Highest Paid Specialties For Doctors

The fact that you chose to become a physician means that you are an innate investor.

After all, becoming a physician means investing in yourself despite all the hardship you took to get here. So I get it when you feel betrayed when you hear about the proposed 3.4% Medicare cuts to physician reimbursements. This is another pay cut on top of the one last year. Yeah, we are physicians and we will always have jobs. But I know of no other job where you earn less to do more the longer you’re there.

It’s no wonder that medical students are increasingly drawn to higher-paying specialties. The financial burden of medical school, residency, and fellowship training is staggering. Coupled with the uncertainty of income in primary care, it’s understandable why many young physicians opt for specialties with more predictable financial rewards.

Unsurprisingly, many medical students and residents grapple with the decision between pursuing a generalist or specialist path. A common factor influencing their choice is earning potential.

The real money comes after residency when you start working towards specialization. 

While primary care doctors earn a nice little chunk of money, specialization just allows for so much more. It gives you better hours, allows you more recognition and opportunities to further your skills, etc. But most importantly, it gives you a huge financial boost.

Specializing in a certain medical field means you start earning in the top tax bracket. 

Getting into a specialty, or sub-specialty is an effective way to move up to the higher income brackets. But the problem is which specialty works best. There are so many out there, each with their own perks and pay grades. They all have different training requirements, skill sets, limited positions in training programs, and different risk profiles for malpractice (yeah, I said that bad “M” word).

In my years of practicing medicine, I’ve kept in touch with many physician friends who later went on to specialize and become respected consultants in their fields. So today, let’s discuss the highest-paid specialties for doctors:

• Why specialization is important to further your career
• The types of specialization
• Which ones offer the biggest paycheck

Specialization Pays Off: Top-Earning Medical Fields

Despite the challenges and lower earning potential compared to many specialties, primary care continues to attract a dedicated group of physicians. Primary care physicians often develop long-lasting relationships with patients, providing comprehensive care across the lifespan. This continuity of care allows for a deeper understanding of patient’s needs and a more holistic approach to their health. I have many friends who have taken care of at least 2 generations of families which is an amazing accomplishment. In many specialties, these types of long-lasting relationships may not be possible.

Primary care offers a wide range of clinical experiences, from pediatrics to geriatrics. This diversity can be intellectually stimulating and keeps the practice from becoming monotonous. Primary care physicians play a crucial role in preventive care, health promotion, and managing chronic diseases. By addressing the underlying health needs of a population, they can significantly impact public health outcomes. Lastly, while the demands of primary care can be high, many physicians find it offers a better work-life balance compared to some specialties, particularly those with demanding on-call schedules.

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So why would future physicians elect to specialize? One of the factors in the selection of a specialty is future pay. From a medical care standpoint, the higher compensation for medical specialists is often tied to these factors:

1. Specialized Expertise and Training:

• Advanced Skills: Specialists undergo rigorous training and possess in-depth knowledge of a specific area of medicine. This specialized expertise is valuable and often requires higher compensation.
• Complex Procedures: Many specialties involve complex procedures that demand advanced technical skills and judgment. These procedures often command higher reimbursement rates.

2. Limited Supply and High Demand:

• Scarcity of Specialists: The number of specialists in a particular field can be limited due to the length and intensity of training required. This scarcity often drives up demand for their services. For example, many training and fellowship programs limit the number of these specialists which drives demand.
• Complex Cases: Specialists often handle complex and challenging cases that require specialized care. This concentration of expertise increases their value.

3. Economic Factors:

• Reimbursement Rates: Procedures performed by specialists tend to have higher reimbursement rates compared to primary care services. This reflects the complexity of the procedures and the expertise required.
• Productivity: Specialists often have higher productivity rates due to the nature of their work, which can translate into higher earnings.

4. Market Forces:

• Supply and Demand: The imbalance between the supply of specialists and the demand for their services can significantly impact their earning potential.
• Geographic Location: The geographic distribution of specialists can influence their salaries. Areas with a shortage of specialists often command higher compensation.

Specialization is the natural step most people take when they want to continue studying medicine and earn more as a doctor. However, not all specialties are built equal. Sure, all of them require hard work, but some indeed pay better than others.

