While a neurosurgeon makes over $750,000 dollars a year, the vast majority of medical specialties do not come with such a high paycheck. In fact, the gap between lowest paid and highest paid medical specialties is over $400,000.
Let's break down the eight lowest paid specialties.
But first, note that our list doesn't include the pediatric versions of specialties because, otherwise, this would just be a list of pediatric specialties. Of the 10 lowest paid physician careers in data from Doximity, eight were pediatric versions of internal medicine specialties.
8. Internal Medicine
In the No. 8 spot is internal medicine (IM) at an average annual income of $312,526.
Internal medicine doctors, also known as internists, are the generalists of generalists, responsible for treating a colossal range of medical conditions, whether complex or straightforward, acute or chronic, common or rare.
Internal medicine is more difficult to categorize than other specialties because it's so broad, and it also has more fellowship options than just about any other specialty, including cardiology, gastroenterology, and hematology/oncology.
It should also be noted that subspecialties of IM make considerably more than a regular internist. Cardiologists, for example, earn an average $565,485 a year, making cardiology the seventh highest-paying medical specialty.
Generally speaking, internists have a good work-life balance. They might work a regular 9-to-5 in the clinic as a primary care doctor, or it's common for hospitalists to have a model of 7 days on and 7 days off. If you're admitting on call, you could work 12 or more hours a day, but this won't occur every day.
If you don't further specialize, internal medicine is the shortest residency at 3 years, tied with pediatrics, family medicine, genetics, and preventive medicine.
7. Rheumatology
Coming in at No. 7 is rheumatology at $305,502 a year.
Rheumatology is an internal medicine subspecialty that focuses on diseases of the joints, musculoskeletal system, and connective tissue. Rheumatologists see quite a range of diseases, including musculoskeletal diseases like osteoporosis and autoimmune diseases like rheumatoid arthritis.
Despite the relatively low pay, rheumatologists have a good work-life balance, as they see very few emergencies and don't have to worry about being called into work in the middle of the night.
To become a rheumatologist, you'll need to finish 2 years of fellowship training after a 3-year internal medicine residency. You can also add an extra year of training to become dual-certified in rheumatology and allergy and immunology.
This means that after 2 to 3 years of extra training beyond the initial 3 years of internal medicine residency, rheumatologists make, on average, $7,000 less a year than IM physicians who chose not to specialize. This is where personal preference and interest come into play. You don't get into rheumatology for the money.
For some extra context, after the same 6 years of residency, plastic surgeons make $619,812 a year, which is over $300K more than rheumatologists. That being said, surgical residencies and attending surgeon lifestyles are more demanding, and the specialty is more competitive to get into -- but that's a discussion for a separate video.
6. Family Medicine
At No. 6 is family medicine, with $300,813 a year.
Family medicine (FM) doctors are the center of primary care and have quite a lot in common with internal medicine physicians. One of the main differences is IM physicians focus on adults, whereas family medicine physicians treat the broadest range of ailments and patients, from newborns to seniors and everything in between. They are not limited to a single disease, organ, or age range.
Family medicine offers a great deal of flexibility and a healthy work-life balance. FM physicians work regular 9-to-5 office hours with minimal call, if any. However, note that since FM is so flexible, if you choose to specialize in hospitalist medicine or emergency medicine, your hours will be closer to what's normal for that specialty.
To become a family medicine physician, you need to complete family medicine residency, which lasts 3 years. In addition to being one of the shortest residencies, family medicine is also consistently the least competitive medical specialty to pursue.
Check out Med School Insiders' least competitive specialties video and download its complete Specialty Competitiveness Index.
5. Endocrinology
In the fifth spot is endocrinology at $291,481 a year.
Endocrinology involves diseases of the endocrine system, which consists of the body's glands, like the thyroid, adrenal glands, and pancreas, as well as the hormones they secrete. This intricate network of glands secretes hormones into the bloodstream to regulate a variety of processes, including metabolism, reproduction, growth and development, sleep, and mood. Endocrinologists commonly see diseases like diabetes, obesity, hyper- and hypothyroidism, as well as cancers related to the endocrine system.
Endocrinologists tend to have a good work-life balance thanks to their regular and reasonable hours. Even if they have inpatient duties and are on call, these duties typically aren't intense or high-volume.
