Medical students who choose primary care lose millions in income

Will medical school loan forgiveness be enough to convince prospective doctors to forsake specialty practice as a career?

I’ve argued previously that it may help a little, but it’s unlikely to change the overall trend away from primary care.

A recent article from Health Affairs compares lifetime earnings from a cardiologist versus a primary care physician. The difference is stark:

Their calculations showed that cardiologists earn a career average of more than $5 million, compared with $2.5 million for primary care physicians, $1.7 million for business school graduates, $846,735 for physician assistants and $340,629 for college graduates, according to the paper.

To make up the difference, “primary care doctors would have to receive a $1 million lump-sum payment or have an annual income boost of $100,000.”

Some argue that, compared to non-physicians, primary care doctors should have nothing to complain about. Consider NPR’s Shots, for instance, which framed the piece with the somewhat obnoxious title, “Primary Care Docs Earn Less Than Specialists, But More Than We Do.”

But that’s an irrelevant argument.  Medical students are not looking at physician assistant salaries or MBA earnings upon graduating. They’re looking at the $2.5 million difference between a cardiologist and primary care doctor.  And, in many cases, moreso considering cardiology isn’t even the highest paying physician field.

Although money isn’t everything, a disparity that wide is more than enough to sway more than a few into a more lucrative specialty career.

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  • csmith

    I haven’t seen the above study but must question it’s validity. If you assume the average career is 30 years, does that mean that a cardiologist is only making $170,000 per year and a PCP $80,000 per year. I don’t doubt that the ratios are accurate however.

  • primary care doc


    PCPs in the US now get paid significantly less than those in Canada and the UK, among other countries, so I think our pay is the major problem.

  • stargirl65

    Many pcps do earn 80K per year, though the average for ENTIRE COMPENSATION is more like 150-180K. Salaries for most of the pcps where I am are more like 105-135K. One pediatrician I know earns only 60K because he is old school, has lots of support staff, takes all insurance including Medicaid, and takes his time seeing patients.

  • Michael Rack, MD

    “$340,629 for college graduates, according to the paper.”

    That figure is hard to believe- it must include many women who leave the work force to raise children.

  • Colin

    But that’s an irrelevant argument. Medical students are not looking at physician assistant salaries or MBA earnings upon graduating. They’re looking at the $2.5 million difference between a cardiologist and primary care doctor. And, in many cases, moreso considering cardiology isn’t even the highest paying physician field.

    I agree that this is true; but I wonder if the problem is not that primary care physicians don’t get paid enough but that some specialists get paid too much…

  • KP Internist

    It is a 30 year career guys. Things will change somewhere in the next couple of decades. Like most industries, medicine is cyclical. In the 80′s, primary care doctors made more than specialists. At KP, we had cardiologist carry primary care panels. The cardiologists were cheaper to hire. Now, it’s reversed. My advice to any medical student who is looking to enter a field soon, don’t think about what your salary will be like in 5 years. Think about your what you would like to do, pick a field that has a lot of with expected growth in demand and you will be fine. PCPs at NCAL make about 230K a year salary with another 50k in other benefits at full time schedule. There are many places where primary care does quite well (not as well as the cardiologist…but stay tuned…the winds are changing).

  • d

    Whoa, maybe specialist are underpaid and pcps are even MORE underpaid. What about the big time business types making hundreds of millions (or even comfortably in the 6 figures) each year?

  • Buck

    If you need a cardiologist at 3 am you won’t think he or she is overpaid, particularly if you try to call your pcp and find out they no longer take call or admit to the hospital.

  • TrenchDoc

    And the reason PCPs no longer go to the hospital is because we got burnt out on staying up all night to stabalize a chronically ill patient. Then we went to the office to see 40 more patients and got paid far less than the specialist who comes in and does a 45 minute procedure.

  • jsmith

    Big confusion on this post: It’s not lifetime earnings that the authors focus on. It’s expected wealth accumulation. In other words, a cardiologist would be expected to have a wealth of 5 million plus change at age 65, given certain living expenses and certain expected investment return. A primary care doc would be expected to be able to accumulate 2.5 million given the same living expenses and investment return. Same analysis for the other players. The idea that a college graduate would earn only 340k over a 30 plus year career is obviously absurd.

  • Buck

    45 minute procedure and 130,000 minutes of free follow up. That allways gets left out. So you no longer go to the hospital or take call, but expect to get paid like the guy that does. Makes sense.

    • Mike

      What a specious argument!!! The one thing primary care docs have gotten a little bit of control over is their lifestyle. If I can’t get paid reasonably for my work, then I’m going to try to improve my quality of life. Believe me, if going to the hospital in the middle of the night once a week added 200,000 dollars a year to my income, I’d be there. Let’s not forget about the huge sums of easy money cardiologists make also. Echos, nuclear stress tests, etc. These don’t require 3 AM visits to the hospital. Cardiologists deserve to be paid well for middle of the night care. It’s the huge disparity in income that’s the problem.

  • tpetrusick

    Do what you like and do it well. You will be rewarded maybe not monetarily but you will be rewarded. Your loans will get repaid , your kids will go to college, you ,your family, your patients and your colleagues will be happy. Will the guy who has 5 mill be and happier? After all you are doing what you like.

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