Physician compensation stethoscope and dollars
Like many other people in the U.S., physicians took a financial hit in 2020 because of the COVID-19 pandemic. (Photo source: iStock)

Have you been wondering how much money US doctors made in 2020? It was, after all, a year marked by one of the worst health crises in modern history – the COVID-19 pandemic. The impact on our healthcare system has been profound.

Not only were hospitals inundated with extremely ill patients in certain parts of the country but their most lucrative source of income, elective surgeries, evaporated overnight. This affected everyone who works in hospitals, including surgeons, radiologists, and other hospital-based-physicians.

Furthermore, visits to primary care doctors dropped precipitously as we were confined to our homes. And, the fear of catching COVID at our doctor’s office scared the bejeezus out of many. Even oncologists and other specialists experienced patients staying away even when they urgently needed the care.

Related content: Poor Payer Reimbursement and Practice Viability during COVID-19

Doctors and other healthcare workers found themselves in an unexpected situation with drastic declines in income and even work furloughs.

Interestingly, but not surprisingly, the healthcare sector responded to these threats with innovations that helped turn the financial calamity around. Telemedicine was rapidly instituted. And, strict procedures were implemented to make surgeries and visits to the doctor’s office safer. Patients were reassured to see their providers wearing masks and face shields.  

So, what has been the net effect of all of this on doctor’s incomes year-to-date? Let’s take a look.

The 2020 Doximity Physician Compensation Report

Doximity is the largest professional network in the US having more than 70% of all U.S. doctors as members. They have been collecting data from survey responses from 135,000 licensed US physicians over the past six years. This is the fourth year that they have published a Physician Compensation Report.

According to one of the lead authors of the story, Peter Alperin, M.D., a practicing internist and the Vice President of Product at Doximity, this survey differs from other physician compensation reports in two important ways: 

  1. The number of licensed physicians participating in the survey is larger
  2. All of the physicians who participated are verified to actually be licensed physicians 

Here are the key findings:

  • Physician compensation growth was relatively flat overall

Compensation growth was only 1.5% according to this year’s report. This is quite modest compared to increases of up to 4% in previous years. Further, because the 2019 inflation rate was 2.3% (as measured by the Consumer Price Index), it suggests that physicians overall had a decline in real income. 

  • There’s a big difference between the highest and lowest compensation by metro area

There is more than a $100,000 difference between the metro area with the highest compensation (Milwaukee – $430,274) and the area with the lowest (San Antonio – $329,475). But it’s hard to know what this really means because there are many factors that contribute to the calculation of “average” compensation, including:

        • Specialty mix
        • Gender mix (more on that later)
        • Physician age mix
        • How much rich benefits compensate for lower salaries

The report provides some detail on another important factor impacting compensation: employment type.

graph: how much money do US doctor by employment type
Graphic provided by Doximity
  • Physician compensation doesn’t track with the cost of living

It is interesting to note that metro areas with the highest cost of living do not appear on the list of places with the highest compensation.

That speaks to the fact that there are other considerations besides compensation and the cost of living that physicians may take into account before they pack their bags and move to Milwaukee. These include:

        • The desirability of the area for their and their families preference (e.g., must live near an ocean to surf, can’t stand cold winters or hot summers)
        • Availability of good schools and safe neighborhoods
        • The presence of an academic medical center in the community is important to some physicians
        • Nearness to extended families (especially important when the physician family includes children)
        • Diversity of the population
        • Proximity to a major international airport to make travel easy
        • The richness of the culture and arts scene
        • Availability of good restaurants, bars, sporting events, recreational, and cultural activities (we are not going to be sequestered forever)
        • Politics (liberal vs conservative)
        • Religious factors (availability of communities with similar beliefs

I could go on and on, but you get the picture. Compensation is important, but it isn’ everything.

  • Metros with the highest growth rate in compensation

Providence, Rhode Island tops the list with an 8.9% growth rate followed by Portland, Oregon with 8.6%. Again this is hard to interpret because so many different factors contribute to how rapidly compensation increases (shortages of physicians, insurance status of patients (and more). So I will just leave it at that.

Compensation by specialty

The single most important decision a medical student makes is what specialty training to pursue. You have to start applying for residencies in your 4th year. However, you may have had to arrange rotation opportunities to position yourself to get a coveted residency long before that. 

There is no question that potential future earnings may play a role in some of those decisions, luring soon to be newly minted doctors into highly compensated specialties. It may also discourage some medical students from choosing the lower-paying specialties, particularly if they are staring a $100,000 or more in student loan debt. 

So what did the report show about who makes how much?