On the downside, it takes a long time to become an endocrinologist, considering their relatively low medical salary. You'll need 3 years of internal medicine residency, followed by 2 to 3 years of endocrinology fellowship, for a total of 5 to 6 years post-medical school training.
4. Geriatrics
Coming in at No. 4 is geriatric medicine at $289,201.
Geriatric medicine focuses on the unique medical needs of elderly patients, including chronic conditions as well as vulnerabilities like a risk of falls.
Geriatric medicine has a similar work-life balance to family medicine thanks to regular 40- to 50-hour workweeks. There are relatively few emergencies. If an elderly patient has a fall or urgent health concern, they'll be sent to the appropriate physician to assist them, such as an emergency medicine doctor or orthopedic surgeon.
To get into geriatric medicine, you must complete a 3 year FM or IM residency followed by a 1-year geriatric medicine fellowship.
Again, this is a case in which if you further specialize after IM or FM, you'll actually earn less. However, there is high demand for geriatric physicians due to the aging population in the U.S.
3. Preventive Medicine
In third place is preventive medicine, with $282,011 a year.
Preventive medicine is focused on preventing health concerns and diseases before these seriously affect their patients' quality of life. It's often utilized by primary care physicians who work directly with their patients on prevention methods like improving sleep quality, stress levels, diet, and exercise. They also watch for early warning signs of health concerns through blood tests, screenings, and fitness monitoring.
Obviously, there are few emergencies in preventive medicine, as the specialty is all about catching health issues before they occur. This translates to a healthy work-life balance and little to no call responsibilities.
There are multiple routes to becoming a preventive medicine doctor. In general, most programs require at least 1 year of training in a primary care setting followed by a 2 year fellowship in preventive medicine, for a total of 3 years.
2. Pediatrics
In the runner up spot for lowest paid medical specialty is pediatrics at $259,579.
Pediatricians provide care for babies, children, and adolescents from birth up to the age of 25. Pediatrics is essentially internal medicine but for younger patients.
Pediatrics is a difficult specialty to generalize as, just like internal medicine, it is an enormous field with a wide range of subspecialties.
Pediatric residency is 3 years, though there are several fellowship options, many of which are also 3 years, such as pediatric hematology/oncology, pediatric nephrology, pediatric endocrinology, and many more.
Unfortunately, this extra training does not result in extra pay. In fact, these specialists actually make even less than pediatric generalists, with pediatric hematology/oncology, for example, earning $251,483 -- about $8,000 less than ordinary pediatricians.
This reduced pay is partly because many children are on Medicaid, which has lower reimbursement than commercial insurance. The U.S. healthcare system runs on a fee-for-service model, meaning payments are made directly based on the amount of service patients receive, regardless of the quality of those services.
Children generally require fewer interventions than adults, which means less money for hospitals. Unfortunately, this results in adult specialties earning higher salaries.
We broke down how the fee-for-service payment model works, as well as how it compares to value-based care, in a previous video linked in the description.
1. Medical Genetics and Genomics
In the No. 1 spot for lowest paid medical specialty is medical genetics and genomics at $244,517.
Medical geneticists focus on the relationship between genes and health. They specialize in evaluating, diagnosing, managing, treating, and counseling patients of all ages with clinical hereditary disorders through the use of modern molecular, cytogenetic, biochemical, and genomic genetic testing.
Even though they are the lowest paid, medical geneticists work 40 to 50 hour workweeks, which translates to a reasonable work-life balance.
Plus, there's variety and flexibility in their day-to-day. No 2 days are the same for clinical geneticists. They can be involved in direct patient care, clinical research, teaching, as well as administrative and supervisory work. They also get to work with patients of all ages, from babies to children to adults to the elderly. This also includes preconception, such as if hopeful parents are interested in understanding the reproductive risks related to their personal or family histories.
The career path is also tied for the shortest residency at 3 years. To get into a medical genetics residency, you must have at least 1 residency year in an Accreditation Council for Graduate Medical Education-accredited primary specialty, such as pediatrics or internal medicine, followed by 2 years of medical genetics and genomics residency training. Combined medical genetics and genomics training programs are also available with internal medicine, reproductive endocrinology and infertility, and pediatrics.
If you're an aspiring physician but don't know which specialty you'd like to pursue, the "So You Want to Be" video series will help you navigate the pros and cons of every medical path to help you choose the one that's best for you. Plus, check out Med School Insiders' guide to the highest paid medical specialties.
This post appeared on Med School Insiders.