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These doctors earn less but say it’s worth it


Earning a huge salary was never a top priority for Sarah Ramer, MD, a nephrologist at the James J. Peters Veterans Affairs Medical Center in New York. That was obvious even when she was still a medical student, since she opted for an extra academic year to get a masters degree in clinical research methods.

After doing a combined internal medicine/pediatric residency, Dr. Ramer completed two fellowships, one in adult nephrology and one in palliative care.

“Every extra year that you spend in training is another year you’re not making a salary as an attending, so by doing 7 years in residency and a fellowship, I was not building my net worth the way some physicians do,” she says.

When Dr. Ramer, now 41, was ready to enter the job market in 2019, she had two offers on the table – one at a large, urban, research-intense medical center that included some clinical work combined with research and that paid $105,000, and one as a clinical nephrologist at a smaller suburban medical center with a $230,000 salary and a $20,000 performance bonus.

She took the first job, because she liked the idea of being ensured of having time to perform research, and she hoped to qualify for a career development grant from the National Institutes of Health.

Over the next few months, Dr. Ramer was diagnosed with cancer and the pandemic began ravaging the country. She considered taking a leave of absence from her job, but since she had only recently started at the job, taking a medical leave would mean she’d get only 50% of her salary, which would have left her with just over $50,000 to cover her mortgage, student loans, and other expenses.

“Financially, it would have been disastrous for me to go on leave at that time,” she says. “Things happen, but that’s something I didn’t consider when I decided to take a very low-paying job.”

Dr. Ramer has completed cancer treatment and has moved on to her current role at the VA medical center, where she is earning less than she would have made at the suburban medical center but more than twice as much as she did at the urban research hospital.

Lifestyle trade-offs

While Dr. Ramer’s salary is nearly four times that of the average American worker, it’s only about 60% of what the average physician earns. That works for Dr. Ramer, who has never put much value in material possessions. She has lived in the same working-class New Jersey neighborhood for more than a decade and drives a 2010 Hyundai Elantra.

“I need a new kitchen and new bathrooms in my apartment,” she says. “I’m still working on that. I have a good cushion, but I need to build up my emergency fund before I start spending money on home renovations.”

Such trade-offs are common among physicians who’ve chosen to work in a rural area, at a Medicaid practice, or in public health. But physicians who find themselves on the lower end of the pay scale say that there are rewards and benefits to opting for less lucrative career trajectories.

For Sean Kissel, MD, 30, a family physician in northern Utah, it’s about the lifestyle afforded by his role, which has earned him between $190,000 and $230,000 over the past few years. “I have no on-call shifts,” he says. “So, when I’m done, I’m done. I don’t have to work weekends or holidays, and I have dinner with my kids every night.”

According to the 2022 Medscape physician compensation report, physicians earned an average of $339,000 annually last year. Primary care physicians took home an average of $260,000, compared with $368,000 for specialists. The disparity in physician income was even greater when broken down by specialty. Plastic surgeons earned the most ($576,000), and public health and preventive medicine physicians earned the least ($243,000).

Still, that study found that physician salaries were up across every specialty, ranging from a 1% increase for critical care physicians to a 13% jump for otolaryngologists.


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