(?doximity First Annual Physician Compensation Repo? Introduction There is one constant in medicine: doctors play a central role in delivering care. And they will continue to do so, irrespective of any future changes to the federal regulatory landscape. However, recent studies have found a growing shortage of physicians in the United States. Considering that doctors occupy the apex of the medical system, this trend should represent a significant concern to nearly all of the stakeholders within the American healthcare industry. Having an accurate view of how physicians are compensated across specialties is a starting point towards understanding the various factors at play in the market. But there are several key areas that are often overlooked, and that this report attempts to fill. First, markets for medical services are deeply regional and unique to their various metropolitan statistical areas (MSAs). Medicine operates within tight-knit clusters of physicians and practices, hospital systems, state licensing and regulation, and networks of payers. Despite this, very few studies focus on compensation at the local level. That is why this report examines physician compensation across major American MSAs – a first in medical market analysis. Second, there is a longstanding concern surrounding the gap in pay between male and female professionals.1 In this report, we analyze the gender gap in physician pay, and report its results across specialties, states, and metro areas. While it is beyond the scope of this study to offer explanations as to why this gap exists in the way that it does, we do hope that this information can shed more light on this important issue. Lastly, this report draws on the responses of over 36,000 licensed doctors to produce the most comprehensive and in-depth look at absolute physician compensation across specialties, states, regions, and gender. With 70 percent of all U.S. doctors as members, Doximity is the largest social network in medicine and uniquely positioned to enable this type of analysis. FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 2 KEY FINDINGS 2 2 Geographic Differences in Physician Compensation 4 8 Doximity’s physician compensation report is based on over 36,000 respondents, drawn from the largest network of U.S. physicians. Because of that, we can map compensation by metro areas, the markets within which healthcare operates. 7 1 5 9 7 4 10 1 5 3 6 9 Primary Care Compensation As the U.S. population ages, it is critical that we have primary care physicians in the areas across the country that need them most. While compensation for specialists is typically higher, we examined where differences in pay for primary care occurs most prominently. One trend we identified is that compensation generally tends to be higher in smaller MSAs, than in larger metro areas. 6 3 10 8 HIGHEST LOWEST The metro areas with the overall HIGHEST compensation for primary care providers: 1. Charlotte, NC - $285,109 2. Bridgeport, CT - $279,138 3. Minneapolis, MN - $272,610 4. Indianapolis, IN - $270,468 5. Phoenix, AZ - $268,869 6. Dallas, TX - $264,771 7. Louisville, KY - $264,026 8. Orlando, FL - $263,494 9. Houston, TX - $260,645 10. Tampa, FL - $257,304 The metro areas with the LOWEST compensation for primary care providers: 1. Durham, NC - $200,594 2. Ann Arbor, MI - $210,911 3. Charleston, SC - $216,038 4. Baltimore, MD - $217,249 5. Washington, DC - $221,815 6. Boston, MA - $223,445 7. Philadelphia, PA - $223,688 8. Denver, CO - $226,282 9. New Haven, CT - $232,260 10. Columbus, OH - $233,436 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 3 7 4 2 9 7 2 3 10 6 1 KEY FINDINGS 3 Physician Compensation – All Specialties Together Because specialists tend to earn more across the board, the combined average compensation for all physicians is higher than primary care physicians alone. 