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PaperclipPerfector  1d ago (text post)   6137 thread views

Culture War Roundup for the week of April 20, 2026

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There has, from time to time, been some discussion concerning doctor salaries. I don't personally care all that much about this. They're highly-trained professionals in an in-demand field, and doctor salaries probably aren't the main driver of overall healthcare costs.

Nevertheless, there's often some debate over what the numbers actually look like. I was just linked to this tweet in one of my econ link aggregators. (Yay, built-in browser translation!)

Their claim is that 84% of American physicians are in the top 10% of incomes, and 26% of American physicians are in the top 1%. Their paper makes comparisons to other countries. They also broke it down into primary care vs. specialists.

So, at least this is one snapshot view of the actual distribution of doctor salaries, which I hadn't really seen before in these discussions. Assuming, of course, that their methodology is sound, which I'm not qualified to assess.

Personally I'm a bit horrified at the thought of putting in all the time and effort to become a doctor and not being in the top 10% of incomes. What went wrong? Would anyone do that on purpose?

Well to start, your math is wrong. A quarter of all physicians in the US are in the 1% of the income bracket and almost half of all specialists in the US are in the 1% of the income bracket.

I strongly require a citation for this.

According to the Google the top 1% of of income earners in the U.S. make between 650-800 per year. According to the most recent salary data I've seen exactly zero specalities have an average salary in that range. Neurosurgery is not shown on this data and probably reaches 1% thresholds, however.

The bulk specialties (what most doctors are) all have average salaries which are less than half of the 1% threshold except for EM which is a tad over half of that threshold.

I also got it from Google. If it’s better sourced elsewhere, I’ll go with that instead but a glance at things seems to suggest otherwise.

According to the Google the top 1% of of income earners in the U.S. make between 650-800 per year.

That's household income. Top 1% individual income is something like 450k.

Does that imply as strong of a correlation between the two incomes of a two-income household as it seems at first glance? Something like "the average 1% individual earner is married to a top 5% individual earner or higher" seems like it would follow unless the distributions are particularly oddly shaped.

Selection effects are likely significant here. If high income people are disproportionately likely to get married, it could simply be a case of "the top 1% of the top 50% has a higher average than the top 1% of the whole."

Probably it's a combination of both.

Ah, correction noted!

I'm responding to the numbers, above, that 16% of American physicians are not in the top 10%. I didn't do any math. (Well I guess I subtracted 84 from 100 but I'm reasonably sure I got that part right.)

To get into the top 10% you only need to make like $220k/year. Is that level of income worth putting your whole life on hold until your early 30s, not to mention the debt from all the education?

Probably many of them are working for charities that pay well below market(and this is essentially a voluntary decision) or are perennial screwups stuck with lower paying jobs, or are at the very beginning of their career…

Pay is pretty flat - once you are an attending that's the salary, if anything it goes down with seniority because more senior people will take on less optional work/call and will take on non-clinical duties that pay less because clinical work is brutal.

Exception is if you go into private practice which is dying in the U.S.

Usually pay differences are more by specialty, some just don't pay well, but also you have working in academia (pay is ass) or working in a big city (pay is ass).

Opposite of most of life, in medicine more prestige and higher cost of living = lower salary.

Not everyone does things for money. Plenty of people get into medicine because they genuinely want to help others.

There are many, many ways to help others that don't require a tenth that much effort to get into. Not to mention the expense in terms of both time and money.

Someone who chooses to become a doctor does so only via willingness to expend blood, sweat, tears, and treasure, and lose a whole decade of their lives more or less before they can even begin. That takes some serious dedication to a very specific form of 'helping others'.

Someone with ten years of their lives and hundreds of thousands of dollars to volunteer could probably make a much larger difference than just being another doctor.

None of what you said is incorrect. And yet, it is a fact that people do indeed go into medicine for the idealized reason to wish to help others. You say you can't imagine it, so presumably you would never do that, but that doesn't change that there exist people who don't see it the way you do and would choose medicine no matter how much or little it paid.

They may not purely do it for the money but it is a big factor after graduating with a quarter million dollars in debt. That’s a contributing factor for why so many of them pursue a specialty at some point in their career.

Somebody's gotta hang out in East Kentucky and treat the Black Lung.

A lot of very intelligent people work very hard for jobs that pay much less than the 90th percentile income.

It did not improve my day to be reminded I'm in this situation.

I swing back and forth between top 1% and right around that (top 10%) every few weeks lately it seems. Business has been absurdly chaotic lately. As though there were writers scripting the whole thing out to generate an exasperating comedy at my expense.

It all seems directionally correct but the whiplash has been killer.

I swing back and forth between top 1% and right around that (top 10%) every few weeks lately it seems.

You forgot to attach the "wiping up tears with handfuls of money" gif.

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