Chris, a reader, commented on the surgeon vs. football player salaries post, "Many of the average/base salaries for physicians/surgeons posted in this article are off by hundreds of thousands of dollars."
I am confident that the data points that make up our averages correspond to the actual salaries received by individual surgeons. In fact, even our broad average salaries compare well with other broad averages, like the Bureau of Labor Statistics survey of all surgeon salaries by metropolitan area, when we select and group surgeons and geography in the same way.
Assuming Chris means his experience with surgeons’ pay is very different from what we report, why are PayScale average surgeon salaries so "off"?
It comes down to which surgeons go into our averages, vs. the people Chris knows. In this post, I will look at what goes into "average" (median) surgeon salaries, why surgeon salaries vary so much, and why even a median may not really "typical."
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A Surgeon’s Life and Income
Surgeon pay is highly variable. Any difference in the surgeons that make up a sample used to calculate a median can have a large affect on that average pay.
The first factor that causes large variations is the surgeon career path.
If you couldn’t wait to get out of high school at 18, consider this: in the US, specialist surgeons do not finish their education until their mid-thirties. For example, a “heart” surgeon after high school has:
- 4 years of college (22)
- 4 years of medical school (26)
- 5-7 years of general surgery residency (32)
- 2-3 years of cardiothoracic residency (34)
- 1-2 years fellowship, e.g. for heart transplant (35 years old!)
Hence, for the better part of 10 years after becoming doctors, surgeons are still in training. These “apprentice” surgeons are often wielding the knife, if you are operated on at a university hospital.
At the other end of their careers beyond the age of about 55, few surgeons are practicing full-time vs. teaching, administrating, or being US Senators. Surgery still requires manual dexterity and visual acuity, both of which start dropping in the mid-40’s.
My wife’s great uncle had a completely typical surgeon’s life: MD at 25; practicing general surgeon at 32; went into full-time administration at 52. He performed some surgeries after that, but he was basically out of the practicing surgeon game. Out of a 40+ year career, only about 20 years were spent as a practicing surgeon.
Hence the “average” surgeon pay depends on whether we include
- Surgeons in their 20’s and early 30’s: still in training, they often are making only $45,000/year for 80-hour weeks.
- Surgeons in their late 50’s and 60’s: should we include their non-surgery income? Are they still “surgeons” when they stop cutting full-time?
Different choices of how much of the career to include can easily change a $300,000 salary from the median to the 75th percentile or the 25th percentile.
Pay For Performance: Surgeon Productivity
Another big factor is productivity. While we are talking about annual salaries, surgeons’ employers are usually paid for each procedure the surgeons do.
For example, a surgeon performing 10 knee transplants a week clearly should be paid much more than one who does only 2, since the high volume surgeon is bringing in more revenue. Those 8 operations would bring in about $55,000 more per week in surgeon fees in metropolitan Washington DC.
Why would a surgeon do fewer operations? Some surgeons work at research hospitals, where they spend less time doing “bread and butter” surgeries, and more time researching new techniques. Research is supported by grants (at best), and generally is far less profitable for the employer.
Chris may be more familiar with “private practice” surgeons, who generally maximize the number of operations performed per week, and hence pay.
Even a few research surgeons can really bring down the average. For example, if 1 in 4 in our average is a research surgeon making $100,000, instead of earning $500,000 in private practice, that would bring down the average by $100,000.
Location also affects productivity. In a major metropolitan area, a surgeon can keep a full schedule of operations. A country surgeon may have more time to play golf, and less income 🙂
Surgeon Salary vs. Surgery Business
Finally, we reported surgeons’ salaries, not total annual income. Many surgeons are not salaried employees, but are closer to small business owners. They run practices, hire staff, and bill for procedures. PayScale generally does not include these self-employed surgeons in our reports.
Salaried surgeons (e.g., employed directly by medical centers), have less of the risk, and typically less reward (pay), than those running a practice. Salaried surgeons also more likely to work in research, further reducing their average pay.
Like CEO salaries in New York City, our “average” surgeon salary can be very different from a reader’s expectations. As I’ve said before, all aggregate statistics lie; there is not such thing as a “true” typical answer.
While I am confident in the underlying individual profiles that make up our surgeon salaries, I am less confident that a broad average we form will match what every reader is thinking 🙂
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Dr. Al Lee