It’s easy to understand why some physicians blame unfair pay for their career dissatisfaction. Six-figure salaries might sound glamorous, but they do little to ease the burden of student debt, burnout, staffing shortages, administrative nightmares, and the general workplace discontent that plagues our healthcare systems. Still, many doctors feel a solution is within reach.
This is the seventh and final piece in our series of reports examining doctor pay trends in 2023. MDLinx surveyed 50 physicians to better understand their sentiments about their own pay, doctor compensation as a whole, and what changes in pay models and employer policies could enhance career satisfaction.
Are physicians satisfied with their pay?
Although physician pay in 2023 bounced back from the pandemic slump, many doctors are feeling squeezed as the modest gains they made were outstripped by inflation. Salaries vary widely based on a multitude of factors, fueling diverse perspectives on compensation. Some physicians feel underpaid, others well-compensated, and some insist their primary motivation isn't financial.
According to MDLinx's poll, 38% of physicians are unsatisfied with their pay, primarily citing lower insurance reimbursement rates and unpaid administrative duties. An even higher percentage—52%—said their compensation is not fair or equitable in the bigger picture.
“Physicians out of training have seen salaries stagnate for about a decade now,” said one survey respondent.
"If you want intelligent, hardworking, and extremely well-educated people to continue to be your physicians, you have to compensate them well financially, as you can't promise a certain lifestyle or amount of time off."
— MDLinx survey respondent
Respondents consistently shared that their salary does not take into account the enormous administrative burden that encroaches on their time, as well as work out in the community.
Data from Medscape found slightly worse results regarding pay satisfaction, with nearly half (48%) of respondents reporting that they were unsatisfied with their pay. Many of the Medscape survey respondents also reported growing concern with reduced insurance reimbursements from Medicare and Medicaid, along with competition from allied health professionals.
One in three doctors surveyed by MDLinx believe their pay is inadequate relative to industry benchmarks or peers, with many citing excessive workloads, particularly in primary care, where "expected broad, comprehensive care" clashes with "inadequate compensation for time, complexity, and 'scut' work," as noted by one respondent.
Balancing job security, autonomy, and fair pay
Here's a universal truth: There's no single physician pay model that works for everyone. Physician compensation boils down to a balancing act between stability, control, and financial reward, with the type of practice and pay model playing a major role in the compensation package that works best.
Most of the doctors surveyed by MDLinx (40%) said they are compensated with straight salary with or without bonuses, followed by fee for service (22%), and performance based (16%).
The majority of those surveyed reported that they work in private practice (54%), meaning they are more likely to reap the full financial rewards of hard work, as they set their own fees. However, these doctors must also shoulder the burden of managing staff, supplies, and overhead costs.
Twenty-four percent of the surveyed doctors said they work in a group or hospital practice—working in these settings often offers a steady paycheck and benefits, but pay ceilings may limit income potential. Facility types and compensation models vary, with distinct benefits and detriments to consider.
Ultimately, the ideal compensation model depends on individual priorities and circumstances. Some doctors prioritize predictability and work-life balance, making group practice a good fit. Others value autonomy and financial freedom, as allowed by ownership of a private practice.Related: 12 compensation types beyond salary to negotiate in your contract
How can compensation become more equitable?
Most US doctors graduate with significant debt, face high malpractice insurance premiums, and are starting families and careers at the same time. These financial obligations make fair compensation essential.
For many doctors, the unpredictability of their schedules is a major source of stress, adding to the already demanding nature of their work. One doctor, Stephanie Moura, MD, an anesthesiologist in Suffern, NY, recalls her time in residency, noting the struggle to balance professional responsibilities with a personal life due to the uncertainty of her schedule. “It was very stressful,” she said.
"I was miserable in residency, not because I lacked money, but because I never knew if I would get home in time to put my kids to bed."
— Stephanie Moura, MD, anesthesiologist, Suffern, NY
However, she also offers a glimmer of hope, acknowledging that things eventually improve—so long as doctors are able to find supportive work environments.
Still, not all doctors are fortunate to work in an environment that provides the ideal employee trifecta: good work-life balance, career advancement opportunities, and high compensation.
Gaining tenure with experience, working in a high-need area or a state with no income taxes, and specializing are some ways doctors can maximize their earning potential, but securing good work-life balance is far from guaranteed. For this reason, physicians—often with little leverage or flexibility—are unionizing as a way to protect their compensation and worker rights.Related: A collective stand: The rising trend of physician unionization
How does pay affect healthcare delivery?
