When considering which specialty to pursue, many premeds place a heavy emphasis on annual salary. What they often fail to consider, though, is the time that is required to make the big bucks.
We took the average annual salary for each specialty and divided it by the number of hours worked per week and the number of work weeks per year to give us the average hourly wage.
It is important to note that the salaries used in our calculations are averages, and variation is expected. Within specialties, salary and weekly hours can vary widely depending on the type of practice, geography, and numerous other factors.
Just because your cousin’s goldfish’s twin sister’s boyfriend is making $10 million per year as a psychiatrist doesn’t mean the data are wrong. It just means he’s an outlier.
With that said, here are the 10 doctor specialties with the lowest hourly rate.
Number 10 is psychiatry, which focuses on the diagnosis, prevention, and treatment of mental disorders.
Psychiatrists have an average annual salary of $275,000 and work an average of 47 hours per week, giving us an hourly wage of approximately $117.
Psychiatry is unique within medicine as it is less algorithmic than most specialties. If you have two patients with the same diagnosis, it is unlikely that you will use the exact same treatment plan for both of them. Instead, you have the opportunity to create a customized treatment plan for each of them that fits their unique biology and needs. If you enjoy thinking deeply and holistically about your patients and want the freedom to individually tailor their treatment plan, psychiatry may be a good fit.
Psychiatry also offers a lot of flexibility, both in terms of your career, as well as work-life balance. You can work in multiple clinical settings, with multiple patient populations, and even have multiple jobs at once.
Psychiatrists also tend to work regular business hours with few overnight emergencies or weekend calls. If lifestyle is important to you, psychiatry has you covered.
Number nine is neurology, which focuses on the diagnosis and treatment of diseases of the nervous system, including the brain, muscles, spine, and nerves.
Neurologists earn on average $290,000 per year and work an average of 51 hours per week, yielding an average hourly wage of approximately $114.
Neurologists focus on arguably the most fascinating organ system of the human body — the nervous system. If we look at even just the last 20 years, we have seen dramatic improvements in our understanding of the brain and spinal cord. This is likely to continue, too, as neurologic diseases are consistently in the top 3 most funded diseases by the NIH each year.
Most neurological conditions are also chronic in nature, so if you enjoy building strong longitudinal relationships with your patients, neurology may be a good fit.
Approximately 80% of neurology is outpatient as well, which means you’re less likely to work weekends and more likely to have regular 8 to 5 business hours.
8. Allergy & Immunology
Number eight is allergy and immunology, which is the area of medicine focusing on the diagnosis, treatment, and management of disorders related to the immune system.
Allergist-immunologists have an average annual salary of $274,000 and work an average of 49 hours per week, translating to an average hourly wage of approximately $112.
As an allergy and immunology physician, you get to see a wide variety of patients and conditions — from young to old and acute to chronic. You will also see a wide range of acuity from common conditions like asthma, food allergies, and allergic rhinitis, to rarer and possibly life-threatening disorders of the immune system.
You also get the opportunity to be on the cutting edge of medical research as our understanding of the immune system and the many other areas of health it affects continue to develop. New immunotherapies and treatments are constantly being developed, so the field of allergy and immunology is constantly growing and evolving.
Of note, allergy and immunology physicians also spend the least amount of time on paperwork and administrative tasks out of any specialty on our list, at just 14.6 hours per week. For perspective, this is a similar amount of time to dermatology, which is known for being one of the best lifestyle specialties.
7. Preventive Medicine
Number seven is preventive medicine, which focuses on the overall health of individuals to protect, promote, and maintain well-being, as well as prevent disease, disability, and premature death.
Preventive medicine physicians have an average annual salary of $237,000 and work an average of 45 hours per week, giving us an average hourly wage of $105.
Preventive medicine, as the name implies, is all about addressing health issues before they become a problem — something that we often don’t focus enough on in Western medicine. So, while preventive medicine isn’t perceived to be cutting edge and doesn’t make headlines, it’s arguably more important and impactful in terms of lives saved.
These doctors also tend to be heavily involved in influencing public policy, public health, and designing healthcare systems to prevent and control the spread of disease. So not only do you have the opportunity to help patients on an individual level, but you can also help to prevent disease on a much larger scale.
Preventive medicine physicians also have some of the lowest rates of burnout out of any specialty, which is significant when you consider that nearly half of all physicians report feeling burned out. This makes sense when you consider that preventive medicine places a heavy emphasis on the importance of lifestyle and overall health.
Number six is rheumatology, which focuses on the diagnosis and treatment of diseases of the joints, muscles, bones, and tendons.
The average rheumatologist earns $276,000 per year and works an average of 54 hours per week, yielding an average hourly wage of $102.
Rheumatology also has the highest change in salary between 2020 and 2021 of any specialty on our list, with an increase of 5% year over year.
One of the biggest draws of rheumatology is the amount of time that you get to spend with patients. The nature of the diseases that rheumatologists treat often require a close, long-term relationship, where treatment decisions are constantly refined depending on the patient’s unique life, needs, and biology.
The medical conditions you treat in rheumatology also tend to be very complex. You get to be a sort of “medical detective” and sort through the most complex clinical facts and physical exam findings before ultimately giving your final diagnosis and treatment recommendations.
Much of rheumatology is outpatient as well, so lifestyle is generally pretty good amongst rheumatologists.
Number five is endocrinology, which focuses on the diagnosis, treatment, and management of diseases of the endocrine system.