The highest compensated medical specialty is neurosurgery

Graph: physician compensation highest
Graph provided by Doximity

Primary care specialties are among the lowest compensated medical specialties

Graph physician compensation lowest
Graph provided by Doximity

The gender wage gap

Sadly, the report documented a 28% wage gap between male and female physicians. This is up from 25.2% last year. We have been arguing about why there is a wage gap ever since I got into medical school as a result of the women’s movement that swept the country in the 70s. You know the drill:

      • Women physicians don’t work as long and hard as men
      • Women choose* the poor paying specialties (pediatrics and primary care) whereas men choose more lucrative surgical specialties, such as neurosurgery and orthopedic surgery. (*it is possible that gender discrimination may also have played a role in women’s choices. Some may have been actively discouraged from applying and others were simply not accepted in surgical subspecialty residencies.)
      • Women choose salaried employment over the more “entrepreneurial” fee-for-service types of arrangements.

But this year’s increase in the wage gap may also reflect gender differences in the impact of the pandemic on the ability to continue working at the same intensity as prior to the shutdowns.

Schools closed down so daytime “childcare” evaporated. Kids were now home all day and many required help with online learning and even full-time homeschooling when online options were not adequate.

  • Women are usually called upon to make the sacrifice

Doximity’s Dr. Alperin, says that “women are usually the ones to called upon to make the sacrifice” if one parent must stay home to care for the children. In addition, because male physicians make more money than women physicians, they may feel that it makes sense for the family unit for the higher wage earner to be the one to return to work.

No matter that “we have come a long way, baby”, the bulk of these duties still fall to the moms of the house – even if she has a medical degree. 

In fact, the widening of the wage gap between men and women has been reported in other industry sectors as well.

The gender wage gap by specialty

The report shows that there are no medical specialties in which women physicians earned the same or more than men. So even if women enter the higher-paying specialties, they still make less than their male colleagues.

graph physician compensation gender wage gap by specialty
Graph provided by Doximity

The bottom line when it comes to physician compensation in 2020

Like many other people in the US, physicians took a financial hit because of the coronavirus pandemic. However, their compensation is still quite generous, placing many of them in the Top 10%. The most troubling finding in the report is the increase in the persistent gender wage gap in physician compensation. It will be interesting to see if this returns to normal once the pandemic is under control and life goes back to more or less normal.

References

1. ITIJ, US hospitals losing around $50 billion a month due to Covid-19. May 4, 2020. https://www.itij.com/latest/news/us-hospitals-losing-around-50-billion-month-due-covid-19

2.  Rubin R. COVID-19’s Crushing Effects on Medical Practices, Some of Which Might Not Survive. JAMA. 2020;324(4):321-323. doi:10.1001/jama.2020.11254. https://jamanetwork.com/journals/jama/fullarticle/2767633

3. Papautsky E, Hamlish T. Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic. Breast Cancer Res Treat 2020 Nov;184(1):249-254. doi: 10.1007/s10549-020-05828-7. Epub 2020 Aug 9.

4.  PSan Jose Mercury News, Coronavirus: 14,000 Stanford Health Care workers hit with furloughs, pay cuts. April 24, 2020. https://www.mercurynews.com/2020/04/27/coronavirus-14000-stanford-health-care-workers-hit-with-furloughs-pay-cuts

 

5. Salber P. Doximity’s New Telehealth Application Makes It Easy to Connect, The Doctor Weighs In, June 3, 2020. https://thedoctorweighsin.com/doximity-telehealth/

6. Salber P. Clinical Care of Cancer Patients in the Age of COVID, The Doctor Weighs In, Aug 8, 2020. https://thedoctorweighsin.com/clinical-care-cancer-patients-covid/

7. U.S. Bureau of Labor Statistics, Consumer Price Index: 2019 in review. January 16, 2020. https://www.bls.gov/opub/ted/2020/consumer-price-index-2019-in-review.htm

8. Eastman S, Vazquez-Soto A. What is the Real Value of $100 in Metropolitan Areas, Tax Foundation 2020: https://taxfoundation.org/real-value-100-metro-2019/

9. New York Times, Pandemic Will ‘Take Our Women 10 Years Back’ in the Workplace. September 26, 2020. https://www.nytimes.com/2020/09/26/world/covid-women-childcare-equality.html


Methodology: Doximity used self-reported compensation survey data from 2019. and 2020 from ~44,000 full-time, licensed U.S. physicians who practice at least 40 hours/week. Responses were mapped across metropolitan statistical areas (MSAs). For more details, please refer to Doximity’s 2020 Physician Compensation Report.


Original article published in 2015. Updated 2/2/17. Updated 11/8/20.



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