Question: What are the 20 highest-paid jobs in America?
Answer: Doctor.
It’s not far from the truth: Of the 20 U.S. occupations with the highest average pay, according to the Bureau of Labor Statistics, 19 are some kind of doctor or dentist.
Pediatric surgeons earn $450,810 a year, on average, as of 2024, according to federal data. Cardiologists make $432,490. Orthopedic surgeons get $365,060.
Of the 20 highest-paid professions, only one is not a doctor (or dentist), and it’s last on the list. The 20th best-paid occupation in America is airline pilot. Pilots, copilots and flight engineers earn a median pay of $226,600.
Doctors earn more than any other broad category of worker, according to federal data: More than engineers. More than computer scientists. More, even, than lawyers.
To find a better-paid group than doctors, economists say, you have to drill down to elite subcategories, such as corporate CEOs and law partners. The average partner at a large firm earns more than $1.4 million a year. The typical S&P 500 CEO pulled down $17 million in 2024, according to research by Equilar and the Associated Press.
American doctors are so conspicuously well-paid that a group of economic researchers spent years trying to figure out why.
Here’s what they found.
Lots of School, Lots of Hours
As any medical-school applicant knows, you have to study for a very long time to become a doctor: college, then med school and years of post-graduate residency training.
And the hours are long. A typical doctor’s workweek runs anywhere from 40-plus hours to 60 or more, depending on specialty, the researchers found.
“There is a lot of training and long work hours that go into the job, and that is naturally associated with higher earnings,” said Joshua Gottlieb, a University of Chicago economist involved in the research.
The researchers found that, within the medical profession, doctors tend to earn more in specialties that require more training and longer hours. Each extra year of training, for example, translates to $143,000 in additional annual income.
But education and work hours don’t tell the whole story. Farmers and ranchers work long hours, an old federal report shows, and they don’t earn doctor pay.
As for training: Many of Gottlieb’s own colleagues in academia spend as many years in school as doctors. And most professors earn less than $100,000 a year.
“My brother is an emergency room physician, and I was in school longer than he was,” said Teresa Ghilarducci, an economist at the New School for Social Research in New York, speaking to USA TODAY in 2024. She was not involved in the research cited above.
Doctors Like Money
The researchers drew flak from doctors for saying it, but they found that physicians seek out higher-paying jobs.
In a 2024 paper, the researchers reported that doctors from the best medical schools flock to the highest-paying specialties. Doctors also favor procedures that yield more profits.
Some medical specialties are eye-poppingly well-paid. Here are some top salaries for doctors in their peak earning years, ages 40 to 55, according to the researchers. The figures date to 2017, so they may be higher now:
Neurosurgery: $920,500
Orthopedic surgery: $788,600
Dermatology: $655,200
Cardiac surgery: $607,300
Ophthalmology: $597,000
“We do see people attracted to specialties where the pay increases,” Gottlieb said, much like salary-conscious workers in any field. “I think it’s the human way.”
Maria Polyakova, an associate professor at Stanford medical school, joined Gottlieb in the research. She notes that med school graduates tend to be exceptional students with lots of career choices.
“For the most part, they are top students in the country who could have pursued other opportunities that pay similarly well,” she said.
The American Medical Association noted, in a statement to USA TODAY, that doctors often spend 12 to 15 years in training, typically exiting medical school with roughly $200,000 in debt. Elevated salaries help them get out of debt and catch up on years of missed work.
There Aren’t Enough Doctors
The United States has fewer doctors per capita than most other developed nations, according to the Organization for Economic Cooperation and Development: 2.7 per 1,000 potential patients, as of 2022, compared to 3.8 in France and 4.6 in Germany.
A big reason, the researchers say, is that the medical industry and federal government keep a lid on the number of seats in American medical schools and on residencies in hospitals.
The shortage stems from an era when health-industry leaders believed the U.S. had too many doctors. Ironically, the same groups now warn of a doctor shortage.
The AMA says its changing stance reflects the evolving state of the industry, noting that the current crop of doctors is aging and coping with burnout.
“We have sort of an artificially constrained supply of doctors,” said Andrew Biggs, a senior fellow at the libertarian American Enterprise Institute, who did not join Polyakova and Gottlieb in the research on doctors.
“That’s what economists call barrier to entry,” he said, and it drives up doctor salaries.
The AMA “is acting like a union for doctors” by limiting their numbers, Biggs said. “The point of it is to keep salaries high.”
The Government Sets Prices
One basic reason why doctors earn a lot is that medical care costs a lot, researchers say. And the federal government largely sets those prices.
Medicare, the federal insurance program, establishes prices for medical services. The prices are high enough that healthcare spending represents 18% of the nation’s gross domestic product.
“The government has decided, policy has decided, to devote a very large share of society’s resources to healthcare,” Gottlieb said.
Customers – patients – have little say in the cost of their medical care.
“It’s not like you’re going to compare prices on surgeons,” Biggs said.
That setup, economists say, makes the healthcare sector almost unique among American industries.
“In some ways, the medical industry is like a defense contractor,” Ghilarducci said. “Their main customer,” the federal government, “has deep pockets.”
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