Here are the top 10 picks:

1. Neurosurgery 

One of the most complicated specializations to master, Neurosurgical residency is one of the longest and most demanding training programs, requiring exceptional intellectual capacity and physical stamina. Neurological conditions often involve life-threatening situations, such as intracranial hemorrhage, spinal cord injury, or brain tumors. There is a narrow margin for error so the stress levels are high. Among the surgical specialties neurosurgery has a pretty high risk profile for malpractice suits. Making it less palatable for many upcoming physicians. The fact that there is only about 1 surgeon for every 60,000 Americans means that there is a shortage for their services. These factors all play a role in the resulting supra-high-income earners among physicians.

That’s why it tops the list, with neurosurgeons earning nearly $800,000 per year. 

2. Cardiothoracic Surgery

You’ve heard it said before: High-risk, high reward. Cardiothoracic surgeries, which involve the heart, lungs, and major blood vessels, are inherently complex procedures that often require intricate manipulation of these vital organs. Many of these procedures are performed in critical, life-threatening conditions, demanding exceptional skill and precision. Cardiothoracic surgery is consistently ranked among the highest liability risk specialties in medicine. This is due to a combination of factors:

• High-stakes procedures: Cardiothoracic surgeons perform complex procedures on vital organs, often in emergency situations.
• Significant morbidity and mortality: Despite advancements, these surgeries carry inherent risks of serious complications or death.
• Complex patient population: Many patients undergoing cardiothoracic surgery have underlying medical conditions that increase their risk profile.
• Public perception: The high-profile nature of cardiac and thoracic conditions can lead to increased scrutiny in cases of adverse outcomes.

Demand and supply certainly play a role in the high salaries that CT surgeons demand.

• Limited Supply: The training to become a cardiothoracic surgeon is rigorous and time-consuming. This limits the number of qualified surgeons available.
• High Demand: Heart disease remains a leading cause of death globally, creating a consistent demand for cardiothoracic services.

Another factor is the on-call burden that many CT surgeons take. This commitment results in higher compensation. It’s important to note that while cardiothoracic surgeons generally earn more, individual earnings can vary based on factors such as geographic location, practice setting, and experience.

It isn’t hard to see why anyone would choose thoracic surgery as a specialty, considering it has become very in demand in the U.S. So, the employment options are endless.

But the $700,000 annual pay doesn’t hurt either. 

3. Orthopedic Surgery

Technically, we all know orthopedic surgery is a lucrative field to get into. But it’s also more about just what doors it opens.

Orthopedic surgery specializes in treating musculoskeletal issues such as bone fractures, torn ligaments, joint replacements, etc.

Orthopedic surgery offers a diverse range of procedures, ensuring a steady workflow for surgeons. Consequently, compensation is often substantial, with many orthopedic surgeons earning upwards of $650,000 annually. Specializing in a subfield like sports medicine can further elevate earning potential. Many orthopedic surgeons have a passion for sports, making this specialty a natural fit for those interested in treating athletes and sports-related injuries.

4. Plastic Surgery

While I was in medical school in a class of about 150 students only 2 people elected to apply to plastic surgery programs. If I remember correctly only 1 of these got accepted. The sheer competitiveness to enter these spots is like getting a personal invitation to Elon Musk’s Mars colony. These folks have to give 14 years of their lives to become plastic surgeons. That’s 4 years of undergraduate, 4 years of medical school, 6 years of specialized plastics residency program, and 1 year fellowship for a sub-specialization (which is optional). The allure of this specialty lies in several key factors:

Tangible Results and Patient Satisfaction:

Unlike many medical specialties where improvement is often measured in subtle changes, plastic surgery offers immediate and dramatic results. This tangible transformation is incredibly rewarding for both the patient and the surgeon. Furthermore, plastic surgery often addresses physical deformities or functional impairments, significantly improving patients’ quality of life. This aspect of the specialty is deeply fulfilling for many physicians.

Artistic and Technical Skills:

Plastic surgery requires a unique blend of artistic vision and surgical precision. It allows physicians to combine their medical knowledge with a creative flair. The field encompasses a wide range of procedures, from reconstructive surgery to cosmetic enhancement, providing opportunities to develop a diverse skill set.