6 5 8 9 1 4 10 5 8 HIGHEST LOWEST The metro areas in which all physicians are paid the HIGHEST average annual salary: 1. Charlotte, NC - $359,455 2. Bridgeport, CT - $353,925 3. Phoenix, AZ - $351,677 4. Milwaukee, WI - $345,831 5. Houston, TX - $345,079 6. Louisville, KY - $344,362 7. Minneapolis, MN - $343,548 8. Orlando, FL - $343,072 9. Indianapolis, IN - $342,699 10. Dallas, TX - $339,911 The metro areas in which physicians are paid the LOWEST average annual salary: 1. Durham, NC - $267,598 2. Ann Arbor, MI - $272,398 3. Baltimore, MD - $281,005 4. Charleston, SC - $285,933 5. Washington, DC - $286,242 6. Boston, MA - $286,971 7. Denver, CO - $288,095 8. Providence, RI - $294,103 9. Philadelphia, PA - $296,351 10. Cincinnati, OH - $297,700 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 4 KEY FINDINGS Compensation by Specialties Ten highest and lowest medical specialty annual compensation HIGHEST average annual compensation LOWEST average annual compensation Neurosurgery $620K Thoracic Surgery $522K Orthopaedic Surgery $503K Vascular Surgery $446K Radiation Oncology $442K Plastic Surgery $420K Dermatology $420K Cardiology $415K Radiology $408K Gastroenterology $403K Family Medicine $231K Pediatric Gastroenterology $225K Pediatric Rheumatology $220K Pediatrics $219K Medical Genetics $217K Pediatric Nephrology $211K Pediatric Hematology & Oncology $210K Preventive Medicine $204K Pediatric Endocrinology $190K Pediatric Infectious Disease $186K FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 5 1 KEY FINDINGS 6 • The average national gender gap among physicians is 26.5 percent less per year, meaning that on average, female doctors make $91,284 less than what the average male doctor makes.This topline number factors in all specialties examined, and regional differences. Compensation for female physicians, like their male colleagues, is significantly influenced by where they practice. Hence, we constructed a ranking of compensation based on MSAs. 7 3 4 9 8 5 1 Gender Differences in Physician Compensation • 3 4 6 8 10 7 2 2 5 9 10 HIGHEST LOWEST The metro areas in which female physicians are paid the HIGHEST average annual salary: 1. Minneapolis, MN - $290,747 2. Phoenix, AZ - $290,536 3. Milwaukee, WI - $287,950 4. Indianapolis, IN - $281,987 5. Dallas, TX - $278,825 6. Sacramento, CA - $274,010 7. Hartford, CT - $267,891 8. Bridgeport, CT - $267,139 9. Houston, TX - $266,605 10. Tampa, FL - $264,377 The metro areas in which female physicians are paid the LOWEST average annual salary: 1. Durham, NC - $205,635 2. Charleston, SC - $219,112 3. Ann Arbor, MI - $225,004 4. Baltimore, MD - $226,048 5. Washington, DC - $227,263 6. Denver, CO - $228,684 7. Philadelphia, PA - $234,306 8. Boston, MA - $234,447 9. Cincinnati, OH - $236,749 10. Providence, RI - $238,403 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 6 KEY FINDINGS Gender Gaps by Specialty There is no medical specialty in which women earn more than men. The specialties with the largest wage gap between MEN and WOMEN Vascular Surgery $454K Occupational Medicine $268K Pediatric Endocrinology $210K Gastroenterology $214K $168K Pediatric Emergency Medicine $264K Cardiology $422K $190K Ophthalmology Neonatal/Perinatology 19% less 19% less 19% less $215K $346K WOMEN average annual compensation 20% less $333K $264K Otolaryngology (ENT) 20% less $412K Pediatric Rheumatology MEN average annual compensation 20% less $365K 18% less $399K $327K 18% less $368K 18% less $303K $306K $253K 18% less FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 7 KEY FINDINGS Gender Gap Between Physicians by MSA • • The Doximity analysis shows a significant gender pay gap across MSAs. To calculate the size of the gender gap, we examined what percentage of an average male physician’s salary does the average female physician make across specialties. If the average male physician earned $100,000 and the pay gap was 20 percent less, then it means that the average female physician made $80,000 per year (or an absolute difference of $20,000 less per year). Charlotte, NC Durham, NC Orlando, FL Pittsburgh, PA Bridgeport, CT Louisville, KY Houston, TX Metro areas with the largest wage gap between MEN and WOMEN MEN average annual compensation WOMEN average annual compensation New Orleans, LA Charleston, SC Atlanta, GA $381K $256K 33% less $296K $206K 31% less $365K $257K 30% less $340K $239K 30% less $378K $267K 29% less $370K $264K $373K $267K 29% less 29% less $348K $249K 29% less $307K $219K 29% less $342K $244K 28% less FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 8 KEY FINDINGS Gender Gap Between Physicians by MSA The SMALLEST gender wage gap is found in the Sacramento, Calif. metro area. There, female physicians on average make 19% less of what male physicians do. To understand what this difference means in real terms, consider that at $63,283, the difference is approximately the equivalent to paying the salaries of two medical assistants in that area ($35,000).2 The LARGEST gender wage gap is found in Charlotte, N.C., where the average female physician makes 33% less of what the average male doctor does. In absolute terms, this is $125,035. To put this in perspective, the average medical school graduate in 2016 left school with $189,165 in debt.3 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 9 KEY FINDINGS The metro areas with the SMALLEST gender wage gap 1. 