What are the Most Lucrative Medical Specialties?

We all know that some specialties make more money than others, but are they actually making more money per hour? Or are they just working more hours? Let’s dive into the data and find out. When discussing which specialties make the most money, the conversation usually starts and ends with annual salaries. Although this is a good place to start, it overlooks one crucial component: the time that it takes to make that salary. We took the average salary for each specialty in 2021 and divided it by the average number of hours worked per week, multiplied by the number of weeks worked in a year, to give us the average hourly wage.

We’ll also discuss factors like competitiveness, on-call responsibilities, and length of training to give you a better understanding of the price you pay to earn that higher hourly wage. Number one on our list is plastic surgery which focuses on the repair, reconstruction, replacement, and alteration of soft tissue. This should come as no surprise as plastic surgery is known for being one of the more lucrative specialties. It is often in the top 3 for highest-paid specialties. Plastic surgeons have an average annual salary of $526,000 and work an average of 52 hours/week, giving us an hourly wage of approximately $202 per hour. It is important to note that this number includes both reconstructive and aesthetic plastic surgeons.

 Plastic surgeons working in aesthetics will, in general, make more than their reconstructive colleagues. That being said, to achieve this compensation you will first have to match into plastic surgery which is no easy feat. It is currently ranked #2 on the MSI competitiveness index, neck and neck with dermatology in first. You will have to commit a great deal of time and effort during medical school to be competitive for plastics, and even then, there is no guarantee that you will match. The training to become a plastic surgeon is also longer than most specialties at 6-8 years depending on the pathway you take. So while many of your peers during medical school are already receiving an attending’s salary, you will still be completing your training.

Once you begin practicing as a plastic surgeon, however, the lifestyle is often pretty good. Plastic surgeons work an average of 52 hours per week which is less than many of the other surgical specialties but middle of the pack when looking at all specialties. Most surgeries are also non-urgent so call typically isn’t terrible. Keep in mind though that if you choose to do microsurgery or handle face trauma, your call obligations can be more taxing. Number two is orthopedic surgery which focuses on the surgical management of the musculoskeletal system including the extremities, spine, and associated structures.

Orthopedic surgeons have an average annual salary of $511,000 and work an average of 57 hours per week, yielding an average hourly wage of $179 per hour. Much like plastic surgery, orthopedic surgery is consistently in the top 3 highest-paid specialties, right in the mix with plastics and neurosurgery. Similarly, it is also one of the more competitive specialties to match into as your USMLE Step 1 score and 1 rep max on bench press will have to exceed 500, which can be a big barrier to entry for prospective applicants. All jokes aside, it is ranked #4 on the MSI competitiveness index which means more time and effort spent during medical school to make yourself a competitive applicant. Ortho residency is 5 years, which is standard for most surgical specialties, but longer than many non-surgical specialties.

Longer residency programs do exist which include additional research experience. Orthopedic surgeons work an average of 57 hours a week, which is in line with many other surgical specialties but on the higher end compared to all specialties. On-call obligations will vary depending on your choice of subspecialty. If you choose to subspecialize in trauma, for instance, be prepared for a heavier call schedule. Number three is dermatology which focuses on the management of diseases involving the skin, hair, and nails. Dermatologists have an average annual salary of $394,000 per year and work an average of 45 hours per week, averaging $175 per hour. Dermatology is currently ranked #1 on the MSI competitiveness index as it is known to have a great lifestyle, and is the only specialty in the top 5 that is non-surgical.

To become a dermatologist, you will have to complete a 1-year internship followed by 3 years of dermatology residency for a total of 4 years in training after medical school which puts dermatology in the middle of the pack when it comes to length of training. Dermatologists work 45 hours per week which is towards the lower end of all specialties. Given the outpatient nature, low acuity of medical conditions, limited call, and flexible workdays, dermatology is known for having a “cush” lifestyle relative to other medical specialties.

