Rheumatologist compensation 2023: Salaries up, still lagging behind other specialties

By Shamard Charles, MD, MPH Published December 11, 2023

The demand for rheumatologists in the US far surpasses their supply, driven by a rising prevalence of rheumatic diseases, physician retirement, and a lack of succession planning, among other factors. Yet rheumatology is still among the lower paying medical specialties, according to multiple sources.

This is the fifth in a series of MDLinx special reports examining doctor compensation trends, leveraging the most current data from the Medical Group Management Association (MGMA), among other sources. Here, we look at rheumatologists’ salaries and the factors that affect their compensation.

The state of rheumatologist compensation

Less than 6,000 full-time rheumatologists are practicing in the US,[1] specializing in rheumatic diseases and conditions of the musculoskeletal and autoimmune systems. With an aging population prone to joint, bone, or muscle issues, rheumatology is more crucial than ever.

In general, rheumatology salaries vary by subspecialty, with more years of training and board certification yielding higher salaries—thus, immunologist/allergists earn more than pediatric rheumatologists.

According to MGMA research (based on 2022 data), national median compensation for rheumatologists is $283,225 with a 3.04% year-over-year increase from 2021 to 2022.[2]

Student debt

Many factors influence a rheumatologist's compensation, including subspecialization, location, scarcity, and work environment, but the need to pay off student debt is especially significant.

Like other specialists, rheumatologists go through extensive schooling. The high cost of medical school forces many rheumatologists to carry a significant amount of debt, which can lead to financial strain, particularly in the early stages of their careers.

A report published by the Association of American Medical Colleges (AAMC) found that 73% of medical students graduate with debt totaling a whopping $202,453 on average, excluding premedical undergraduate and other educational debt.[3]

After medical school, new doctors who aspire to specialize in rheumatology start a 3-year internal medicine or pediatric residency program, which hardly pays enough to offset the debt they’ve accumulated. Upon graduation, physicians complete an additional 3-year rheumatology fellowship, meaning they must complete approximately 10 years of training before commanding their terminal salaries.

Highest and lowest paying states for rheumatologists

According to current MGMA data, rheumatology salaries range from $313,250 in Florida to $232,680 in Ohio. This narrow salary range means location does not factor as highly into compensation compared with other specialties, such as cardiology and hematology-oncology. However, lower cost of living and no state income tax can play a significant role in take-home income.

Type of practice and ownership

Where a rheumatologist decides to work, whether in an academic medical center or private practice, plays a major role in salary. In general, rheumatologists who work in for-profit hospitals earn the most, due to the potential for large signing and volume-related bonuses.

Rheumatology salaries are also lower in hospital-owned or other majority-owned practices relative to physician-owned practices. The median salary for rheumatologists in physician-owned practices is $337,848, compared with $275,001 in hospital-owned practices, and $297,179 in other majority-owned practices, according to MGMA data.

Experience and tenure

Rheumatologists with more experience and seniority earn more money, as evidenced by a linear relationship between years of experience and salary, per MGMA data.

Those who achieve seniority—that is, have 18 to 22 years of experience—earn an average median salary of $411,928, compared with $255,426 for entry-level physicians.

Over time, incentive bonuses, ownership stake, administrative promotions, and other benefits may also increase total compensation.

Challenges

The retirement of rheumatologists, coupled with rising workplace demands and the absence of systematic succession planning, has exacerbated the rheumatologist shortage. Simultaneously, the increasing prevalence of rheumatic diseases, particularly among Black and Hispanic populations, and the aging demographic requiring more care, have further strained the limited rheumatology workforce.

In addition, burnout is a major issue in the field of rheumatology, due in part to supply and demand imbalances. Other factors that contribute to burnout include:

Long hours
Inadequate staffing
Administrative burdens
Workplace violence
High stress and general unhappiness in the workplace
Lower reimbursement rates
Racial, ethnic, and gender pay gaps

A recent Medscape survey revealed that 40% of rheumatologists felt inadequately compensated.[4] This sentiment, coupled with increased administrative burdens and work environments that hinder work-life balance, fuels career dissatisfaction among rheumatologists.

Under-representation and a sustained racial, ethnic, and gender pay gap further contribute to career dissatisfaction, ultimately underscoring the need for research that supports culturally competent care, equitable compensation, and better work-life balance.

Parting thoughts

While doctors are among the top earners in the US, rheumatologists bring in lower salaries than their peers in other medical specialties, despite high demands. Like most physicians in today's healthcare landscape, they are experiencing high debt and burnout. Reducing student loan burden is one way to maximize salary. Achieving seniority and gaining experience also translates to higher salary, but in the absence of adequate staffing and better work-life balance, feelings about career satisfaction remain mixed.

Working at a hospital early in one’s career and transitioning to private practice seems to be the best way to achieve wealth in this specialty. Geographical location/region and the size of the area in which one works changes compensation only marginally for rheumatologists. All these factors, along with differences in organization ownership, taxes, lower reimbursement rates, health insurance benefits, and rising inflation, must be considered when considering an employment package.

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Sources

Monga K. Rheumatologist shortage threatens arthritis care. Medscape. November 21, 2023.
Medical Group Management Association (MGMA) DataDive. 2021-2023 data.
Budd K. 7 ways to reduce medical school debt. AAMCNews. October 14, 2020.
McKenna J. Rheumatologist Compensation Report 2022: Incomes gain, pay gaps remain. Medscape. May 13, 2022.