Medical doctors are the highest-paid professionals in the US, but some medical specialties are better compensated than others.
The top-six lowest-paid MDs are related to the pediatric specialty.
Other physicians who aren’t paid as well include medical genetics doctors, family medicine doctors, and preventive medicine doctors—something residents should keep in mind when applying for programs.
Many lists of the highest-paid jobs in the US are dominated by medical doctors. Neurosurgeons, cardiologists, and urologists are all well-paid, each earning more than $500,000 annually on average, according to Doximity’s 2023 Physician Compensation Report.
But not all doctors are so well-compensated.
While US medical doctors are considered well-paid compared with the general population, there is a sizable gap between the top and bottom earners.
The six lowest-paying medical specialties of 2023 were all related to pediatric care, according to Doximity’s report. Of the bottom-10 paying medical specialities, eight were related to pediatric care. MDLinx has grouped all these specialties together.
Pediatric specialty salaries rank as follows:
Pediatric endocrinology: $218,226
Pediatric infectious disease: $221,126
Pediatric rheumatology: $226,186
Pediatric hematology and oncology: $237,005
Pediatric nephrology: $238,208
Pediatric pulmonology: $263,742
Child neurology: $273,167
Low pay is a longstanding issue for doctors practicing pediatric medicine. According to a paper published in Neurology, only 26.5% of child neurologists feel positive or extremely positive about their total compensation, while 42.4% feel negative or extremely negative about how they’re paid.
“This is corroborated by the 52% of our respondents who believe that the perceived lower income of child neurologists compared to other specialists explains at least in part the lower match rates for training programs,” the authors wrote.
The authors also note that child neurologists frequently endure long work hours, work stress, and a lack of recognition from hospital systems and healthcare reimbursement structures.
Despite the stress and lower pay, many find purpose in working as a pediatric doctor. In a presentation about the specialty for Northwestern University’s Feinberg School of Medicine, Jennifer Trainor, MD, quoted pediatric specialists who have found meaning in working as a pediatrician.
“I chose it because I was inspired to enter medicine by my own pediatrician,” Linda DiMeglio, MD, was quoted. "I also feel strongly about advocating for those who legally need adult voices and medically need someone always acting in their best interest."
Doctors who specialize in medical genetics have the second lowest pay of any specialty, according to Doximity’s report. These doctors make an average of $244,107 annually.
In a speech for the American College of Medical Genetics and Genomics (ACMG), Gerald Feldman, MD, said the starting salary for medical genetics doctors is competitive. However, he believes these doctors, while already practicing, are not compensated as well as they should be.
“That’s what needs to be fixed, not the starting salaries,” Dr. Feldman said.
"As these newer trainees move up in the ranks, I hope their salaries will increase appropriately. It’s important to be proactive and support each other in this process."
— George Feldman, MD, in a speech for the ACMG
Doximity’s report notes that doctors who practice family medicine are paid $273,040 annually, on average.
Family medicine and other primary care doctors are also frequently crunched for time, according to research from the University of Chicago. A 2022 study found that if these doctors were to follow nationally recommended guidelines for preventative, chronic disease and acute care, they would need 26.7 hours in a day to see an average number of patients.
“There is this sort of disconnect between the care we’ve been trained to give and the constraints of a clinic workday,” said Justin Porter, MD, lead author of the study and an assistant professor at the University of Chicago. “We have an ever-increasing set of guidelines, but clinic slots have not increased proportionately,” he added.
Preventive medicine specialists make $275,068 each year on average, according to Doximity’s report.
Use of preventive medicine is less common than treating diseases after they arise, according to an essay published by the Centers for Disease Control and Prevention in their Preventing Chronic Disease collection. The authors cited an implementation gap between treating disease and using preventive medicine.
“A major reason the implementation gap exists is that financial incentives do not align with a focus on preventing chronic diseases,” they wrote.
"Currently, most providers, including hospitals and physicians, are paid to treat rather than to prevent disease."
— Authors, writing for the CDC's Preventing Chronic Disease collection
“Payers have the potential to increase utilization of preventive services with value-based payment models and contractual requirements that include reporting on preventive health quality measures,” the authors wrote.
Doctors who specialize in geriatrics make $275,704 per year on average, according to Doximity’s report.
With the lower pay, there’s poised to be a shortage of geriatrics doctors, according to a study published in the Journal of Aging and Health.
Despite the increasing average age of the US population, the geriatrics workforce decreased from 10,270 in 2000 to 8,502 in 2010, the researchers found.
In 2018, the number was down to 7,300 board-certified geriatricians in the US, which meant there were 1.07 geriatrics doctors for every 10,000 elderly patients.
“The need for more expertly trained and passionate geriatric physicians is clear,” the researchers wrote. “Enhanced undergraduate, medical school, and residency exposure to geriatrics will increase interest in geriatric medicine. Strategies to promote the growth of geriatrics must include better reimbursement for clinicians with geriatrics training and certification.”
What this means for you
The decision as to what medical field to specialize in is personal. Some people who work as pediatric doctors, the lowest-paid medical specialty, feel their career brings them meaning and purpose. For others, the specialization has brought them stress. With certain specialties, such as geriatrics and family medicine, low pay has meant staff shortages. The answer from researchers across institutions seems to be uniform: More pay for these specialities would mean fewer shortages.