The Bigger Picture: How Much is Enough?

Nearly half of all primary-care physicians make less than $175,000 a year, and about 15 percent earn less than $100,000, according to Physicians Practice’s new compensation survey, which is the subject of this month’s cover story. The average salary for primary-care physicians was $161,000 last year.

Is that fair? Most physicians we asked called their salary “disappointing.” So if $161,000 isn’t enough, how much is? And what are you willing to do to get it?

Are there ways to become more entrepreneurial to make more money? Or perhaps the best response is to decide that making less is OK as long as you don’t have to squeeze more patients into your day.

At what point do physicians - especially primary-care physicians already seeing 40 or 50 patients a day - get like lobsters in the proverbial pot, wanting more but not realizing they are just inflicting more pain on themselves?

Case in point from another industry: Hal Steger is worth $3.5 million, yet he says it’s not enough. And he isn’t alone; many in Steger’s tax bracket find themselves disappointed despite being wealthy by nearly any measure. Steger recently told The New York Times that he works 70 hours a week at a technology firm to try to keep up with what he sees as a need to make even more.

“I know people looking in from the outside will ask why someone like me keeps working so hard,” Steger says. “But a few million doesn’t go as far as it used to.”

To be fair, Steger and others interviewed for the article live in one the country’s most expensive areas, Silicon Valley, but their feelings rather dramatically raise the question: What does a not-disappointing salary look like? Does it exist?

In an attempt to answer these questions, let’s put your salary numbers into some context:

While the average primary-care doc surveyed by us pulled down $161,000 last year, the average American earned about $27,000. I know - you invested exponentially more time and money developing your skills. Point granted.

But it’s not as if physicians in other countries are significantly out-earning you. On the contrary, the median income for your peers in other industrialized nations was $70,324 in 1999, the latest data available. To break this down further, the average U.S. physician makes about 5.5 times more than the average American. In Germany, it’s 3.4 times more; Canada, 3.2; United Kingdom, 1.4. (This information comes from an Uwe Reinhardt article in the May/June 2002 Health Affairs.)

This doesn’t necessarily mean American physicians should accept less. For one thing, the public safety net here has more holes than it does in most other countries. You need to fund your own 401(k), pay college tuition for your kids, and foot the bill for your family’s health insurance. You can’t depend on government handouts.

Just last week, I had my own annual performance review with my boss. I took the opportunity to ask for a raise. Now, between you and me, I’m already doing OK relative to other editors, at least according to the not-so-scientific data I find at online career sites. But I’ve never once asked for a raise before, so it seemed like time.

Still, if it was the money that drove me, I could make more as a consultant and independent speaker. But I’m not willing to do the things it would take to earn more, such as travel more. And I love this magazine.

Are physicians making less than $175,000 justified in being disappointed if they are purposefully less productive than their peers? Or if they selected a career that isn’t as lucrative? Maybe. I’m interested to know what you think.

Pamela Moore, PhD, is senior editor, practice management, Physicians Practice. She can be reached at pmoore@physicianspractice.com.

This article originally appeared in the October 2007 issue of Physicians Practice.