Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Last year was a welcome reprieve for many physicians; practices reopened, patients ventured out, and elective procedures ramped up. Still, many physicians struggled with a tougher workload, having to see more patients, taking pay cuts, and having less staff to work with.
Over 13,000 physicians in more than 29 specialties told us how their compensation fared, how they now feel about being physicians, how they've been supplementing their income, and how they've been paying for their own healthcare.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Income took a jump from the prior year, but some of that was compensating for stagnant or declining income in 2020, when practices were closed and patients were staying home.
"Compensation for most physicians is trending back up as demand for physicians accelerates," says James Taylor, chief operating officer of AMN Healthcare's Leadership Solutions Division. "At the height of the pandemic in 2020, Merritt Hawkins saw a 30% decrease in client physician recruiting engagements year-over-year. But in the 4th quarter of 2021, physician recruitment engagements hit an all-time high. The market for physicians has done a complete 180 over just 7 or 8 months."
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
The highest-earning specialties are virtually unchanged this year from 5 years ago, in 2017. For employed physicians, these figures include salary, bonus, and profit-sharing contributions. For self-employed physicians, they include earnings after taxes and deductible business expenses before income tax. Only full-time salaries were included in our results.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
It's a first in Medscape's 11 years of Physician Compensation Reports: All specialties have seen an increase in income. (Although many physicians saw their income decline individually.)
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Since 2015, physician compensation has increased by 29% overall, 33% for primary care physicians and 30% for specialists.
Rising salaries help everyone get back on track by covering living costs and keeping up with inflation. In the 5 years since 2017, the United States has experienced a 14.7% cumulative rate of inflation.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
More than half (57%) of physicians have an incentive bonus element to their income; they can earn this payment through productivity or other goals set by the employer, such as patient satisfaction or clinical processes. A 2021 report showed that incentive bonuses effectively inspire people to work longer and earn more, to the point that they will even choose to spend more time with colleagues rather than family.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
The income gap between men and women has remained fairly constant over the years, but overall, salaries have risen. A decade ago, in our 2012 Compensation Report, male primary care physicians earned 23% more than their female peers ($174,000 vs $141,000). This year, men earned 25% more than women.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
The gender gap in specialist salary, which is 31% this year, has declined somewhat over the years (37% in 2017; 36% in 2018; 33% in 2019). One likely reason is that more women are going into specialties, especially higher-paying ones.
"A great many of the specialty organizations have efforts underway not just to increase the number of women in specialties but also to address gender pay gaps and bias in evaluations during residency and fellowship," says Ron Holder, chief operating officer of the Medical Group Management Association (MGMA). "Also, as more women have been able to break down barriers into specialties where they have not been as present before, aspiring female medical students, residents, and fellows now have opportunities for more female mentors in the field of interest. The benefit of that in recruiting women to the specialty can't be overstated."
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
All groups have seen an increase in income over the past 5 years, since our 2017 report. Compensation for African American/Black physicians increased by 19%, 21% for Latinx/Hispanic physicians, 16% for Asian American physicians, and 14% for Caucasian/White physicians. As was true 5 years ago, Caucasian/White physicians are the highest earners.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Many or most of the higher-earning states on this year's list were also on the lists in prior years. Many southern states have made extra efforts to attract physicians, especially to rural areas. Higher salaries and incentives are among the tactics that they are using to lure more physicians.
"Demand for healthcare is high in these states as all six are in the worst 20 states for overall health according to America's Health Rankings, United Health Foundation," says Holder. "The supply of physicians who want to work there may be low because, of the states listed above, three of them are listed in the bottom 10 of 'best states to live in' according to an article from US News and World Report. If you want people to move to a state that does not seem as attractive of a place to live, there needs to be something about the opportunity to get physicians to take a look at the job, and sometimes that is above-national median pay."
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Thirty-six percent of physicians took extra work to supplement their income. "Physicians are highly educated, so they're more likely to appreciate the value of generating supplemental income and having multiple streams of income, and they are more likely to have the knowledge necessary to create or find a feasible side hustle," says Sylvie Stacy, MD, MPH, author of 50 Nonclinical Careers for Physicians. "Physicians are fortunate to have a huge array of potential side gigs available to them. Supplemental income that pays well is not difficult to find."
"I don't think that the 36% figure is due to COVID," continues Stacy. "I expect it's either stable, or rising because of reasons other than COVID, such as an increasing interest in early retirement and financial independence, rising student debt leading younger doctors to seek ways to pay off their debt faster, etc."
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
"The Arkansas legislature made independent practice legal for Certified Registered Nurse Anesthetists, so we are no longer needed."
"Our hospital changed groups so they can make more money."
"Hospitals are hiring primary care physicians and forcing referrals to hospital physicians."
"Urgent care clinics are our competition."
Competition may heat up even more in coming years because Walmart, Walgreens, CVS and Amazon plan to build new or larger retail clinics that will offer many aspects of traditional primary care.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Although physician income rose overall, about one fifth of doctors still saw their income drop. This year, only 70% of respondents blamed the decline on COVID-related factors compared with 92% of respondents last year.