2. 3. 4. 5. 6. 7. 8. 9. 19. New Haven, CT - 25% 20. San Antonio, TX - 25% 21. Miami, FL - 25% 22. Salt Lake City, UT - 25% 23. Philadelphia, PA - 26% 24. Virgina Beach, VA - 26% 25. Las Vegas, NV - 26% 10. Boston, MA - 23% 11. Riverside, CA - 23% 12. San Francisco, CA - 23% 13. Dallas, TX - 23% 14. Baltimore, MD - 24% 15. Cincinnati, OH - 24% 16. Providence, RI - 24% 17. San Diego, CA - 24% 18. Austin, TX - 24% Sacramento, CA - 19% Minneapolis, MN - 20% Portland, OR - 21% Rochester, NY - 21% Phoenix, AZ - 21% Indianapolis, IN - 21% Ann Arbor, MI - 22% Hartford, CT - 22% Milwaukee, WI - 22% 3 2 9 1 22 8 7 23 16 19 14 6 12 10 4 15 24 25 11 17 5 13 18 20 21 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 10 KEY FINDINGS The metro areas with the LARGEST gender wage gap 1. 2. 3. 4. 5. 6. 7. 8. 9. Charlotte, NC - 33% Durham, NC - 31% Orlando, FL - 30% Pittsburgh, PA - 30% Bridgeport, CT - 29% Louisville, KY - 29% Houston, TX - 29% New Orleans, LA - 29% Charleston, SC - 29% 19. Chicago, IL - 27% 20. Detroit, MI - 27% 21. Seattle, WA - 27% 22. Denver, CO - 27% 23. Washington, DC - 27% 24. Tampa, FL - 26% 25. Los Angeles, CA- 26% 10. Atlanta, GA - 28% 11. Nashville, TN - 28% 12. Columbus, OH - 28% 13. Kansas City, MO - 27% 14. New York, NY - 27% 15. Birmingham, AL - 27% 16. San Jose, CA - 27% 17. Jacksonville, FL - 27% 18. Cleveland, OH - 27% 21 5 20 18 19 12 16 22 14 4 23 13 6 11 25 15 2 1 10 9 17 7 8 24 3 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 11 KEY FINDINGS Differences in Compensation Between Foreign and Domestic Trained Physicians • • There has been a significant debate recently over newly proposed immigration restrictions, and how these changes could impact medical labor markets. While the vast majority of physicians are U.S. trained, over 8 percent do train and come from outside the country. Further immigration restrictions could contribute to the growing shortage in the physician market at the margin. On average, foreign-trained doctors make 2.5% less than U.S.-trained doctors, a difference of $8,300 a year. FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 12 Conclusion Physician compensation is an important lens through which we can better understand labor market trends in the healthcare system. It’s worth noting that some rural and midwestern markets are already seeing shortfalls large enough to significantly increase the average compensation for doctors relative to large metro markets where the cost of living can be significantly higher. The North Dakota market is one example, where it appears that the supply side of the market equation favors doctors. Despite these positive conditions, a talent shortage is still looming, so it is our view that more research should be done to understand the causal factors underpinning this trend. Moreover, our study uncovered significant disparities in compensation between male and female physicians across specialties, metro areas, and all states. This data was consistent with previous studies in the physician labor market, and aligns with a persisting gap found between male and female employees in the general labor markets. It’s beyond our scope to speculate on causation of this effect, but our data indicates that this presents a very real trend that the system will need to address. Hopefully, our research can serve as a baseline for the size of the challenge, and prove helpful to employers, policymakers, and those interested in further study of this topic. In closing, the Doximity data set represents the largest, self-reported sample for U.S. physician compensation available, and in the future, we plan to evaluate these trends over a multi-year time frame to understand how these markets evolve over time. FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 13 Methodology Doximity’s study is drawn from self-reported compensation