Oncologist compensation 2023: High salaries, mixed career satisfaction

Oncologists command high salaries, but like their peers in other medical specialties, they carry the weight of long hours, student debt, burnout, staffing shortages, pay inequities, and other issues that can breed dissatisfaction. 

The state of hematologist-oncologist compensation

Hematologist-oncologists are physicians who have completed training in both oncology and hematology, and specialize in treating patients with blood cancers, other blood diseases like sickle cell anemia, and bleeding disorders like hemophilia. 

There are nearly 17,000 hematologist-oncologists, also called heme-oncs, practicing in the United States.[1] They're increasingly in demand, thanks to medical advancements that have enabled greater detection of cancer cases and prolonged survival rates.[2]  

According to the latest MGMA research (based on 2022 data), the national median salary for a hematologist-oncologist is $516,017, representing a 4.33% year-over-year increase from 2021 to 2022.  

Student loan burden

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

For heme-oncs, that number is a lot higher—these specialists amass significant student loan debt. After medical school, new doctors who aspire to specialize in heme-onc start internal medicine or pediatric residency programs, which hardly pay enough to offset the debt they’ve accumulated.

Upon graduation, physicians typically complete a 3-year heme-onc fellowship; all told, they must complete approximately 11 years of training before commanding their terminal salaries.  

Highest and lowest paying states for heme-oncs  

Salaries range widely depending on the state one practices in—highest salaries are commanded in Mississippi ($763,020) and Iowa ($756,652), and lowest salaries in Louisiana ($373,453) and New Jersey ($379,890).[4]

This is likely due to differences in supply and demand for hematologist-oncologists in different states, and underscores how scarcity affects compensation across the nation. 

Hematologist-oncologists earn more in rural areas ($549,637) compared with metropolitan areas ($515,199). This $34,000 difference may not seem large, but when you factor in no or lower state taxes and a lower cost of living, it can make a big difference.

Facility and ownership

Where hematologist-oncologists decide to work—whether in an academic medical center, outpatient clinic, private hospital, ambulatory care unit, or private practice—plays a major role in their salary.

Organization ownership also plays a role in heme-onc compensation—according to MGMA data, hematologist-oncologists who work for physician-owned hospitals earn an average salary of $471,855, compared with $533,047 for those who work for hospital- or IDS-owned organizations.  

Experience and tenure

Not surprisingly, there is a linear relationship between years of experience and salary in this field.

Challenges

Long hours, staffing issues, administrative burdens, workplace violence, and general unhappiness in the workplace are contributing to burnout among heme-oncs.[5] In addition, the emergence of the COVID-19 pandemic exacerbated burnout and contributed heavily to the national shortage of hematologist-oncologists. 

Lower insurance reimbursement rates, under-representation, and a sustained racial, ethnic, and gender pay gap further contribute to career dissatisfaction and underscore the need for research that supports culturally competent care, equitable compensation, and better work-life balance. 

Inadequate representation of minorities

The field of hematology-oncology continues to struggle with under-representation of racial and ethnic minorities. According to 2022 US census data, nearly one-third of all Americans identify as Black/African American (13.6%) or Latino/Hispanic (19.1%).[6] In contrast, only 2.3% of practicing oncologists self-identified as Black/African American and 5.8% practicing oncologists self-identified as Latino/Hispanic.[7] 

Moreover, while women make up over half (57.6%) of all US oncologists, they make 82 cents on the dollar relative to men, bringing in $257,845 compared with $313,303 for male oncologists in the US. 

Parting thoughts

Despite their lucrative salaries, hematology-oncologists still experience high debt and burnout, with mixed feelings about career satisfaction.

In general, more experience translates to higher salary. Other factors that impact physician compensation include location, organization ownership, scarcity, and work environment. All these factors must be considered in light of state differences in taxes, lower reimbursement rates, and rising inflation.

Of note, implicit biases along the basis of race and gender also play a role, albeit unfairly, and more research needs to be done on the impact and magnitude of under-representation and pay gaps throughout this field.

Sources

1. Shih YCT, Kim B, Halpern MT. State of physician and pharmacist oncology workforce in the United States in 2019. JCO Oncol Pract. 2021 Jan; 17(1):e1–e10.

2. Kapur R. The Future of Hematology: The Growing Demand for Subspecialists and Ideas to Increase Interest in the Field Among Medical Residents. Hematopoiesis. March 2022. 

3. Budd K. 7 ways to reduce medical school debt. AAMCNews. October 14, 2020.

4. Medical Group Management Association (MGMA) DataDive. 2021-2023 data. 

5. Lee AI, Masselink LE, De Castro LM, et al. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Advances. 2023;7(13):3058–3068.

6. United States Census Bureau. Quick Facts. United States. 2022.

7. American Society of Clinical Oncology (ASCO). Facts & Figures: Diversity in Oncology. 2023.

8. Oncologist demographics and statistics in the US. Zippia. 2023.