"I'm able financially to just make ends meet and hoping this will turn around. Last year, we got loans and grants to help, but nothing so far this year."
"The company reduced our pay by 20%."
"I'm forced to work in non-EM settings, my retirement contribution was lowered, and I had a pay cut."
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Some of COVID's harshest impact has receded. In last year's report, 22% of physicians noted a reduction in hours (compared with 10% this year) and 13% had reduced staff hours (compared with 5% this year). Last year, more than half of physicians (55%) said that COVID negatively impacted their job compared with 36% who said that this year.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
What determines the feeling of being fairly compensated? "Part of it is the dollar amount," says Taylor. "It's not surprising that high-earning specialties consider their incomes to be fair. Today, however, it's not necessarily the dollar amount physicians earn that may cause them dissatisfaction, but the methods by which their compensation is determined. These can include production bonuses that can penalize physicians for seeing relatively sick patients, or formulas that track quality measures physicians don't believe are relevant or meaningful. That's one reason we are seeing a decline in the number of clients offering a salary plus production bonus and an increase in those offering a straight salary."
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Some specialties have seen a notable increase in the percentage of women physicians since our 2016 report. At that time, 36% of family physicians were women, as were 31% of internists, 26% of oncologists, and 25% of critical care physicians. The percentage of general surgeons who are women has remained about the same.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
The challenges of treating COVID patients and working during the pandemic, as well as the changing tone of medicine, have prompted a number of physicians to leave the profession and disenchanted many others. Still, the percentage of physicians who would choose medicine again is higher than it was over a decade ago; in our 2011 Compensation Report, only 69% of respondents said they would choose medicine again.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Many physicians love their specialty; dermatologists and orthopedists show up as the top groups year after year. Although the primary care specialties have lower rates of doctors wanting to remain in their specialty, still more than half of each (68% of family physicians and 63% of internists) would choose the same specialty again.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Self-employment has been on the wane for some time, yet the potential for higher income is there. Self-employed physicians earned 20% more than employed physicians.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Although there are generally more self-employed physicians who are in older age groups, physicians under 45 years of age who are self-employed are doing quite well. A 2018 study by the American Medical Association shows that employed physicians make up 47.4% of patient care doctors and self-employed physicians make up 49% of patient care doctors.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
In our report 5 years ago (2017), more than half (57%) of physicians spent more than 10 hours per week on paperwork and administration. This year, the overall average is 15.48 hours per week spent on paperwork and administrative tasks.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Nearly 64 million US residents are covered by Medicare; Medicare patients typically see physicians more often than younger people do. For most physicians, it would be hard to replace their patient base if they did not take Medicare. Medicaid pays physicians less than Medicare does; one study showed that Medicaid programs pay doctors' fees at 72% of Medicare rates.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Many physicians feel an obligation to care for their existing patients, and others feel that they have few options and must take all patients no matter how the insurer pays. In 2015, 22% of respondents said they would drop the insurers that paid the least.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Fee-for-service appears to remain alive and well, despite many insurers' and institutions' efforts to switch to other forms of payment.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
More and more medical practices have been adding NPs and PAs to their staff. The PA profession grew 28.6% between 2016 and 2020, reaching 148,560 certified PAs at the end of 2020.
The top five states with the largest percentage of growth in the number of PAs from 2016 to 2020 were Rhode Island, Mississippi, Arkansas, Indiana, and Nevada.
The United States has more than 325,000 NPs, of whom 88.9% are certified in an area of primary care.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
A large number of patients lost their health coverage when they lost or had to leave their jobs during COVID. In 2019, of the US residents who were uninsured, 12.7 million of them had full-time jobs and 4 million had part-time jobs. The Affordable Care Act requires large employers to offer insurance but does not require the same for small firms with fewer than 50 employees, which is where many people who are uninsured work.
In addition, insurance doesn't cover deductibles and many other expenses, so some patients aren't able to or choose not to pay their medical bills.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
About three quarters of physicians have medical insurance coverage through their workplace; that's much higher than the national average. According to research from the Kaiser Family Foundation, about 49% of the US population has insurance coverage through their employer.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
There's been a shift in these values over the past several years, perhaps reflecting changing relationships with patients. In both 2015 and 2017, "Gratitude/relationships with patients" scored higher (34% in 2015; 33% in 2017), as did "Being very good at what I do/finding answers, diagnoses" (32% in 2015; 33% in 2017).
"Knowing that I'm making the world a better place" increased from 12% in both 2015 and 2017 to its current 23%.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Physicians named hectic pace and too many patients; administration, government, and other uneducated people imposing their opinions on the practice of medicine; documentation; a noncomprehensive EHR system; little or no upward mobility; the emotional toll of caring for very sick patients, doing high-risk surgery, and helping patients navigate end-of-life issues; and patient noncompliance as the most challenging parts of their jobs.
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
Medscape Physician Compensation Report 2022: Incomes Gain, Pay Gaps Remain
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