By Jacquelyn Smith, Forbes Staff
No. 2 Cardiology (invasive)
No. 3 Cardiology (non-invasive)
No. 4 Gastroenterology
Those are the highest-paying jobs for doctors right now, according to the medical search and consulting firm Merritt Hawkins & Associates’ pending 2013 Review of Physician Recruiting Incentives.
Merritt Hawkins analyzed its internal data to find the average starting salaries offered to doctors and clinicians in the 20 most requested specialties, between April 1, 2012 and March 31, 2013.
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Recruited non-invasive cardiologists were offered a starting salary of $447,143, on average, in the twelve-month period. Invasive cardiologists were guaranteed an annual salary of $461,364, while orthopedic surgeons, the highest-paid doctors, made $464,500.
These numbers reflect base salaries only, and do not include signing bonuses, production bonuses, or benefits. Merritt Hawkins’ numbers therefore do not reflect total physician incomes, but rather starting salaries physicians are being offered when they are recruited, either from residency programs or from other practice settings in which they may be established.
The fourth best-paying specialty: Gastroenterology. These doctors, who, according to the American College of Gastroenterology, specialize in the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver, are guaranteed $441,421 a year, on average.
At the other end of the spectrum are pediatricians, family practitioners, and internists. Recruited doctors in each of these areas were offered an annual salary of less than $210,000, on average, in the same twelve-month period.
No. 5 Urology
No. 6 Hematology/Oncology
Why are specialists offered so much more than primary care physicians? One reason is they simply bring in more revenue per doctor, in part because more value is placed on procedures than on diagnosis and preventive care in medicine today—but Travis Singleton, senior vice president of Merritt Hawkins, says things are finally changing.“Specialists still are at the top of the compensation food change, but the curve is bending–not because primary care doctors are getting huge increases but because specialists often are getting less, thanks to reimbursement cuts and to emerging delivery models that promote preventive care, efficiency, and quality based outcomes,” he says. “We are counting on primary care doctors to drive these emerging systems which promote value over volume. Through models like the patient centered medical home, primary care doctors have greater influence over what happens to the patient: the specialists they see, the tests and procedures they receive, and the hospital to which they may be admitted. The drive not to do more, but to do what is appropriate, emphasizes the patient management role of the primary care doctor and seeks to deemphasize the role of ‘proceduralists’ who do tests and surgeries. Primary care doctors will benefit financially from this tilt and some specialists will take hits. When all the toys are counted at the end, specialists will still have more, but the gap in pay and power won’t be as profound.”
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 most are avoiding the field altogether.
And it’s no wonder why. According to the Association of American Medical Colleges (AAMC), the median tuition and fees at private medical schools in the 2012-2013 academic year was $50,309. The 2012 crop of graduates owe about $183,066 in education debt, on average (including undergraduate loans). The average debt for all 2012 med school grads—both private and public school alumni—amounts to $166,750; while the median debt for all grads is $170,000, excluding interest.
But, Singleton says, “the truth is that medical students have long been deterred from going into primary care not only because of economic concerns, but also for reasons connected to professional prestige.” But that perception is slowly fading, partially because hospitals, medical groups, and other facilities are now rewarding doctors not just for volume, but for value.
“Physicians are earning the top end of their compensation potential not just by seeing a lot of patients or conducting a lot of procedures but by achieving high patient satisfaction scores, reduced medical errors and hospital re-admissions, and by following treatment protocols,” he adds. “This is a complete reversal of field and some physicians are experiencing whiplash.”
Singleton says more medical students are catching on to this trend and the number of students selecting primary care residencies has consequently increased in the last several years. “The stigma attached to primary care in medical education is coming off, though this is a cultural change that will take time.”
Here’s how much the highest-paid doctors in the top recruited specialties were offered in the twelve-month period between April 2012 and March 2013, according to consulting firm Merritt Hawkins & Associates’ pending 2013 Review of Physician Recruiting Incentives, which will be released in full next month. These are the average offered base salaries or guaranteed income, not including bonuses or benefits.
No. 7 Dermatology
No. 8 Radiology
No. 9 Pulmonology
No. 10 General Surgery