A closer look at the biggest pay gaps in physician pay

Data show that healthcare is one of the top-paying industries. And, as a physician, you’re probably paid well relative to many other professions—a reward for the long years of education, grueling hours, and high-stakes work the profession requires. 

But your salary may not be commensurate with that of your physician peers. Your gender, specialty, and location are three of the biggest factors influencing how much you make—in some cases by hundreds of thousands of dollars.

Here’s a closer look at how gender, specialty, and geographic area affect physician pay.

Pay gaps between men and women

Disparities between men’s and women’s wages remain a challenge across industries, and healthcare is no exception. The last decade of Medscape physician compensation reports have found that men earn more than women in healthcare—and the same remains true this year. 

What’s worse, there is no justifiable reason for these differences. Male and female physicians work about the same hours—averaging 51 hours per week, including more than 16 hours spent on paperwork and administrative tasks. Interestingly, this year’s survey found women report spending 10% less time seeing patients than men do. Still, studies have found that female physicians often outperform their male counterparts—their patients often experience lower mortality rates and fewer rehospitalizations. 

Despite this, according to the 2021 Medscape Female Physician Compensation Report, male physicians earn 35% more than their female colleagues. The survey defines compensation for employed physicians by salary, bonus, and profit-sharing contributions. For physicians who are self-employed, it includes salary, earnings after taxes, and deductible business expenses.

The most dramatic pay gaps occur between male and female specialists—male specialists made an average of $376,000, or 33% more than female specialists, who earned $283,000. Primary care physicians also saw a wide pay gap by gender, albeit smaller than the one affecting specialists: Female physicians reported average salaries of $211,000, or roughly 27% less than male physicians, who reported earning $269,000. 

The survey results also found that among primary care providers and specialists, women earn a lower percentage of their potential incentive bonus than men. The results are also consistent across age ranges, with male physicians between 45-54 earning about $100,00 more, and those 55 and older earning around $75,000 more than female physicians. 

Pay gaps between specialties

A physician’s specialty also determines how well they are paid. Comparing female physicians in different areas to control for gender, the Medscape survey found female specialists earned $283,000, while women in primary care earned $211,000, as described above. With an average annual compensation of $281,000, women in office-based solo practices earned better than most of their peers, followed by those who work in hospitals ($269,000) and in office-based/single-specialty groups ($268,000). Female physicians working in outpatient clinics generally made less than their peers, at $233,000. 

The survey accounted for more than 29 specialties for physicians practicing in the United States and found the highest-paying specialties are dominated by men. These include plastic surgery ($526,000, 20% women), orthopedics ($511,000, 9% women), cardiology ($459,000 14% women), and urology ($427,000, 11% women).

Specialties on the lower end of the pay scale are made up of larger proportions of women physicians. These include pediatrics ($221,000, 61% women), diabetes/endocrinology ($245,000, 50% women), and infectious disease ($245,000, 46% women).

Geographic areas

Where you practice also plays a huge role in your overall compensation. In some cases, physician compensation follows the laws of supply and demand, and physicians are paid more in states with fewer doctors, and earn less in states with more. States with the lowest physician density include Oklahoma, Alabama, Nevada, and Arkansas, according to the 2019 State Physician Workforce Data Report. This largely aligned with the states that paid doctors the most that year.  

In 2021, states not known for high salaries in other industries dominated the top-paying list for physician compensation. Alabama ($348,000), Kentucky ($340,000), Oklahoma ($338,000), Indiana ($337,000), and Missouri ($332,000) rounded out the top five highest-paying states.

According to a 2020 report from Doximity, the top-paying metro areas for physicians are Milwaukee, WI ($430,000), Atlanta, GA ($428,000), Jacksonville, FLA ($427,000), Buffalo, NY ($407,000), and Orlando, FL ($407,000). The report also found metro areas where physicians make the least include San Antonio, TX ($329,000), Virginia Beach, VA ($332,000), Boston, MA ($348,000), Baltimore, MD ($348,000), and Washington, DC ($352,000).

Bottom line

Awareness is a great first step, but what will it take to close these physician pay gaps? In a JAMA Network Viewpoint report, experts argued that transparency is key. Institutions need to be clear about what they are paying doctors and what they are doing to remedy pay disparities. 

“Leaders in medicine must work to mitigate unconscious bias, encourage women to follow their passions rather than steer them away from traditionally male specialties, and embrace the fact that half of the profession may take maternity leave (and some may take paternity leave). Doing so will help close the gender wage gap and contribute to achieving professional equity in medicine beyond salary,” the authors wrote.