Being aware of the earning potential of different medical specialties empowers doctors to plan their finances effectively and set realistic expectations for debt repayment after medical school. More importantly, fair compensation is one piece of a complex puzzle that keeps doctors happy. When doctors are burdened by inadequate pay, they are more likely to deliver subpar care and reduce access to essential services, the results of MDLinx’s survey show. This domino effect fuels career dissatisfaction—and ultimately harms patient outcomes.
While most doctors surveyed by MDLinx strive to keep their dissatisfaction with pay separate from patient care, some acknowledge its negative impact. Low or unfair compensation can chip away at morale, fuel burnout, and even push doctors to consider early retirement or leave medicine altogether. As resentment builds, it's reasonable to believe that patient care may suffer.
To offset the squeeze from low pay, some doctors take on outside work to make ends meet, with nearly half of the survey respondents indicating that they supplement their income with side gigs—both medical and nonmedical, such as taking speaking engagements, consulting, moonlighting as a hospitalist, or taking telehealth visits.
It's important to remember that not all doctors experiencing compensation issues will necessarily experience a decline in their quality of care—and some insist money is not their primary motivator at all.
"Money is important, but not the most important. You need to find a job where you are happy. "
— MDLinx survey respondent
However, the research highlights the potential risks and underscores the need for fair and sustainable compensation models to ensure optimal patient care in addition to a healthy, thriving medical workforce.
What we heard from HCPs: Do you feel you are fairly paid?
"No, primary care doctors do not get adequate compensation."
"Yes, because I put extraordinary effort into my work and business, much more than other surgeons."
"No, we deserve higher pay considering the complexity of our patient cases."
"My total compensation is fair; however, this is dependent on ancillary income. Practice income alone is not competitive or fair."
"For the most part I'm fairly compensated, but not from insurance companies; in this area I feel we are significantly underpaid."
"I do not feel it is honorable to complain since medicine is a field that must always be based upon honor, integrity, and compassion for our patients."
"No. Doctors are fleeing private practice for corporate and concierge platforms. The eventual shortage is obvious."
Two-thirds of doctors surveyed by MDLinx believe more paid time off and a flexible work schedule would improve overall job satisfaction, as opposed to self-care benefits—such as subscriptions to mindfulness apps and online counseling sessions—that are currently offered. Other valuable incentives that contribute to physician happiness include tuition and childcare assistance and premium health insurance.
Notably, one-third of surveyed doctors said they would consider taking a pay cut for better work-life balance, underscoring the many factors that belie a happy work environment. Beyond paychecks, many doctors crave time and recognition—often overlooked factors in job satisfaction.
"For me, having a predictable schedule trumps even money," Dr. Moura tells MDLinx. Dr. Moura juggles motherhood, marriage, and a demanding career, and for her, work-life balance is paramount. "It's the difference between hitting the gym, making my doctor's appointment, and picking up the kids, or missing out on those precious moments."
Dr. Moura’s experience highlights a crucial point: For many doctors, recognition comes in many forms, including flexible scheduling and the ability to prioritize their personal well-being. "I'd trade money for more time with friends and family,” she says. “I’d trade money for the maternity leave I get [which is unheard of at many practices] or the time back I get some days. Valuing my personal time helps me to feel appreciated, which is essential for my mental health."
What we heard from HCPs: Other factors that should be considered when evaluating compensation
"Satisfaction surveys, quality scores, and years of experience."
"Time spent outside of regular hours working with EHR."
"Length of training and overall demand."
"Efficiency, the ability to multitask, business acumen, and talent. Doctors are intelligent by nature, but do not always possess these additional four traits."
"None. I believe in getting paid for work performed."
"Some specialties, like infectious disease, save a considerable amount of money for the institutions that hire them. This is rarely taken into account but should be considered."
While money alone doesn't guarantee a happy doctor, fair compensation plays a crucial role in physician well-being, ultimately enhancing patient care. Instead of tepid resources with little time to take advantage of them, such as one-off counseling sessions, it’s clear that clinicians yearn for tangible support.
Dr. Moura's words resonate with many: "Knowing my boss and colleagues will cover for me when my kids are sick is priceless. That makes me feel more valued than any award or paycheck,” she says. “Although fair pay is still important."
Providing adequate and effective resources, such as additional paid time off, sufficient staff, childcare assistance, and more-flexible schedules seems to be the key to unlocking greater happiness and productivity among physicians.Read Next: Trends in medicine that may affect your compensation
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Kane L. Medscape Physician Compensation Report 2023: Your Income vs Your Peers'. Medscape. April 14, 2023.