surveys of over 36,000 full-time, licensed U.S. physicians who practice at least 40 hours per week. The timeframe ranges from 2014-2017. Responses were mapped across metropolitan statistical areas, and the top 50 were ranked by the number of respondents in the data. For foreign-trained doctors, the subset includes U.S. citizens and nationals who have trained abroad. To control for differences in specialty, geography, and other provider-specific factors that might influence spending, we estimated a multivariate regression with fixed effects for provider specialty and MSA. We also controlled for how long each provider has practiced medicine and their self-reported average hours worked per week. This regression was estimated using a generalized linear model with a log link and gamma distribution. For the geographic and specialty rankings, we used the predicted values from this regression. For the national numbers on the gap between average gender pay and average pay location of where trained, percentage changes were converted to dollar values by taking marginal effects. References 1. https://www.bls.gov/opub/reports/womens-databook/archive/women-in-the-labor-force-a-databook-2014.pdf 2. https://www.bls.gov/oes/current/oes319092.htm 3. https://members.aamc.org/eweb/upload/2016_Debt_Fact_Card.pdf FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 14 1. 2. 3. 4. 5. 6. 7. 8. 9. APPENDIX The metro areas with the overall HIGHEST compensation for primary care providers Charlotte, NC - $285,109 Bridgeport, CT - $279,138 Minneapolis, MN - $272,610 Indianapolis, IN - $270,468 Phoenix, AZ - $268,869 Dallas, TX - $264,771 Louisville, KY - $264,026 Orlando, FL - $263,494 Houston, TX - $260,645 19. Austin, TX - $248,458 20. New York, NY - $248,338 21. Virginia Beach, VA - $247,107 22. Rochester, NY - $246,280 23. Los Angeles, CA - $245,286 24. Birmingham, AL - $244,930 25. Seattle, WA - $244,869 10. Tampa, FL - $257,304 11. Riverside, CA - $255,859 12. Sacramento, CA - $254,809 13. Milwaukee, WI - $253,821 14. Kansas City, MO - $253,815 15. Salt Lake City, UT - $251,704 16. Las Vegas, NV - $250,987 17. Miami, FL - $250,560 18. Cincinnati, OH - $249,875 25 3 22 2 13 20 15 12 4 14 16 11 18 7 23 21 1 5 24 6 19 9 10 8 17 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 15 APPENDIX The metro areas with the LOWEST compensation for primary care providers 1. 2. 3. 4. 5. 6. 7. 8. 9. 19. Detroit, MI - $242,648 20. Atlanta, GA - $243,060 21. Jacksonville, FL - $243,090 22. Nashville, TN - $243,651 23. San Francisco, CA - $243,999 24. San Antonio, TX - $244,359 25. Hartford, CT - $244,418 10. Columbus, OH - $233,436 11. Portland, OR - $234,975 12. Providence, RI - $235,781 13. San Diego, CA - $236,494 14. Chicago, IL - $237,938 15. Cleveland, OH - $238,389 16. San Jose, CA - $238,996 17. New Orleans, LA $239,292 18. Pittsburgh, PA - $242,010 Durham, NC - $200,594 Ann Arbor, MI - $210,911 Charleston, SC - $216,038 Baltimore, MD - $217,249 Washington, DC - $221,815 Boston, MA - $223,445 Philadelphia, PA - $223,688 Denver, CO - $226,282 New Haven, CT - $232,260 11 2 6 9 19 14 15 5 10 8 20 17 4 1 22 13 25 7 18 16 23 12 3 21 24 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 16 APPENDIX The metro areas in which all physicians are paid the HIGHEST average annual salary 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Dallas, TX - $339,911 11. Tampa, FL - $333,591 12. Jacksonville, FL - $333,130 13. Kansas City, MO - $331,966 14. Miami, FL - $331,420 15. Salt Lake City, UT - $329,627 16. Birmingham, AL - $328,598 17. Hartford, CT - $324,790 18. Sacramento, CA - $323,659 Charlotte, NC - $359,455 Bridgeport, CT - $353,925 Phoenix, AZ. - $351,677 Milwaukee, WI - $345,831 Houston, TX - $345,079 Louisville, KY - $344,362 Minneapolis, MN - $343,548 Orlando, FL - $343,072 Indianapolis, IN - $342,699 19. New York City, NY - $323,313 20. Los Angeles, CA - $323,079 21. San Antonio, TX - $322,574 22. New Orleans, LA - $321,920 23. Pittsburgh, PA - $320,889 24. San Jose CA - $320,592 25. Riverside, CA - $320,030 7 2 4 15 18 19 23 9 24 13 25 17 6 1 20 3 16 10 12 5 21 22 11 8 14 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 17 1. 2. 3. 4. 5. 6. 7. 8. 