When most people think about medicine as a profession, there is a common assumption that becoming a doctor equals earning a considerable amount of wealth. Does that apply to doctors with lower paying specialties? Let’s weigh in on the details of stretching your money.
For some doctors, with specialties such as surgery or cardiology, there is great potential to earn a healthy six-figure salary, sometimes as much as half a million dollars per year. Even with such a salary, though, “rich” is still a relative term. After all, the national average for medical student loan debt in this country is close to $200,000 per year, if not more.
It also can take up seven years of training to get to the point where you earn a salary like that. So, think about it: you graduate from medical school and owe x $200,000. You work 80 hours a week for anywhere from years it takes to become a cardiologist or plastic surgeon. During that time, you earn approximately $55,000 per year. You barely have enough time for sleep let alone work on budgeting or working with a financial planner.
Then, seven years later, you finally – finally! – hit the big time. Sure, you’ll still working crazy hours, but you can work on paying down those student loans. Life is gravy, right?
Except: your student loans have been accruing interest all this time, and that interest has compounded. No matter how much money you throw at your loans when you have any extra to throw, you never seem to make a dent on paying them off. Maybe you’re tired of living the life of a poor resident and want to buy a fancier car or a nice house. No judgment here. Medicine is a tough gig. You have certainly earned some conveniences and even some luxuries.
Even if you have chosen a higher paying specialty, that student loan debt will hound you. It will keep you up at night. It will grow and expand and create lots of stress (though it really doesn’t have to.
What about if you choose one of the lower paying specialties? Did you know that there is such a thing as a lower paying specialty when you’re a doctor? Don’t all doctors make lots of money?
No. They really don’t. Not all specialties pay the same. In fact, that is a glaring disparity of pay between the lowest paid specialties (family medicine, pediatrics) and the highest paid specialties (surgery, cardiology).
What are the lower paying specialties?
According to Forbes, the lowest-paid medical specialties are:
- Family Practice – $178,000
- Pediatrics – $183,000
- Family Practice with Obstetrics – $197,000
- Internal Medicine – $205,000
- Hospitalist – $217,000
- Endocrinology – $218,000
- Psychiatry – $220,000
- Emergency Medicine – $255,000
- Neurology – $256,000
- Obstetrics and Gynecology – $282,000
What are the higher paying specialties?
According to Forbes, the highest-paid medical specialties are:
- Orthopedic Surgery – $464,500
- Cardiology (invasive) – $461,364
- Cardiology (noninvasive) – $447,143
- Gastroenterology – $442,421
- Urology – $424,091
- Hematology/Oncology – $396,000
- Dermatology – $370,952
- Radiology – $368,250
- Pulmonology – $351,125
- General Surgery – $336,375
Why are some specialties lower paying?
That’s a great question. All professions have variations on what people earn as individuals and within subsets of the profession. For medicine, family doctors are often paid based on the number of patients they see. Specialties are also limited based on the number of slots available at hospital residency training programs. There is a greater need for family doctors to work at hospitals and care for patients in private practice, and so there are more slots. Surgery and cardiology are expensive specialties to train for and there aren’t as many slots to go around. The surgical theater can also cost much more to fund than a regular doctor’s office.
The real reason for the disparity, though, is one that is difficult to quantify but that we all know is likely the case: society values certain professions more than others, and people are willing to pay more for certain services and expect other services for free. For example, think about teachers. Most people in our society know how valuable a good teacher is, yet there is also an expectation that education is something to which we are entitled, so it’s not something many people are willing to pay (much) for.
With medicine, it’s not uncommon for patients to argue, complain, or think they know better about their condition because they read about it on the internet when it comes to accepting the advice of their family doctor. Yet when you need surgery, there’s no arguing. Have you ever heard the saying that no one cares about the bedside manner of a surgeon as long as he or she is good at their job? There is an inherent value placed on services considered life-saving, as opposed to family medicine which is, unfortunately, all too often “only” considered life-enhancing.
Why choose a lower paying specialty?
So, if you know that medical school will cost you, and you know you want to be a doctor, why not choose a specialty off the list of the highest paying specialties? For the same reason, some of us choose to be teachers or writers or police officers instead of choosing professions that pay much more: we feel called to do it.
Family medicine is the lowest paid medical specialty yet it’s not hard to make an argument that it’s also the most important. Family medicine doctors, and pediatricians, and hospitalists, and psychologists are all doctors who make connections. They take time to get to know their patients, listen to them, and try to help the whole person not just get well, but often to stay well. Those connections over time, the history they know, the whole person they treat are valuable parts of medicine that also involve an element of customer service and connection.
These are also professions that a person might choose if empathy and interpersonal skills are important to them, which means that these specialties tend to be more of a calling. We don’t knock doctors with specialties that are traditionally more procedural and less holistic, by any means. We simply recognize that, just as someone might choose to teach in an underserved location with a shoestring budget and a lot of idealistic hope, a person might choose family medicine or psychiatry or obstetrics because they value that human connection. The salary that comes with the vocation is a detail, but not a driving factor of the vocation itself.
In what universe is $150k considered “low paying?”
You may have noticed that even the lowest paying specialties still pay pretty well, by most standards. With a median income in the United States at $61,372, anything over $150,000 means a pretty healthy paycheck.
Don’t forget those student loans, though. Even with financial planning, those loans take time and strategy to pay down and will affect your quality of life. In today’s economy it can be legitimately difficult to afford to support a family on $150,000 a year. Even if you have a spouse who is working, when you factor in those student loans, it’s important to plan wisely to make the most of your income.
How can you be a doctor with a lower paying specialty and still live a good life?
