The Moral Healthcare Blog

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N Engl J Med. 1994 May 5;330(18):1280-6.
Comment in:
N Engl J Med. 1994 May 5;330(18):1311-2.
A comparison of the educational costs and incomes of physicians and other professionals.
Weeks WB,
Wallace AE,
Wallace MM,
Welch HG.
Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, VT 05009.
BACKGROUND. Efforts at physician-payment reform in the United States have focused largely on the relative incomes of primary care physicians and specialists, who more often have procedure-based practices. Comparisons of the incomes of physicians and other professional groups have received less attention. METHODS. We used standard financial techniques to determine the return on educational investment over a working lifetime for five groups of professionals: primary care physicians, specialist physicians, dentists, attorneys, and graduates of business schools. RESULTS. In current dollars, the difference in the average future hourly income between a given professional and a high-school graduate of the same age, after educational expenses are subtracted (average hours-adjusted net present value of the educational investment) was greatest for specialist physicians and attorneys; dentists and businesspeople had intermediate values; and primary care physicians had the lowest value. The annual yield on the educational investment over a working life (hours-adjusted internal rate of return) was 15.9 percent for primary care physicians, as compared with 29.0 percent for businesspeople, 25.4 percent for attorneys, 20.9 percent for specialist physicians, and 20.7 percent for dentists. A sensitivity analysis showed that primary care physicians did less well in terms of the return on investment than the other groups even when we varied the assumptions in our model widely and that specialist physicians did less well than attorneys working in law firms and dental specialists. CONCLUSIONS. Students can expect a poorer financial return on their educational investment when they choose a career in primary care medicine than when they choose a procedure-based medical or surgical specialty, business, the law, or dentistry.
PMID: 8145784 [PubMed – indexed for MEDLINE

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Am J Med. 2002 Oct 1;113(5):393-9.
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Long-term financial implications of specialty training for physicians.
Weeks WB,
Wallace AE.
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA. william.b.weeks@dartmouth.edu
PURPOSE: Given the recent changes in physician reimbursement and managed care penetration, we examined the financial returns that might be anticipated when considering different medical careers. METHODS: We used survey data from the American Medical Association and standard financial techniques to calculate the return on educational investment (as the discounted, annual hours-adjusted, net present value of additional training) over a working lifetime for six different specialties (family practice, pediatrics, general internal medicine, gastroenterology, cardiology, and general surgery). RESULTS: From 1992 to 1998, the annual yield on specialty training (hours-adjusted internal rate of return) declined for all specialty groups, especially for primary care specialties. The difference in the average income between a given specialty and general practice decreased for general internal medicine, from $5400 (95% confidence interval [CI]: $5000 to $5800) in 1992 to $1180 (95% CI: $1160 to $1205) in 1998, and became negative for family practice (from $5200 [95% CI: $1000 to $9500] to -$2500 [95% CI: -$5800 to $800]) and pediatrics (from $4000 [95% CI: $1200 to $6800] to -$6300 [95% CI: -$9700 to -$2900]). Values for surgery decreased from $33,100 (95% CI: $29,400 to $36,400) in 1992 to $27,200 (95% CI: $21,700 to $32,100) in 1998, whereas there were increases for cardiology, from $35,100 (95% CI: $30,000 to $39,700) to $36,700 (95% CI: $26,500 to $45,700), and for gastroenterology, from $30,000 (95% CI: $21,800 to $37,200) to $34,700 (95% CI: $22,700 to $45,300). CONCLUSION: Our analysis suggests that recent efforts to use financial incentives to make primary care fields more attractive have not been effective. Financial returns and the incentives they create should be carefully considered as part of health care reform.
PMID: 12401534 [PubMed – indexed for MEDLINE]

Link to Bureau of Labor Statistics info on American physician salaries (from MGMA)
Physicians and surgeons

Physicians and surgeons: “Earnings[About this section] Back to Top

Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association’s Physician Compensation and Production Survey, median total compensation for physicians in 2004 varied by specialty, as shown in table 2. Total compensation for physicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bonus and/or incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation.
Table 2. Median total compensation of physicians by specialty, 2004Less than two years in specialtyOver one year in specialty
Anesthesiology$259,948$321,686
Surgery: General228,839282,504
Obstetrics/gynecology: General203,270247,348
Psychiatry: General173,922180,000
Internal medicine: General141,912166,420
Pediatrics: General132,953161,331
Family practice (without obstetrics)137,119156,010
SOURCE: Medical Group Management Association, Physician Compensation and Production Report, 2005.

Self-employed physicians—those who own or are part owners of their medical practice—generally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, and skill, personality, and professional reputation. Self-employed physicians and surgeons must provide for their own health insurance and retirement.”