Even before the completion of medical school, future physicians have a number hovering over their heads that may shape their future—the balance owed on their medical student loans.

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For about half of physicians, that number can exceed $200,000. For 80 percent it is greater than $100,000. Those medical student-loan debt figures may inspire some trainees to factor earning potential into their career plans.

For medical students aiming to maximize their earnings as physicians, here are a few things to keep in mind.

It takes years to realize your earning potential. As a physician, you will not maximize your earnings until the completion of your graduate medical education. The average first-year resident makes around $60,000, and there’s not much wiggle room.

Resident salaries are determined by an institution and correlate with training year rather than specialty. So, in a given training institution, all residents who are in their third year of training get the same salary, and all in their sixth year are paid the same.

Surgical specialties typically pay more. The highest-paying medical specialties are generally procedure-based. According to an online survey of more than 20,000 physicians across 29 specialties, the highest-paying medical specialties are:

  • Plastic surgery—$501,000 per year.
  • Orthopedics—$497,000.
  • Cardiology—$408,000.
  • Radiology—$401,000.
  • Dermatology—$392,000.

The lowest-paying specialties, according to the Medscape report, are in the primary care fields, with internal medicine ($230,00), family medicine ($219,000) and pediatrics ($212,000) being listed among the bottom five specialties in annual compensation.

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Lucrative specialties require more training. Trainees who do pursue a career in a higher-paying specialty may have a smaller window for optimal earning. Those specialties tend to require the most training between residency and a subspecialty-focused fellowship.

The primary care specialties earn less by comparison but require less training. With some primary care programs offering pathways for physicians to go through medical school and residency in as little as six years, students in these programs can reduce med school debt and earn more money quicker by spending less time in residency.

For details on graduate medical education training periods, consult Choosing a Specialty: An AMA Resource for Medical Students.

Consider demands in the workforce. The 2018 survey marked the seventh consecutive year of steady physician salary growth. In terms of specialty-specific salary increases, psychiatrists reported a 16 percent increase in compensation from the prior year’s data. That number, the largest increase in any specialty, portends a looming shortage in the specialty. A 2017 report compiled by the recruiting firm Merritt Hawkins found that more than half of the 30,000 working psychiatrists in the U.S. were over 55 years old.

Other specialties that saw significant pay increases from the prior-year data included plastic surgery (14 percent), physical medicine and rehabilitation (13 percent), oncology (10 percent) and critical care—rheumatology (9 percent).

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Where you’re earning matters. Survey respondents indicated that Indiana was the state in which physicians earned the most on average with a mean salary of $334,000. The top-earning locations included Oklahoma ($330,000), Connecticut ($329,000), Wisconsin ($327,000) and Nevada ($323,000).

The states listed above vary widely in terms of cost of living. On paper, it may seem like Connecticut’s average compensation is impressive in its generosity, but it is among the most expensive states to live in. While pondering your future earnings in a location, it is worth consulting a cost-of-living calculator.

Ownership may offer more risk, reward. In line with recent trends, only one-quarter of survey respondents categorized themselves as self-employed, while 69 percent indicated they worked in an employed setting. The data indicated that self-employed physicians, those who owned a stake of the practice in which they worked, regardless of specialty choice, earned about $350,000. That compares with earnings closer to $300,000 for employed physicians. 

Whether it be as owner of a solo practice or partner-owner of a group practice, the potential for earnings and autonomy will be higher in a self-employed setting. So too are the financial and operational risks. The AMA offers a number of resources that offer guidance on the pros and cons of practice settings and general career guidance.

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