Lifestyle and Work-Life Balance:

Many of the surgical specialties tend to have a heavy pager/call burden. Compared to some other surgical specialties, plastic surgery often offers a more predictable work-life balance. While on-call hours can vary, the overall lifestyle tends to be more manageable. Plastic surgeons often enjoy competitive salaries, which can contribute to a desirable lifestyle.

 You’re looking at a nice $590,000 to $620,000 yearly depending on factors like geographic location, practice setting, and patient volume. 

5. Oral And Maxillofacial Surgery aka OMFS

Oral and maxillofacial surgeons operate at the intersection of medicine and surgery.  OMFS requires a deep understanding of both medical and dental sciences. This dual expertise is essential for managing a wide range of conditions affecting the mouth, jaws, and face.

OMFS surgeons are at the forefront of managing facial trauma, requiring a comprehensive understanding of facial reconstruction and rehabilitation. Also, this subspecialty focuses on the surgical procedures related to teeth and jaws, including extractions, implants, and orthognathic surgery. A significant portion of OMFS practice involves treating children, requiring specialized knowledge of pediatric anatomy. While primarily focused on reconstructive surgery, OMFS also encompasses aesthetic procedures like facial rejuvenation and rhinoplasty. The training to become an Oral and Maxillofacial Surgeon (OMFS) typically takes 8 to 10 years.

The expertise and knowledge expected to specialize in oral and maxillofacial surgery is probably why the pay is so high, rounding out at an even $600,000 per year. 

6. Radiation Oncology

Radiation oncologists play a critical role in treating cancer, a disease that affects millions worldwide. The ability to directly impact patient outcomes and improve quality of life is immensely rewarding. One factor that makes radiation oncology so compelling to many is that it involves close collaboration with other medical specialties, fostering a team-oriented approach to patient care.

When you look at this career overall one walks away with the feeling that it is very technology-driven: Radiation oncology is at the forefront of technological advancements, with continuous development of new treatment modalities and techniques. This offers opportunities for intellectual stimulation and career growth.
Also, precision medicine drives this field to be increasingly focused on personalized treatment plans, allowing for tailored care based on individual patient characteristics.

Compared to some other medical specialties, radiation oncology often offers a more predictable schedule with fewer on-call hours which makes for an amazing work-life balance.

Thus, the pay matches the intensity of the field, with radiation oncologists being paid nearly $550,000 annually.

7. Cardiology

Cardiology is a beast on its own, with a lot of demand worldwide. Cardiology offers a compelling blend of intellectual challenge, procedural skills, and patient impact. For future physicians considering their specialty, cardiology presents several compelling advantages:

• Intellectual Stimulation: The cardiovascular system is a complex and dynamic organ system. Understanding its intricacies and applying that knowledge to patient care provides ongoing intellectual stimulation. It’s such a dynamic specialty with advances in tech, procedures, and medications arriving at a fast and furious pace. Just attend one American Heart Association national convention and you’ll see what I mean.
• Procedural Diversity: Cardiology offers a broad spectrum of procedures, from non-invasive imaging to invasive interventions. This diversity keeps the field engaging and allows for subspecialization based on individual interests. However, they also need to be proficient in diagnostic procedures such as echocardiography. And if that wasn’t enough, they are also required to scrub in for surgeries such as valve replacements, CABG, and electrophysiology procedures.
• High-Impact Care: Cardiovascular diseases remain a leading cause of morbidity and mortality globally. Cardiologists have the opportunity to directly impact patient outcomes and save lives.
• Collaborative Environment: Cardiology often involves collaboration with other specialties, fostering a multidisciplinary approach to patient care.
• Financial Stability: Cardiology is a well-compensated specialty, offering financial security and the ability to build a successful practice.
• Career Advancement: The field offers opportunities for leadership roles, research, and academic pursuits, allowing for continued professional growth.

When you look at the pros listed above you can see why they are in high demand in the ambulatory and in-patient settings.

With that much to do, you need a pay that’s actually worth it.

Luckily, cardiologists are expected to make around the same amount as oncologists, so a little under $550,000. 