This really is possible. There are some key considerations to make regardless of where you are in your medical journey: student, resident, or fully trained physician.
Choose your location wisely
If you are considering medical school, follow the same philosophy you likely did as an undergrad and be sure to apply to a “safety” school. The degree “Medical Doctor” grants you the same rights and privileges from a state-run medical school as the much more expensive one you might earn at a private school. While your student loans will likely be large either way, you can save easily $100,000 worth of student loan pain by factoring cost into your medical school choice.
Your match is also a factor, and while you have less control over that, you can arm yourself with information about the possible geographic locations where you could end up for your residency.
If you are finished with your residency, choose your permanent location wisely. Consider areas with a low cost of living over the bigger cities for your private practice. Look for under-represented communities, or towns that have an acute need for a specialty such as yours. The more you know about the cost of living of each location you’re considering, the better prepared you are to make a choice that will benefit your financial future.
Embrace a poor mindset
While $150,000 a year is well above the national median salary, it won’t make you rich, especially if you have a family to support, and if you are working to survive on a budget that includes $200,000 or more of student loans.
Don’t think of yourself as rich, even though other people will undoubtedly treat you that way. You do not need to be financing anyone else’s education, or offering loans (or co-signing loans), or picking up the check every time you go out to dinner with friends. Work on developing some frugal habits and make conscious decisions about what types of things are worth your money and what are impulse purchases you can live without.
Buy a modest car
It is tempting to buy a more expensive car than you should. We all struggle with this. The reality is that a car is transportation, plain and simple. You do not need a fancy car to show your status. The letters M and D after your name are enough for that, for the people who put stock in such things. Since you chose as your life’s calling a specialty that focuses on caring for people and developing relationships, you are likely not someone who puts much stock in flashiness anyway. A car is not an investment. It depreciates the moment you drive it off the lot. Embrace your inner sense of frugality and buy something used and practical. The money you save will be worth it.
Buy a house you can realistically afford
Consider a condominium or townhouse. These types of homes tend to be more reasonably priced than detached houses and have the added benefit of serving as potential real estate investment properties later on.
Work with a financial planner
You likely never took a course on financial planning. That certainly isn’t covered in medical school (though it should be). Working with a professional financial planner you can trust to manage those student loans and maximize your salary can help you save tens of thousands of dollars over the life of your career, and put thousands back in your pocket each month. Give us a call or look for a fee-only planner to review your finances and help you design a plan to maximize every dollar you bring in every month.
Embrace public schools
When you are considering where to live, factor in the quality of the local public schools, because on your salary, you likely won’t be able to afford private school tuition. This is not a bad thing, as there are many truly excellent public schools around the country. The key is to be mindful of considering them and embracing them for the tremendous value that they are.
In the same vein, set the expectation early on with your children so they understand that they will have to find ways to be proactive and maximize their college tuition. There are many ways to save for state tuition starting when they’re young and don’t underestimate the quality of a community college education, trade school, or military service. There are many paths to help people get to where they want to go professionally. Draining your bank account doesn’t have to be one of them.
Find ways to increase your income
You can do this with all of your spare time, right? We kid, but in all honesty, a side hustle is possible with a physician’s lifestyle. Some suggestions to consider are:
- Staff urgent care
- Pick up extra shifts
- Take more call
- Own the practice (we like this one the best)
- Look for a new job that pays more (easier said than done, but not impossible.)
Some of these options may look difficult, and no one said hard work – or being a doctor – was easy. As long as you have the mindset of someone who needs to live mindfully, you will find ways throughout your life and career to maximize your salary and your time and live your best life. We see it all the time.
Get help with your taxes
Taxes never go away, but there are ways to learn how to minimize the pain. Seek professional advice from a Certified Professional Accountant (CPA) to provide sound guidance on ways to maximize deductions and minimize payments. A CPA handles taxes specifically, while a financial planner looks at your overall financial health, so it’s not a bad idea to hire both. The money you save in tax deductions and student loan interest by working with these professionals will more than pay for their fees.
Maximize your retirement contributions
It’s not uncommon for us to hear “but I can’t afford to save for retirement.” You absolutely cannot afford not to save for retirement. Not only can participating in your employer’s retirement plan save you money on your taxes, but if your employer offers a match to a 401(k) or similar retirement account and you don’t at least put in enough to get the match, you are leaving a sizable chunk of your compensation on the table. And none of us, no matter what we do for a living or how much we earn, should turn down any part of our compensation.
Attitude is everything
Don’t worry about what you can’t have. Instead, focus on the choice you made and why you made it. Going into medicine is a noble endeavor, and choosing the specialty that is not only your job but your calling is even better.
Anyone can live their best life on any salary, really. It’s all about perspective, looking to what you can control, letting go of what you can’t, and asking for help from the right people along the way.
Work down that student loan
The only way to tackle student loan debt is with a plan. Ignoring the debt and throwing money at it when you can will not make it go away, unfortunately.
Working for a nonprofit hospital or other nonprofit will help qualify you for federal student loan forgiveness, which is a wonderful opportunity to reconcile your debt without drowning it in.
And, talk to a financial planner, like us. We can determine if you qualify for student loan forgiveness or another loan forgiveness product. We can also help you design a budget, and make some long term financial plans. It really is possible to live your best life even on a lower salary and with student loan debt as long as you embrace a frugal mindset and accept a little help from the pros whose job it is to help you live your best life, so you are free to do your job taking care of us.
And remember that wealth can mean a lot of things. Do you have the life you always imagined? Are you doing work that is meaningful to you? Do you have your health (oh, the irony)? If so, you are very rich, indeed.