Endocrinologists have an average annual salary of $245,000 and work an average of 49 hours per week, giving us an average hourly wage of $100.
Endocrinologists have the second-highest change in salary on our list, with an increase of 4% between 2020 and 2021.
Much like with rheumatology, endocrinologists get to be medical detectives. They focus heavily on building patient relationships and exercising clinical reasoning. If you enjoy the cerebral side of medicine as opposed to performing procedures, endocrinology may be a good fit.
In addition, lifestyle diseases like obesity and diabetes are the bread and butter of endocrinology. Similar to preventive medicine, you can take pride in knowing that you are helping your patients make lasting lifestyle changes that will positively impact their health for years to come.
Number four is pediatrics, which focuses on the care of babies, children, and adolescents, from birth up to the age of 25.
Pediatricians earn on average $221,000 and work an average of 47 hours per week, yielding an average hourly wage of $94.
It should be noted that pediatricians have the lowest annual salary out of any specialty on our list; however, they also work fewer hours than most specialties.
The biggest draw for pediatrics is that you get to work with children and adolescents. You have the unique opportunity to make an impact early in someone’s life, which can compound to yield tremendous changes over their lifetime. As such, pediatrics could be considered one of the most powerful forms of preventive medicine.
Treating the full spectrum of patients from infancy to adulthood also means that you see a lot of diversity — both in terms of patients and pathologies. Each stage in human development has its own unique physiology and pathologies, so you will always have a great deal of variety in your caseload as a pediatrician.
You also have the opportunity to make long-lasting patient-physician relationships and watch as your patients grow from infants to fully grown adults.
3. Infectious Disease
Number three is infectious disease. These physicians are the experts in the diagnosis and treatment of diseases caused by bacteria, viruses, fungi, parasites, and prions.
Infectious disease physicians have an average annual salary of $274,000 and work an average of 53 hours per week, giving us an average hourly wage of $92.
Infectious disease is one of the most rapidly evolving fields of medicine. It seems that every year or two there is some outbreak of a new pathogen — whether it be swine flu, Zika virus, or more recently the SARS-CoV-2 coronavirus pandemic. As such, infectious disease physicians are also often involved in public health, so if you are interested in making a difference on a larger scale, infectious disease may be a good fit.
Infectious disease physicians are constantly learning about new pathogens and relearning old, forgotten pathogens, which keeps the specialty interesting and ID docs on their toes.
Job satisfaction also tends to be high amongst infectious disease physicians, with approximately 89% reporting that they would choose the same specialty again.
2. Internal Medicine
Number two is internal medicine, which focuses on the diagnosis, treatment, and prevention of a broad number of diseases that affect adult patients. These are the quarterbacks of the hospital healthcare team and what most people think of when they hear the word “doctor.”
Internal medicine doctors earn on average $248,000 and work an average of 55 hours per week, yielding an average hourly wage of $90.
Although internal medicine physicians have the highest annual salary out of our bottom five specialties, they also work the most hours — which is why they’ve found themselves at our number two spot.
One of the biggest draws for internal medicine is the tremendous career flexibility that it offers. If you want to work as a hospitalist and take care of admitted patients, you can do that straight out of residency. If you want to do primary care and see patients in an outpatient clinic, you can do that too. And if you decide that you’d like to specialize and further your interest with something more focused, IM offers a clear path to multiple fellowships, including cardiology, gastroenterology, and oncology, to name a few.
Being generalists, IM doctors also maintain their level of medical knowledge. You spend thousands of hours and incredible effort learning about various organ systems and their pathologies in medical school; however, much of this is forgotten as you specialize during residency and fellowship. Internal medicine is one of the few specialties where you can continue to develop this broad knowledge.
1. Family Medicine
And, finally, the specialty with the lowest hourly rate is family medicine.
You’re probably not surprised, since family medicine is known for being one of the least lucrative and least competitive specialties.
Family medicine is the center of primary care. These are the generalists of generalists. Unlike other specialties that focus on a particular organ, disease, or age range, family medicine physicians see the full spectrum of patients — from young to old, healthy to unhealthy, and everything in between.
Family medicine doctors have an average annual salary of $236,000 and work an average of 53 hours per week, giving us an average hourly wage of $89.
Don’t let the hourly wage fool you, though; there’s still a lot to love about family medicine.
If you enjoy getting to know your patients and building relationships, family medicine offers amazing access to longitudinal care, as you can see patients from the time that they’re born through to adulthood.
Family medicine is also one of the few specialties where you can continue to maintain and develop the vast medical knowledge you learned during medical school. Being a generalist means that you can take satisfaction in knowing that you’re able to manage most anything that walks through the door — at least to some extent.
And, lastly, family medicine physicians often enjoy a desirable schedule, usually working regular 9 to 5 office hours with minimal, if any, call.
Remember, money is just one piece of the equation. You should never choose a specialty primarily based on salary. Each specialty has its own unique pros and cons that you need to weigh for yourself. At the end of the day, it is much more important for your long-term happiness to choose a specialty that you enjoy than one that just pays well.
Regardless of what specialty you choose, it always benefits you to keep your options open — not only if you’re one of the 52% of medical students who change their mind about their intended specialty — but also so that you can match into the most desirable programs in your chosen specialty, which are always competitive, no matter the field. At Med School Insiders, our specialty is helping students maximize their potential and be the most competitive candidates possible. Check out our Residency Admissions Consulting Services to learn more.
This post appeared on Med School Insiders.