9. APPENDIX The metro areas in which physicians are paid the LOWEST average annual salary Durham, NC - $267,598 Ann Arbor, MI - $272,398 Baltimore, MD - $281,005 Charleston, SC - $285,933 Washington, DC - $286,242 Boston, MA. - $286,971 Denver, CO - $288,095 Providence, RI - $294,103 Philadelphia, PA - $296,35 19. Virginia Beach, VA - $314,540 20. Nashville, TN - $314,653 21. Seattle, WA - $315,511 22. Detroit, MI - $315,680 23. Atlanta, GA - $316,488 24. Las Vegas, NV - $317,858 25. Cleveland, OH - $318,973 10. Cincinnati, OH - $297,700 11. New Haven, CT - $301,475 12. Columbus, OH - $305,553 13. Portland, OR - $306,195 14. San Diego, CA - $306,409 15. Austin, TX - $309,185 16. Rochester, NY - $311,545 17. San Francisco, CA - $311,829 18. Chicago, IL - $312,477 21 13 8 2 6 16 11 22 25 18 17 7 10 9 12 3 5 19 24 1 20 14 23 4 15 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 18 APPENDIX The 24 specialties with the HIGHEST average annual compensation Neurosurgery $620K Thoracic Surgery $522K Orthopaedic Surgery $501 K Vascular Surgery $446K Radiation Oncology $443 K Plastic Surgery $420K Dermatology $420K Cardiology $415K Radiology $408K Gastroenterology $403K Urology $400K Otolaryngology (ENT) $390K Anesthesiology $384K General Surgery $367K Ophthalmology $357K Oncology $357K Hematology $353K Colon & Rectal Surgery $353 K Pulmonology $330K Obstetrics & Gynecology $314 K Emergency Medicine $314 K Pathology $301K Nephrology $288K Neonat/Perinatology $287 K FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 19 APPENDIX The 24 specialties with the LOWEST average annual compensation Pediatric Infectious Disease $186 K Pediatric Endocrinology $190 K Preventive Medicine $204 K Pediatric Hematology & Oncology $210 K Pediatric Nephrology $211K Medical Genetics $217K Pediatrics $219K Pediatric Rheumatology $220K Pediatric Gastroenterology $225K Family Medicine $231K Medicine/Pediatrics $235 K Pediatric Pulmonology $235 K Endocrinology $239K Geriatrics $243K Pediatric Emergency Medicine $244 K Psychiatry $244K Internal Medicine $246K Infectious Disease $247 K Rheumatology $257K Pediatric Cardiology $257K Occupational Medicine $261 K Neurology $269K Allergy & Immunology $283 K Physical Medicine/Rehab $284 K FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 20 APPENDIX The metro areas in which FEMALE physicians are paid the HIGHEST average annual salary 1. 2. 3. 4. 5. 6. 7. 8. 9. Minneapolis, MN - $290,747 Phoenix, AZ - $290,536 Milwaukee, WI - $287,950 Indianapolis, IN - $281,987 Dallas, TX - $278,825 Sacramento, CA - $274.010 Hartford, CT - $267,891 Bridgeport, CT - $267,139 Houston, TX - $266,605 10. Tampa, FL - $264,377 11. Louisville, KY - $263,811 12. Rochester, NY - $262,306 13. Miami, FL - $262,242 14. Salt Lake City, UT - $261,162 15. Kansas City, MO - $259,434 16. Riverside, CA - $257,963 17. Orlando, FL - $256,811 18. Charlotte, NC - $256,235 19. Jacksonville, FL - $255,776 20. San Jose, CA - $255,650 21. Portland, OR - $254,090 22. San Francisco, CA -$253,993 23. Los Angeles, CA- $253,937 24. New York, NY - $253,878 25. Birmingham, AL - $253,190 21 1 12 3 22 20 14 6 8 4 15 16 7 24 11 23 18 2 25 5 19 9 10 17 13 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 21 1. 2. 3. 4. 5. 6. 7. 8. 9. APPENDIX The metro areas in which FEMALE physicians are paid the LOWEST average annual salary 19. Virginia Beach, VA - $245,070 20. Cleveland, OH - $246,209 21. San Diego, CA - $246,269 22. Las Vegas, NV - $247,641 23. New Orleans, LA - $248,947 24. Austin, TX - $250,424 25. San Antonio, TX- $252,864 10. Providence, RI - $238,403 11. Pittsburgh, PA - $239,047 12. Columbus, OH - $239,188 13. New Haven, CT $240,887 14. Detroit, MI - $242,890 15. Nashville, TN - $243,227 16. Atlanta, GA - $244,346 17. Chicago, IL $244,478 18. Seattle, WA - $244,746 Durham, NC - $205,635 Charleston, SC - $219,112 Ann Arbor, MI - $225,004 Baltimore, MD - $226,048 Washington, DC - $227,263 Denver, CO - $228,684 Philadelphia, PA - $234,306 Boston, MA - $234,447 Cincinnati, OH - $236,749 18 10 3 14 17 8 13 20 7 11 9 12 6 4 5 19 22 1 15 16 21 25 2 23 24 FIRST ANNUAL PHYSICIAN COMPENSATION REPORT 22 Founded in 2011, Doximity connects physicians and advanced practice clinicians to make them more successful and productive. Doximity is the largest secure medical network with over 70 percent of all U.S. physicians as members, enabling collaboration across specialties and every major medical center. Doximity is based in San Francisco and was created by the founders of Epocrates and Rock Health. WWW.DOXIMITY.COM