Attending physicians get paid more than residents and fellows, but how much more depends on several factors, including your specialty, location, practice setting, and pay structure.
As you progress throughout your career, you’ll become more efficient and productive, which puts you in a position to earn more at your current job or command a higher salary at a different one.
Realize that total compensation over the course of your career largely depends on four factors: how much you work, the percentage of your salary that is based on productivity, your ability to negotiate raises, and whether or not you have additional streams of income.
Whether you’re a recent grad who just started your first job out of training or a seasoned attending preparing to re-negotiate your contract, it’s important to know how compensation might change throughout your career.
In the beginning
When you first start a job, you may be given a set salary or your pay may be based solely on productivity—though the latter is more rare.
Employers realize that you need time to learn the system and build a patient panel or referral base, so having a set salary provides a stable income from the start.
Your base salary will depend on a few factors, including your specialty, location, practice setting, and level of expertise. It may also depend on how in-demand physicians are at the specific organization, the ease at which they have been able to hire physicians in the past, their estimation of how long it may take you to develop a patient panel, and how much they are paying other physicians in the same specialty.
New attendings are paid much more than residents or fellows, but this amount is likely lower than you will make throughout your career.
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Two to four years in
Once you’ve been an attending physician for 2 to 4 years, there’s a good chance your pay will increase.Related: Physician compensation 2023: The good, the bad, and the ugly
This increase tends to occur for one of three reasons:
You’ve become more productive: After a few years, you’ve likely learned the system or, at the very least, gotten better at your job. This increase in confidence and productivity makes you more efficient and tends to increase your pay.
Your pay structure has changed: While you may have had a set salary during your first year, at least part of your compensation may be based on productivity by the 2nd or 3rd year. The ability to be paid from productivity or receive an increase to your base salary results in higher compensation overall.
You switched jobs: Believe it or not, one of the easiest ways to increase your pay is to change jobs. Why? Because you have the most negotiating power before you sign a contract, and many organizations will offer higher pay to new physicians.
"It may be easier to get a new job with a higher salary than to convince your current job to give you a raise to do the same work."
— Lisha Taylor, MD, MPH
I’m not advocating that you switch jobs, especially if you like the one you currently have. My point is that by the time a physician has been an attending for 2 to 3 years, they typically see a pay increase.
After the first 5 to 10 years
Compensation during this time can be quite variable. While many attending physicians 5 to 10 years out make more than they did when they first started, this is not the case for all physicians.
In fact, I find that most physicians fall into one of three categories. The first includes the physicians who are getting a pay increase. These are the doctors who are about to make partner at their private practice group or are getting promoted within their health system.
The second category includes the doctors whose salary is stable. Perhaps they are working a decent amount in their current job but have not experienced an increase in pay in the last few years due to a handful of reasons—decreased insurance reimbursement, budget issues at their job, or not negotiating a raise, for example.Related: Retirement investing: Everything you need to know
The third category of doctors are those who are preparing for a pay decrease. Perhaps they have gotten burned out from medicine and decided to work part time in order to pursue other passions or have more time with their family. Which camp you fall into really depends on how much you decide to work in medicine, whether or not you like your practice, and your overall priorities and long-term goals.
Compensation after 10 to 20 years
For most physicians who are still practicing medicine full time, or close to it, this is the point in their career where they make the most money.
They are now considered to be one of the most experienced physicians at their practice, and they are usually paid more as a result. This increase in compensation tends to occur because they either got promoted and/or made partner, which comes with a higher base salary, bigger productivity bonus, or a larger share in profits; or they have undergone a “restructuring,” and how they make money has changed.
Perhaps they still work clinically but have picked up a lucrative side job that adds to their income. Maybe they have been awarded research grants that cover a portion of their pay. Or perhaps they have accepted positions of leadership and had their time bought out to do other duties they find more fulfilling.
Regardless of the type of restructuring or promotion, most physicians who have worked for 10 to 20 years and are still practicing medicine fairly regularly make much more than they did when they first became attendings.
Compensation after 20 to 30 years
By this point, many physicians have retired or stopped practicing medicine full time, meaning compensation can vary widely. Most of the physicians who are still working regularly tend to make an income that is similar or higher to what they made before. However, the majority of physicians in this range have started to work less and are nearing retirement.
It can be difficult to go from practicing medicine 4 to 5 days a week to not working at all, so many of them transition into retirement gradually. Usually this means they decrease their shifts, operate less, or have fewer clinical days each week. But just because they make less as a physician does not necessarily mean their income has changed. Many physicians may have additional sources of revenue or have made certain investments that add to their total compensation and net worth. Some have started businesses, invested a great deal in the stock market, or found other fulfilling jobs that add to their compensation.
What this means for you
While you are likely to start off with a set salary, your pay structure and the amount you make usually changes over time. Many physicians will have stable or increasing income unless they chose to cut back and work part time. If you’d like consistent compensation without the pressure to see as many patients as possible, then you may want to opt for a set salary or take on other roles that buy out your clinical time. If you’d like your compensation to increase, you’ll need to negotiate periodic raises, have a part of your pay based on productivity, or find additional sources of income.