Physicians are facing the same economic and compensation pressures as the broader workforce with inflation putting a squeeze on doctors' real income.
Average physician pay fell by 2.4% from 2021 to 2022, and that decline in physician compensation comes at a time when U.S. healthcare workers are facing significant challenges, including economic strains, a growing physician shortage issue and high rates of work-related burnout, according to the sixth annual Physician Compensation Report from professional medical network Doximity.
The average pay for doctors increased by 3.8% from 2020 to 2021, which was up from a nominal increase of 1.5% in 2020.
This year's study was based on self-reported compensation data from 31,000 full-time U.S. physicians. Doximity claims it is also the largest study to provide six years of year-over-year trends data, gathered from surveys of over 190,000 physicians from 2017 to 2022.
In 2023, physicians will also experience a 2% Medicare payment cut after two decades of flat payments.
Many doctors experienced a decline in real income as inflation ran rampant. Inflation reached a 40-year high of 9.1% in June, as measured by the Consumer Price Index.
According to the American Medical Association, when adjusted for inflation, Medicare physician payment declined 22% from 2001 to 2021.
These economic and financial pressures also are impacting physicians' job satisfaction, according to Amit Phull, M.D., Doximity's medical director and senior vice president of strategy.
"Those trends are likely influencing what we also see in the reports and some surveying we've done of the user base that there is an increase in reported overwork and burnout, exacerbated by the fact that we have some of these real compensation issues coming to the fore," Phull said in an interview. "We would often say in our own practice in Chicago how we try to manage physician well-being that burnout, even though different people have different definitions of the term, but it often boils down to having significant investment in the system that you have little influence or control over."
He added, "With our survey of the physician population, we see that the vast majority of them, about 86% of them, report feeling overworked, with more than a third of them actually reporting they're considering early retirement."
According to a separate Doximity survey, about two-thirds of physicians (66.7%) said they are considering an employment change.
Economic pressures like inflation and Medicare payment cuts are leading many doctors to pursue supplemental side gigs or moonlighting. In a survey of 2,000 physicians, nearly half (47%) reported they are likely to pursue a side gig, increase their patient caseloads or work additional hours to adjust for economic factors.
But many employers include noncompete clauses in employment agreements that can make it difficult for physicians to find additional work or change employers. In early January, the Federal Trade Commission unveiled a proposed rule to ban noncompete agreements across most industries. The American Hospital Association came out against the noncompete ban, saying it could have unforeseen impacts on a volatile healthcare labor market.
In a recent poll of over 4,800 physicians, 62% say they currently have a noncompete clause, and the majority (87%) say they would support the FTC banning noncompetes in employment agreements.
Another 26% of physicians reported they are inclined to pursue a salary increase through their existing employer or through an employer change.
The annual report also unveiled some contradictory trends. Despite the financial squeeze that many doctors are facing, many healthcare professionals are considering lower compensation in a quest to achieve more autonomy or work-life balance,
Seventy-one percent of doctors said they would be willing to accept, or have already accepted, lower compensation for more autonomy or work-life balance, according to another survey of 3,000 physicians.
Pete Alperin, M.D., Doximity's vice president of product, said the goal of the annual report is to provide key insights to better understand and address employment trends shaping U.S. healthcare.
"By improving the transparency of physician compensation data, we also aim to help doctors make better-informed career decisions. To achieve this, we analyze data at the metropolitan level and across medical specialties and employment types," said Alperin, who serves as an associate professor of internal medicine at Dell Medical School in Austin.
Substantial gender pay gap persists
The gender pay gap for physicians decreased in 2022—albeit slightly—from 28% in 2021 to 26%.
On average, women physicians earn nearly $110,000 less than male physicians, even when salaries were controlled for specialty, location and years of experience, Doximity found, which indicates that physician pay parity continues to be a critical area in need of improvement.
In 2020, an analysis of Doximity's physician compensation data from 2014 to 2019 estimated that over the course of a career, male physicians make over $2 million more than female physicians.
"We actually see that significant gap across all specialties with very few specialties even having a gap of less than 10%," Phull said. The only exceptions were pediatric cardiology, which had a pay gap of 9.2%, and nuclear medicine, which had a gap of 3%, he noted.
According to Doximity data, in 2022 there were no medical specialties in which women earned the same or more than men.
This disparity may be contributing to an even higher burnout rate among female physicians, with nearly 92% of female physicians surveyed reporting overwork, compared to 83% of men.
Primary care docs, psychiatrists in high demand
Doximity also looked at physician staffing trends, including an analysis of tens of thousands of job opportunities across the company's network.
In 2022, primary care specialties, such as family and emergency medicine, psychiatry, and obstetrics and gynecology, were some of the most highly recruited specialties on Doximity, as front-line physicians continue to be in high demand.
These findings are consistent with reports from the Association of American Medical Colleges (AAMC), which projects a shortfall of between 17,800 and 48,000 primary care physicians by 2034.5
Psychiatry also took two of the top five spots in 2022. According to the AAMC, the U.S. had too few psychiatrists even before the pandemic increased rates of anxiety and depression.
"In my own experience, I feel that that is a continued indication of societal issues or gaps in the system that were highlighted, frankly, by the COVID-19 pandemic and that the workforce is still trying to kind of catch up with," Phull said.
Highest- and lowest-paid doctors in 2022
Which specialties are doing the best when it comes to annual compensation? Doximity found that the 20 specialties with the highest average annual compensation in 2022 tend to be surgical and procedural specialties treating adult patients.
Neurosurgery comes out on top, followed by thoracic surgery, orthopedic surgery, plastic surgery and oral and maxillofacial surgery.
The specialists with the highest pay didn't necessarily see the biggest bumps in growth in 2022. Overall, compensation in 2022 was stagnant or down across many specialties, contributing to the overall decline observed across the industry. But, emergency medicine physicians reported the highest increase in compensation in 2022 at 6.2%, a likely result of the continued demand for emergency healthcare services.
Pediatric infectious disease specialists saw a 4.9% bump in pay, pediatric rheumatologists reported a 4.2% pay increase while preventive medicine specialists and pulmonologists saw their pay increase by about 4%.
The specialists with the lowest annual compensation tend to be pediatric and primary care doctors. Pediatric endocrinologists had the lowest annual compensation ($218,266) followed by pediatric infectious disease ($221,126), pediatric rheumatology ($226,186), pediatric hematology and oncology ($237,005) and pediatric nephrology ($238,208).
Family medicine doctors had average pay of $273,040, and internal medicine specialists brought in $293,894 in 2022.
Here are the top 20 specialists by average pay:
1. Neurosurgery — $788,313
2. Thoracic surgery — $706,775
3. Orthopedic surgery — $624,043
4. Plastic surgery — $571,373
5. Vascular surgery — $557,632
6. Oral and maxillofacial — $556,642
7. Radiation oncology — $547,026
8. Cardiology — $544,201
9. Urology — $505,745
10. Radiology — $503,564
11. Gastroenterology — $496,667
12. Otolaryngology (ENT) — $488,536
13. Dermatology — $468,509
14. Anesthesiology — $462,506
15. General surgery — $451,489
16. Ophthalmology — $449,315
17. Oncology — $447,312
18. Colon & rectal surgery — $445,685
19. Pulmonology — $400,650
20. Nuclear medicine — $392,196