8. Urology

Urology is often overlooked when fresh medical grads are looking into a field to specialize in. But that’s a mistake.

Urologists manage a wide range of conditions, from urolithiasis (kidney stones) to prostate cancer, female urology, and pediatric urology.

This breadth of practice requires a comprehensive understanding of both male and female anatomy and physiology.  Interestingly, unlike many surgical specialties focused primarily on operative procedures, urology encompasses both surgical and medical management of urological diseases.  When it comes to minimally invasive techniques Urology has been at the forefront of developing and adopting these techniques where procedures like laparoscopic and robotic surgery have revolutionized the field.  A relatively new field is endourology which is a subspecialty that focuses entirely on minimally invasive techniques for treating urinary tract conditions.

The above factors collectively contribute to the unique nature of urology, distinguishing it from other surgical specialties.

And because there is such a huge range of issues, both invasive and non-invasive, urology pays over $500,000 per annum. 

9. Gastroenterology

Gastroenterologists often command higher salaries compared to other medical specialties due to a combination of factors:

• Procedural Income: A significant portion of a gastroenterologist’s income is derived from performing endoscopic procedures such as colonoscopies and endoscopies. These procedures are often reimbursed at higher rates than traditional office visits.
• Complex Cases: Gastroenterologists manage a wide range of complex conditions, from inflammatory bowel diseases to liver diseases, requiring specialized knowledge and expertise.
• High Demand: Digestive disorders are prevalent in the population, leading to a consistent demand for gastroenterological services.
  Subspecialization: Gastroenterology offers opportunities for subspecialization, such as hepatology or advanced endoscopy, which can further increase earning potential.
• Training and Experience: The path to becoming a gastroenterologist involves extensive education and training, including medical school, internal medicine residency, and a gastroenterology fellowship. This specialized expertise is valued in the marketplace.

While these factors contribute to higher earnings, it’s important to note that individual income can vary based on factors like geographic location, practice setting, and patient volume. They are one of the most consulted services in the in-patient setting.

With so much to work through, gastroenterologists deserve the $500,000 they make.

10. Otolaryngology

Otolaryngology is known to most people by the simpler ENT moniker. But there is nothing simple about the field itself.

Otolaryngology encompasses not just one but three different body parts and their synchronized workings, making it a complex specialty to enter. It isn’t all sore throats and runny noses; otolaryngologists often deal with rare conditions such as Ménière’s disease and even head and neck cancers.

Otolaryngology has always been one of the most competitive specialties, and a lot of it has to do with its $500,000 paycheck. 

The Verdict

I know this entire article is about the top-paying specializations but the truth is, that almost all specializations pay enough for an above-average life. That’s kind of a given with medicine in general. If you are not keen on specializing or if it’s too late career-wise another option is to enter the world of side gigs. For example, I am Internal Medicine trained -which is far from any of the specialties listed above. And yet with side gig work that I structured on top of my regular work, I augmented my yearly income by as much as $250k. Also, autonomy has been a significant factor in my career decisions, as it is for many physicians. I’ve often prioritized independence over higher compensation. Looking back, I’ve never regretted these choices.

The keyword here is finding the perfect specialization for you. You can’t just go for one based on financial benefits alone. This is the kind of decision that needs consideration from all ends, from whether the money is worth the work or if you even have the passion for it. We just can’t have selective amnesia about the reasons we entered medicine -to make a positive impact on the health of our patients.

It’s Not The Years, But the Mileage

The most important element that needs to be considered is how the above specialties play out in real life and not in your bank account. Real life involves relationships,  balance, and validation. Choosing a specialty without taking into consideration how it affects your life, sleep, peace of mind (remember that litigation is a real thing), and retirement goals is like choosing a destination without setting up your GPS. You’ll eventually arrive at your destination -but with a lot of mileage.

This leads to the last statement which I hear a lot in medicine. “It’s not the years, but the mileage.” It’s not necessarily about the number of years you’ve spent on the road (or the high amount of cash you collect), but the condition of your vehicle when you arrive (retirement). Those who have pushed their careers to the limit may find that while they’ve accumulated many miles of experience (cash), they may need more time to recover before fully enjoying their retirement.