What are the most and least stressful physician specialties in America?

What’s it like to be a physician? Different images come to mind for different people. For some, it means financial freedom, an easy work-life balance, or a luxurious lifestyle. For others, it’s about intense workloads and an even more intense commitment to helping others.

Reality often falls somewhere in between. When it comes to finances, physicians largely live up to widely held expectations about above-average incomes. According to U.S. News and World Report, the median physician salary in 2018 was $194,500—a number that varies by specialty and location, but was more than triple the median US household income of $61,937 that year.

A large income doesn’t mean an absence of stress, though, nor is it a clear indicator of financial health. In 2020, the average medical student debt was roughly $232,000, which experts say takes about 13 years to pay down, even with a $200,000+ annual income.

Beyond financial stress lies the stress of the job. The number of patients you’re expected to see, the diseases you treat, the setting where you treat them, and whether you’re employed or self-employed all depend in part upon your specialty. Each of these aspects also plays a part in determining how much stress you’ll face as a physician.

In this article, we’ll outline the most and least stressful physician specialties.

Measuring physician stress

Between 23% and 48% of physicians experienced burnout depending on their specialty, with an average 42% burnout rate in 2018, which was down from 51% the year prior. In other words, being a physician means coming to terms with a high likelihood of being stressed out regardless of specialty.

According to data reported by the American Medical Association pulled from a survey of more than 15,000 physicians across 29 specialties, some specialties are much safer from burnout than others.

Least stressful specialties by burnout rate

Plastic surgery: 23%. According to the American College of Surgeons, plastic surgery is constantly changing, so those who specialize in this field will encounter new opportunities and smarter strategies almost every day. On top of that, they can design practices that fit their lifestyle goals and reap the rewards of helping patients feel safe and secure through deeply emotional life changes. Plastic reconstructive surgeons earn an annual median income of $408,841 including salary and bonuses.

Dermatology: 32%. As reimbursements have dwindled, many dermatologists are making ends meet by seeing more patients—as many as 100 per day. Still, those who choose to own their own practices earn a chance to make their own hours, with many running half days for surgeries, taking full-hour lunch breaks, and prioritizing free time with family and friends. Dermatologists tend to earn well, with a median compensation of $366,400 including salary and bonuses.

Pathology: 32%. This field typically attracts thinkers and problem-solvers—those who like to tackle diagnostic mysteries and provide critical expertise. Pathologists who interact with students and trainees are seen as role models. There’s also an optimistic forecast for job availability, solid work-life balance, and good compensation, with a median income of $286,600 including salary and bonuses.

Ophthalmology: 33%. Eye specialists enjoy a solid combination of office-based care and surgery, which offers new challenges and an agreeable work-life balance. What’s more, many ophthalmologists work together in group practices, so they share responsibility for treating trauma patients who have ocular emergencies. Their annual median pay, including salary and bonuses, is $301,200.

Orthopedics: 34%. Between involvement in trauma care and elective reconstructive surgery, orthopedic surgeons spend lots of time working on the kind of procedures that can help breathe new life into patients’ mobility and independence. At the same time, these procedures challenge orthopedists to continually leverage their cognitive and physical abilities to tackle unique problems—the kind patients often thank them for. According to Salary.com, orthopedic surgeons earn a median of $531,590, with even the lowest 10% earning a substantial $314,429 including salary and bonuses.

Most stressful specialties by burnout rate

Emergency medicine: 45%. When these doctors show up to work, the only thing they ought to expect is the unexpected. Hours vary widely, and night, weekend, and holiday shifts are a guarantee. Expectations are high and interruptions are frequent. But for those who love a challenge and thrive in chaos, there’s nothing quite like it. Emergency medicine physicians earn a median income of $299,836 including salary and bonuses.

Internal medicine: 46%. These doctors tend to work with older and sicker patients, who have multiple medical problems and often significant social and psychological challenges. There’s no such thing as a typical day, so internal medicine doctors should be prepared for complicated challenges and be good listeners. The flip side of that is that it’s never boring, and internists enjoy long-lasting relationships with their patients. Average compensation, including salary and bonuses, falls around $228,643.

Obstetrics and gynecology: 46%. Like internal medicine, there’s no typical day in obstetrics and gynecology. For some, that’s a stressor. For others, it’s a gift. Typical work weeks can include three or four days of in-office care, plus one 24-hour call day, in addition to remaining on call for patients delivering babies in the hospital. While there are many joyous moments, OB/GYNs may see a lot of tragedy as well. Average income, including salary and bonuses, is about $300,590 annually.

Family medicine: 47%. For family medicine physicians, there’s always an element of uncertainty because patients rarely present with textbook symptoms. Over the years, patients have become more complex because of earlier hospital discharges, emphasis on avoiding nursing homes, and aging of the population. But if you’re a people person who enjoys lifelong relationships with patients and their families, family medicine can’t be beat. While there are signs that primary care compensation is finally rising, these doctors still have the lowest average income on the list at roughly $214,620 including salary and bonuses.

Neurology: 48%. Neurologists are expected to provide compassionate care to patients, many of whom have diseases with no reliable cure and few treatments. On top of that, these physicians need to manage patient caregivers, who reflect an important aspect of their patients’ well-being. Average compensation for neurologists is about $266,700 including salary and bonuses.

Critical care: 48%. An ICU doctor sees people die almost daily, which can be extremely difficult to handle. Many of these doctors need to find ways to cope with anxiety and depression and help families of deceased patients move through trauma. Despite these stressors, helping families understand what’s happening to their loved ones and cope with death can be rewarding. The COVID-19 pandemic has exemplified the important work they do. Median income for a critical care physician is around $342,700 including salary and bonuses.