A career as a physician, whether you're a primary care doctor or a specialist, is a noble calling. Doctors adhere to the Hippocratic Oath, which stems from Greek medical history, and calls for physicians to swear to uphold the highest ethical standards in the service of medicine.

Besides the responsibility and obligation to the highest tenets of health care, physicians earned a good living, especially those practicing in high-demand areas.

How much can a physician earn in a thriving practice, or in a hospital, clinical or other specialist setting? It depends on what skills a good doctor brings to the table.

What Is an Average Salary of a Doctor?

The numbers do vary for the average physician salary, depending on the source of the information.

Data from ZipRecruiter notes the average annual pay for a "medical doctor" stands at $224,190 in 2018, with the highest salaries in the $397,000 range and on the lower end at $23,500. Most physicians earn an annual income between $150,000 and $312,000, ZipRecruiter reports.

Separate data from Medscape's 8th Physician Compensation Report for 2018 states that the average U.S. primary care physician earns $223,000 annually. Meanwhile, medical specialists earn an average of $329,000, as of 2018. Across all specialties, Medscape found that the average salary for physicians is $299,000.

Those numbers are up moderately from 2017, when primary care physicians average $217,000 in professional income, while specialists averaged $316,000.

Overall, though, physician annual salaries are up from $200,000 in 2011, to $299,000, on average, in 2018.

Geographic Breakdown of Physician Salaries

For physicians, where you practice medicine and wellness matters as much as what you practice, from a professional point of view.

According to the Medscape survey, there is a significant wage gap for doctors practicing in the nations' breadbasket than in the Northeast.

In the mid-western states (especially Illinois, North Dakota, Minnesota and Wisconsin), doctors earn, on average, $319,000 annually. But in the U.S. Northeast, including states like Massachusetts and New York, where the population is heavy and health care options abundant, physicians only average $275,000 in annual income - a difference of $44,000. Those numbers aren't an outlier - they're roughly the same as the figures in Medscape's 2017 physician salary study.

Here's a geographical breakdown of physician salaries across the U.S., for 2018 (from the Medscape study)

  • North Central U.S. - $319,000
  • Southeast U.S. - $309,000
  • Northwest U.S. - $306,000
  • South Central U.S. - $303,000
  • Great Lakes - $303,000
  • Western U.S. - $299,000
  • Mid-Atlantic U.S. - $281,000
  • Southwest U.S. - $277,000
  • Northeast U.S. - $275,000

Let's further breakdown physician incomes by state, with figures from Medscape:

The "Top Five" states for physician incomes (2018 numbers.)

  1. Indiana - $334,000
  2. Oklahoma - $330,000
  3. Connecticut - $329,000
  4. Wisconsin - $327,000
  5. Nevada - $323,000

Top 5 "least earning" states for physician incomes.

  1. Maryland - $256,000
  2. New Mexico - $261,000
  3. Hawaii - $268,000
  4. Massachusetts - $275,000
  5. Michigan - $277,000

Physician Incomes by Specialty

It's also helpful to pinpoint doctor annual salaries by specialty, as what type of medical care a physician practices can sway income, as well

Here, the top income brackets for specialized medical caregivers include (but are certainly not limited to) what industry professionals call the "ROAD" specialties - radiology, ophthalmology, anesthesia, and dermatology. While they're in the top earner list, most ROAD specialties lag behind high-end medical care practices like plastic surgery and orthopedics.

Here's a list of the top physician salaries based on specialty, using annual incomes for 2018:

1. Plastic Surgery - $501,000

2. Orthopedics - $497,000

3. Cardiology - $423,000

4. Gastroenterology - $408,000

5. Radiology - $401,000

6. Dermatology - $392,000

7. Anesthesiology - $386,000

8. Otolaryngology - $383,000

9. Urology - $373,000

10. Oncology - $363,000

11. Ophthalmology - $357,000

12. Critical Care - $354,000

Why Certain Doctors Get Paid More

Like most income models, physician incomes are influenced by economic factors like demand, level of training, skillsets, and age/experience.