Number four is cardiology which focuses on diseases of the heart and the blood vessels. Cardiologists have an average salary of $459,000 per year and work an average of 58 hours per week, yielding an average hourly wage of $158 per hour. Cardiology is the first specialty on our list that does not have a dedicated residency. Instead, you must first complete 3 years of internal medicine residency followed by 3 years of cardiology fellowship, for a total of 6 years of training after medical school. Although it is difficult to compare the competitiveness of cardiology to other specialties on our list due to the fact that it is a fellowship and not a residency, it should be noted that cardiology is one of the most competitive internal medicine fellowships to get into.

Cardiologists work an average of 58 hours per week, which is towards the higher end when compared to most other non-surgical specialties. This time is split between clinic, Cath lab, performing procedures, general rounds, and research. Of note, 30-40% of emergency room admissions are cardiac-related, so there is certainly no shortage of work if you’re a cardiologist. On-call responsibilities will vary depending on your sub specialization. If you choose to subspecialize in interventional cardiology, for instance, you can expect lots of call with long days in the cardiac Cath lab.

Number five is otorhinolaryngology, or ear, nose, and throat, which focuses on the surgical management of diseases of the head and neck region. Ear nose and throat doctors, or ENTs, have an average salary of $417,000 per year and work an average of 53 hours per week, averaging $157 per hour. ENT is a highly competitive specialty, consistently ranking #5 on the MSI competitiveness index right after dermatology, plastic surgery, neurosurgery, and orthopedic surgery. ENT residency is 5 years, which is the standard for most surgical specialties, but longer than many non-surgical specialties. Longer residency programs do exist which include additional research experience.

ENT’s will work an average of 53 hours per week which is middle of the pack when looking at all specialties. Work is typically split between surgery and clinic with clinic days generally having regular 9 to 5 hours, and OR days being half days or full 12-hour days depending on the complexity of the cases. Given the greater proportion of time in the clinic coupled with the fact that ENT typically splits face call with plastics and OMFS, on-call obligations are typically less than other surgical specialties. This can vary though depending on the hospital or institution you work for.

Number six is emergency medicine which focuses on the treatment of acutely ill patients with urgent healthcare needs. Emergency medicine physicians have an average salary of $354,000 and work an average of 46 hours per week, averaging out to $154 per hour. In terms of competitiveness, emergency medicine is at the lower end of the MSI competitiveness index at 17. It is also at the shorter end of residency lengths at just 3 to 4 years of training after medical school. Emergency medicine physicians will work on average 46 hours per week, which is towards the lower end of all specialties. They are also unique in that they do shift work, meaning that they clock in and clock out and don’t take work home with them which is something you can’t say about many medical specialties. Emergency medicine is not without its downsides though.

Although many people view shift work as a positive, it also means that you might end up working irregular hours depending on your shifts, so a regular circadian rhythm can be hard to come by. Emergencies don’t take days off either so it is not uncommon to miss important events or holidays, particularly during training or when you are a freshly minted attending. EM physicians also experience some of the highest rates of burnout despite working fewer hours than most other medical specialties which can be attributed to working on the front line, consistent high intensity and stress, unpredictability, increasing charting demands, and irregular circadian rhythms.

even the highest-earning specialties are not without their downsides. This is why money, although important, should not be the only factor when choosing a specialty. It is much more important to find a specialty that is a good fit and you enjoy doing. If you have your eyes set on a particular specialty but find yourself getting discouraged because it’s highly competitive, don’t fall into the trap I’ve seen many succumb to.

we’ve come across many who wanted to do a different specialty, but ultimately decided they weren’t competitive enough for the specialty that they truly desired. If you think you’re not the smartest and that you’re doomed, stop right there. Your ability to crush your MCAT, USMLE, and have dozens of research articles is less a function of your intelligence and more a function of working smarter at sufficient intensity. Having a stellar medical school or residency application and crushing the interviews is no different, even if you don’t consider yourself a natural “people person” or gifted writer.