According to a recent Medscape compensation report that surveyed nearly 18,000 physician respondents across 29 specialties, pediatricians continue to be the lowest paid, with significantly lower incentive bonuses than many of their counterparts in other specialties. This has been suggested to be a key factor in deterring medical students from specializing in pediatrics and other primary care fields, including internal medicine and family medicine, especially as rising education costs have lead many prospective physicians to take on exorbitant student loans and other debts. Alarmingly, in 2019, only 45.6% of the spots in the primary care specialties in the Main Residency Match program were filled by US allopathic medical school seniors. In contrast, various surgical fields and otolaryngology, which are among the highest paid specialties, had fill rates of more than 90%.
So, how big is the disparity? The Medscape report found the average annual income for pediatricians to be $221,000 in 2020, which was down from $232,0000 in 2019. In contrast, plastic surgeons, who were the highest paid specialty, reported an average annual income of $526,000 in 2020, reflecting an 82% difference in compensation between the lowest and highest compensated specialties. When considering all specialties surveyed, the average salary was about $342,000, a difference of more than $120,000. Even the next lowest paid specialty, family medicine, had an average annual income of $15,000 more than pediatrics, at $236,000.
Furthermore, a 2020 Forbes report examining occupational data from the Bureau of Labor Statistics found significant disparities in pediatrician salaries between states (Table). Alaska was the highest paying state, with pediatrician salaries averaging more than twice those of pediatricians in Kansas, the lowest paying state. The report also noted a disconcerting trend. While states with low salaries for certain occupations showed trends toward salary increases in recent years, this was not the case for pediatrician salaries. In Kansas, the average pediatrician salary declined by about 13% from 2013 to 2018. In the second lowest-paying state, Michigan, there were declines of 27.8% in this same period, dropping from $183,330 to $132,310.
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While salary is only part of the compensation picture, the Medscape report found incentive bonuses for pediatricians to be low, averaging $26,000. Only psychiatrists reported lower average bonuses ($24,000). The highest incentive bonuses were reported by orthopedists, which averaged $116,000. When collectively considering the 19 specialties that had sufficient sample sizes to characterize bonus data, the average incentive bonus was about $50,000.
Despite ranking as the lowest paying specialty with low average incentive bonuses, 55% of the pediatricians surveyed by Medscape reported feeling fairly compensated. Additionally, 77% said they would pick medicine again, which was similar to physicians overall (78%), with 82% indicating they would choose pediatrics again.