Purpose The estimated lifetime earnings of physicians are multifactorial and have not been extensively modeled. This study projects and compares lifetime earnings of US-based physicians across different career pathways.

Methods We developed a customizable model to estimate physician lifetime earnings using data from the publicly available 2016-17 Association of American Medical Colleges (AAMC) and Medical Group Management Association (MGMA) survey results across variable undergraduate training time, MD/DO vs MD-PhD degree programs, attending practice settings, state income tax levels during attending practice, loan repayment options, and promotion timeline. Post-tax earnings were calculated using U.S. tax codes and specialty-specific salary data. We created an interactive web-based interactive application using R Shiny to simulate individualized financial projections. App: https://physician-lifetime-earnings.shinyapps.io/physician-lifetime-earnings/.

Results The median cumulative lifetime earnings averaged across 19 specialties was $6,509,474. Specifically, the average was $5,167,507 across primary care specialties (family medicine, internal medicine, and pediatrics) and $7,696,166 across all specialties excluding primary care. Pursuing two paid undergraduate gap years (vs zero) resulted in a weighted average 5.2% (IQR: 5.2, 5.7) decrease in cumulative lifetime earnings, private practice (vs academia) resulted in a 14.7% (IQR: 8.9, 22.4) increase, and repaying loans at 30% of income (vs obtaining Public Service Loan Forgiveness) resulted in a 6.1% (IQR: 3.0, 6.5) decrease. Completing one undergraduate gap year (vs zero), a combined MD-PhD degree (vs MD/DO alone), and accelerated academic promotion at eight years to full professor (vs 14) all had minimal impact on cumulative lifetime earnings (< 3%).

Conclusion We created a model to compare the lifetime earnings of US-based physicians across different career pathways.

The authors have declared no competing interest.

This study did not receive any funding

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