Earning 500K+ Salary as an Internist.

In almost, every physician salary compensation report posted out there, the top rows are filled with surgical specialties.  Orthopedic Surgery, Plastic Surgery and a sprinkle of medical specialties like Intervention Cardiology and Gastroenterology are the ones with top salaries. According to Medscape’s 2017 salary survey, average annual physician compensation for Orthopedics Surgery was 489K. At the bottom rungs, is an average of 202K for Pediatrics, 209K for Family Medicine and 225K for Internal Medicine.

What if I tell you it is possible to earn more than 500K as an internist ? And this is without any additional fellowship training. Not by any questionable pill clinic type operation.

That has been my average salary the past 3 years. This will like go down in the next year or two as we will have more employees heading into employer-ranks.

Here is a how-to for those who are curious. Keep these ideas in mind when you are job hunting. There are also contract terms to be aware of when you are looking for a new job.

Private Practice Is the Way to Go, Find a Good Place and Stick with It

Since graduating residency, I had worked with the same group. I started working here as an employee with a salary of 150K annually in Hospital Medicine. Over the past 10 years, I have risen in ranks. I am now part-shareholder. We have a very fair system where qualifying employees are offered equal position as a shareholder after several years. Despite the pains of running a private practice, the rewards far outweigh it.

Besides the autonomy, salary surveys have always proven that doctor working in self-owned group practices – either single or multi-specialty group, tend to earn the most.

There are risks at times: an unexpected low paycheck where the month Medicare takes a hiatus in processing claims, it will normally catch up in the next few months.

Consider Working in a Rural/Semi-rural Location

I graduated residency in New York City, where physician salaries (across specialties) are among the lowest in the country Cost of living, on the other hand, among the highest. Many of my fellow-residents have chosen to remain in the city after graduating, due to personal preferences and family ties. I do not know of a single friend living in NYC who earns more than 225K in Internal Medicine, 10 years on. If you are willing to move away from major cities, such as New York, Boston and San Francisco, you will definitely find higher paying jobs.

Hospital Based Practice (Generally) Pays Better

After speaking to other medical doctors in clinic practice, I would say it is safe to conclude that practicing inpatient medicine pays better – a lot better. The starting pay for a general internist in my area would be in the 200K range, for hospital medicine, it is at least 50-70K more.

Obviously, the hours are more demanding: I count on working 2-3 weekends a month, alternate holidays with my colleagues (and generally work 2/3 major holidays). I work ungodly hours: the dreaded swing shift and night shift. In exchange, especially after garnering some seniority in the group, my pay is likely 2-3 times that of a general internist.

While it is true that burnout rate can be high, as it is with many shift-work type jobs, and I do feel that having the extra autonomy as part-owner helps off-set this to a certain extent. Besides, despite its banker hours, many primary care providers are bogged down by paperwork even after their regular day is over. At least, that is what my friends often complain about.

I find that my Type A personality works well for the challenges that come with dealing with the sicker inpatient population.

Work More Shifts

For all shift-based specialties, one can easily earn more money by working more shifts. In hospital medicine, as our shifts are 12 hours long, 15 shifts a month is considered full time work. In order to earn a higher compensation, I often pick up 1-2 extra shifts every month.

Several of my colleagues pick up extra locum shifts, which pays even better, and more deductions can potentially be made as those are paid under 1099 terms instead of W2. However, that would entail travel (which would mean less time with my family) and working in a different work environment, all of which makes this less desirable to me. One employee in our group made over 350K working full time for us and another 120K with locum tenens work!

Consider Part-Time Gigs/Passive Income

This, I am still looking into, and have not explored in-depth yet. There are many forums and facebook sites where physicians share interesting part time gigs, which may or may not be related to Medicine. White Coat Investor and Physician On Fire are probably the two most prominent personal finance bloggers who have made it big in the blogsphere.

Passive Income MD reported in one of his latest posts that his side gigs, which includes real estate investments, real estate crowdfunding ventures and with his wife, Mrs PIMD – into direct sales marketing, and is now financially free from medicine.

Other bloggers have reported substantial income from pharmaceutical writing and speaking gigs, utilization management consulting, venturing into media, advertising and other interesting jobs.

Do you have an interesting side gig? How much do you earn from your side gig? I would love to learn more and venture into other passive income opportunities beyond my regular medical practice.

Before signing your new contract, consider hiring a contract negotiation team to review your contract. Contract Diagnostics specializes in such negotiations. They offer numerous packages (starting at $200 for a basic review – up to more detailed legal, a benefit, and a compensation review. They also offer direct negotiation with your employers. With their an all-in-one human resources, legal team that will help you negotiate the best compensation possible.