Those are the top factors in determining the difference between, for example, a cardiologist earning a bigger annual income than a primary care physician (a big difference in 2018, at $200,000, based on the Medscape study.)

But they're not the only reasons.

There are myriad other factors and impactors that explain why some doctors earn more money than others. They're not as well-known as medical school training, specific vocation and experience, but in many ways, they're important differentiators, too.

The biggest physician earners share the following traits:

  • They see more patients. In the medical field, quantity is as important as quality, at least from an income earning point of view. In the health care area, like most service sectors, the more patients you see, the more bills you invoice, and the more income you make.
  • They diversify. A cardiologist (or any doctor) who spreads his wings and provides services that go beyond seeing heart patients can earn substantially more income. For instance, the specialist does so by offering medical consulting services, offers expert legal testimony for individuals seeking financial redress after an accident or illness, or appear on media platforms as an expert on a specific topic for pay.
  • They adjust on the fly. Some doctors start off in a practice or specialty that ranks on the lower end of the physician pay scale, then shift specialties and move upward income-wise. Consider a general practitioner who trains to become a dermatologist. The difference in annual pay in doing so can add up to millions of dollars over the course of a career.
  • They pay attention to their service contracts, and negotiate them upward. Savvy physicians in a hospital, clinic or another specialist medical service setting often have employment contracts in place. Instead of accepting the common offer of a small raise, they negotiate those contracts on more favorable terms. Terms that include productivity bonuses, stock options, and more favorable specialty compensation should all be in play for physicians on contract, and it's the smart doctors who pay attention to contracts and regularly seek to upgrade them.
  • They become "rainmakers" at hospitals and other large health care organizations. Physicians who excel at a given medical care specialty, like radiology, cardiology, or oncology, for example, and who have a track record of garnering new patients, can substantially pad their annual incomes. Not only do they earn much higher incomes when signing on to a (usually) large health care provider or system, the rainmakers often earn big signing bonuses, too. A bonus: rainmakers who sign on to a deep-pocketed health care provider also gain access to better medical equipment, better technology, better benefits, and opportunities to have their pet medical causes funded.

Key Trends in the Physician Field That Impact Income Potential

According to data from Medicus, and its 2017 Physician Practice Preference & Relocation Survey, which tracks key trends in the medical services professional sector, these issues weigh most on the minds of practicing physicians:

  • Income satisfaction is largely balanced out. According to Medicus, doctors seem equally split on income satisfaction, with 35.8% satisfied, 32.5% unsatisfied, and 31.8% "neutral" on the topic of physician income satisfaction.
  • Reimbursements an issue. The factor that bothers doctors most, according to Medicus? Reimbursement reductions from government health care programs like Medicare, Medicaid, and the Affordable Care Act. 32.2% of doctors cite reimbursement declines as the issue that is most likely to limit their income. Overhead, a decision to work fewer hours, and patient volume also rank high on income limiters for physicians.
  • A move toward production. About 44% of survey respondents say their income is not based on quality care, but instead on productivity goals that lead to raises and bonuses.
  • Need for insurance. In a separate study by Merritt Hawkins, 99% of physicians say malpractice insurance is the best perk a physician can have, followed by quality health care insurance and a good retirement plan.
  • Educational loan forgiveness not in large demand. Despite a general business trend towards employees wanting college loan help as a workplace perk, only 26% of doctors deem educational loan forgiveness as a big workplace benefit.

Payment Outlook

Over the course of a lifetime, general care doctors, on average, will earn more than $6.5 million, while specialists will fare significantly better, earning $10 million over their entire careers, according to Medscape.

Clearly, that's an ample income for U.S. physicians, most of whom say they love their work, and don't mind the long hours and paperwork that come with the life of a doctor. In that regard, the Hippocratic Oath doesn't cover money, but physicians adhere to the idea of a higher income, just the same.