A long time ago, I was very close to becoming a cardiologist.  Really.

Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too.  Plus, the guy who was Chief of Medicine was very influential.

When I came to my senses, and realized that I wanted to go into ID, there was a small problem — I had already matched in a cardiology program. Hence, I faced the tricky task of telling the program director, “Thank you very much for your kind offer, but I’ve decided I want to be an infectious diseases specialist.”

I remember his look of annoyance (understandable).  It was soon replaced by one of disbelief.  And then came a line I will never forget:

At least your motivation isn’t financial — ID doctors get paid s–t.

All of this came back to me when I read this fascinating survey over on Medscape on what we doctors get paid.

Some of the interesting results:

• Yes, ID specialists (median of $174,750/year) are at the lower end of the specialist scale.  Other bottom feeders?  Pediatrics, rheumatology, endocrinology, primary care …
• And the program director at my cardiology-fellowship-that-never-happened was right:  Cardiologists are the third-highest-paid physicians (after orthopedic surgeons and radiologists), with a median income of $325,000.  20% of Cardiologists report making more than $500,000, while almost this many ID/HIV docs get < 100,000.
• However, despite this disparity, a higher proportion of ID docs (55%) than cardiologists (45%) report they were fairly compensated. Is that because ID is the most fascinating field in medicine?  And that an endocarditis case is surely more interesting than the simple plumbing they generally care for?  (That was a joke.  Some of my best friends are cardiologists.)
• Weird disconnect between geographic cost of living and salaries, with the lowest pay coming in the most expensive places to live.  This is of course the complete opposite of salaries in business, banking, and law.  So if you want your doctor’s pay to go further, don’t live in California or Washington/NYC/Boston!

Of course, as we tell our kids, when choosing a career, it’s not about being rich — it’s about being happy.

But if you want to be both rich and happy, the specialty-of-choice is clearly dermatology — median annual income is nearly $300,000, and a whopping 93% said they’d choose the same specialty again, the highest of all the fields surveyed.

Acne treatment never looked so good.

Paul Sax is the Clinical Director of Infectious Diseases at Brigham and Women’s Hospital. His blog HIV and ID Observations, is part of Journal Watch, where he is Editor of Journal Watch AIDS Clinical Care.

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