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18 thoughts on “Earning 500K+ Salary as an Internist.

  1. You know about my side gig. 🙂

    I am impressed by your work ethic and ingenuity. Many physicians accept that they will earn a salary in the range of what is reported as “normal” in their chosen specialty, but for those willing and able to look for more money, it can be there if you work for it.

    Thank you for the mention, and welcome to the blogosphere!


    1. Thank you for your comments! You are who I aspire to be one day, God willing. My spouse and I are actively exploring a Donor Advised Fund either this year or for 2018. Thanks to you and other physician personal financial bloggers, I have learned so much about investing within the past 1-1.5 years. We have always worked hard, live a frugal life and have a high savings rate (over 80% of our gross annual income on average), could you believe that until 1.5 years ago, we have only kept our money in a low yield savings account! I hope to share our experiences here and educate the masses! (was passionately talking to the nurses about HSA and Stealth IRA at work).

    1. No matter what profession we have chosen, i think there are always ways to ‘think outside the box’ and build on our strenghts. I am constantly learning and exploring – now working on side gigs and passive income streams.

  2. Burn out seems imminent with those hours, and all the weekends you’re working, however make that $$$ while you’re young and still have the ability to work weekends. Do you have a family? I couldn’t see how working almost half the weekends per month would work if you did.

    1. I am looking at cutting down, especially the off-hours ie nights. Hence thinking of new passive investments and side gigs. Will be sharing my experiences here. I am also hopefully getting closer to financial independence.

  3. Wow you are so hard-working! I think it’s great that you explore all the possible ways to maximize your main income while looking for ways to do side hustles and make an extra income. Half a million dollars is definitely something to think about. 🙂

    1. Likewise, I admire your grit – getting up early to blog, long commute, etc. I love my sleep 🙂 My high pay won’t be forever, as we get more partners all the time, so might as well make the most of it when I can.

  4. Great insight, I’m an IMG, new career hospitalist here in rural setting. I’ve been practicing the points you listed and I am debt free, 2 yrs from residency with the plan to pursue FIRE. What I need to find next is how to start a group practice with 3 other hospitalists. Any tips?

    1. Thanks for visiting my blog. Congratulations on being debt free. I would recommend hiring a practice consultant initially. It will be good investment with helping you negiotate terms with the hospital, etc. Pm me with questions and check back on my blog for more articles on this.

  5. Nice write up. In residency and fellowship I did a lot of moonlighting to earn that extra money. Funny thing is I am not sure where it all went.

    Now I am a cardiologistndoing fine financially, but am also interested in earning more money. We will see how this blogging thing goes.

    Keep up the good work.

    1. Thank you for visiting my blog. As an International Medical Graduate, I could not moonlight until I completed my residency. Currently, my mission with blogging is two-fold: stress relief for me, and hopefully as a source of information for others by sharing my experiences. If this turns out to be an income stream, that’ll be an extra bonus 🙂

  6. Wonderful blog post. I was also group owner with a couple others in my group. I started out fee for service private practice but those days I think are pretty much gone. Being boss is good but considerable extra work, but there is considerable extra return. One thing to consider is where you practice. I moved to a little fruit town in FL with a 300 bed hospital next to NASA. At one time it had one of the top three payer mixes in the state. I chose a low tax environment with plentiful water resources. You can’t have growth without water. Things to consider. I’m an anesthesiologist and set up a side practice doing pain blocks for both in-patients and outpatients. I worked out of the hospital or SDSC so the overhead was just billing. That gig put an extra $300K per year in my retirement until block reimbursement started to be cut. It also brought me into closer contact with the medical staff than an anesthesiologist often enjoys because surgeons and internists had someone they could send their patients to for diagnosis and blocks or needed help managing someone’s pain post op. I was a guy they could call when they had a problem so we were better integrated into the hospital.

    My friend was a surgeon from Guatemala and his wife was an anesthesiologist. When they came to the US he became an internist, pulmonoligist and intensivist. He also got credentialed in sleep apnea. He also opened up an office which he staffed along with his wife and a couple PA’s. He’s very busy but he does very well. He also did first assist surgery since he was a trained surgeon in the old country.

    The point is as an employee it’s hard to get ahead unless you develop a skill (like my block practice or my friends first assist, sleep apnea, ICU stuff), but even 10 years of ballin the jack with that extra gig can make big inroads into creating wealth, especially when early in your career.

    Very entrepreneurial! I love to read stories like this.

    1. Hi thanks for sharing your entrepreneurship. I am still finding my niche/side gig and that is partially why i started this blog. I have ‘met’ so many docs with interesting and inspiring stories. Hence, even when i have no idea how this blogging journey will bring me, ill enjoy the trip in the meantime.

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