulty in attracting physicians to underserved areas with lower living costs.

Several government policies geared toward improving physician access in rural regions have resulted in higher incomes in several poorer regions, with the three top-earning states listed as North Dakota and Alaska ($330,000 each), and Wyoming ($312,000).

Overall, the highest salaries in this year’s survey were reported in the Northwest ($281,000) and South Central ($271,000) regions of the United States, and the lowest earnings were in the Northeast ($253,000) and the Mid-Atlantic ($254,000).

In 2011, the Medscape Compensation Report noted that the highest earners were in the West and North Central areas of the United States and the lowest earners were in the Southwest and Northeast.

This year’s report shows the lowest-paying regions were the District of Columbia ($186,000), Rhode Island ($217,000), and Maryland ($237,000) — all which are on the East Coast, where nonphysician incomes are generally higher than in other parts of the country. New Mexico and Utah were the only non-Eastern states in the bottom 10 for compensation.

Employment vs Self-Employment

In this year’s survey, most (63%) physicians are employed and make significantly less than the 32% of their colleagues who are in private practice. According to a major physician recruiter, 11% of physicians were employed by hospitals in 2004, and this rose to 64% in 2014.

PCPs who are employed make $189,000, and self-employed PCPs report annual earnings of $212,000. These figures are far less than average compensations for employed ($258,000) or self-employed ($329,000) specialists.

Women Earn Less, Work Fewer Hours

Women still earn less per year ($215,000) than their male counterparts ($284,000), according to the report, although the overall difference between women and men has decreased slightly since 2011, going from 28% in 2011 to 24% this year.

The data show that even women who are employed full-time work fewer hours per week and see fewer patients than their male counterparts. Greater flexibility and shorter hours may help improve female physician satisfaction and fend off burnout.