How does your salary affect your overall job happiness?

These days, doctor salaries are under scrutiny because of the public perception that highly-compensated physicians are driving up health care costs. The reality is that there are some physicians who work full-time and don't even generate a six-figure salary. Of course, there are also medical specialists and subspecialists who generate well over $300,000 to 400,000 each year. I also know some physicians who essentially work 2 jobs (a standard job + moonlighting so much that they're over 80 hrs/week). They make a lot of money, but they're always working.

How does your salary affect your overall job happiness?  If you feel underpaid, that's one thing. If you feel that your salary is a "fair" salary for the type of work you do, then how much happier would you be if your salary went up? How much higher would it need to go up in order for you to feel a sense of greater happiness?

Quality of life, debt, and burnout among doctors-in-training (residency)

A recent JAMA article titled, "Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents," concludes:

In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores (Internal Medicine In-Training Examination (IM-ITE) scores).

Here's what the researchers found:

• Quality of life was rated “as bad as it can be” or “somewhat bad” by 2402 of 16 187 responding residents (14.8%). 
• Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16 192 (51.5%), 7394 of 16 154 (45.8%), and 4541 of 15 737 (28.9%) responding residents, respectively.
• In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >$200 000 relative to no debt).
• Residents reporting QOL “as bad as it can be” and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL “as good as it can be” and no emotional exhaustion symptoms, respectively.
• Residents reporting debt greater than $200 000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively.

So, what does this suggest? For one thing, residency is grueling and many people burn out or feel that life is terrible. Does this change once physicians complete their residency and enter the busy working world of high-volume patients and stressful working conditions? For some, their outlook improves because their salary has significantly gone up. For others, they battle with greater stress and anxiety because they now have more responsibilities to shoulder as an attending. They no longer have that backup or safety net they used to have during residency training. 

Earning potentials in sales (business development)

People frequently ask, "how much can you make as a physician if you choose to leave clinical medicine?"

If you're a medical specialist and you're working for a pharma or biotech company in a "Medical Director" role, then you can expect to see a salary that's close to your current salary (or it's also very likely to be quite a bit higher). On the other hand, if you're not a specialist and if you lack significant industry work experience, then it's probably fair to say that you'll probably start with a base salary of less than $150k/year (and in many cases less than $100k/year).

Now, in the world of sales (or business development), your earning potentials can be much higher if your compensation structure revolves around commissions and other performance-based incentives. The beginning is often the most difficult part because you'll be spending a considerable amount of time prospecting new clients to build your business. It's always exciting when you close a sale because you know that you've accomplished something tangible and you know that you'll be financially rewarded.

I was speaking to one person the other day who makes a base salary of $150k/year, but also has the ability to make over $150k/year with commissions alone. You could actually double your salary if you're talented, persistent and if the market is able to support your business. The flip side is that the economy or industry could struggle and you may lose a lot of business. As a result, your commission-based income could be minimal and if you may need to dig into your savings to support your lifestyle. In the world of sales, it's important to be realistic about your income goals and to set aside a significant buffer so that you can anticipate swings in sales and income.

Another Physician Compensation Survey

According to the American Medical Group Association (AMGA) 2008 Medical Group Compensation and Financial Survey, physician pay went up in 2007 by roughly 3.5%. According to this report, medical specialties that experienced the lowest increases included allergy medicine, endocrinology, pulmonary medicine and emergency medicine. With Medicare reimbursement decreasing and managed care organizations trying to push pay-for-performance (P4P) and other initiatives, physician payment is all over the map for various specialties. The survey was conducted among 44,000 health care providers, 2,700 medical groups, and 116 specialties in the United States.