Who earns the highest salaries in the US?

If you try to name the 20 highest-paying professions in the United States, the task turns out to be easier than it seems: almost all of them are related to medicine. According to the U.S. Bureau of Labor Statistics, of the 20 professions with the highest average income, 19 are doctors or dentists, writes USA Today.

The median annual income for pediatric surgeons as of 2024 was $450,810. Cardiologists earn $432,490, and orthopedic surgeons earn $365,060.

Of the top twenty, only one profession isn't related to medicine—and it ranks 20th. It's airline pilots: pilots, co-pilots, and flight engineers have a median income of $226,600.

According to federal statistics, doctors earn more than representatives of any other profession: engineers, computer technology specialists, and even lawyers.

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To find higher incomes, economists advise looking not at broad categories but at narrow elite groups, such as CEOs of large companies or law firm partners. The average partner at a large law firm earns over $1,4 million per year. The average CEO of an S&P 500 company will earn around $17 million in 2024, according to research by Equilar and The Associated Press.

The high incomes of American doctors are so noticeable that a group of economists spent several years trying to understand what explains it.

Many years of study and long hours of work

Becoming a doctor requires a long education: first college, then medical school, and years of postgraduate residency training.

The workweek is also long. Depending on their specialty, doctors typically work from 40 to 60 hours or more per week.

"These jobs require a lot of training and time, and that's naturally associated with higher incomes," said University of Chicago economist Joshua Gottlieb, who led the study.

Researchers found that within the medical profession itself, those whose specialization requires longer training and more work hours earn higher salaries. For example, each additional year of training adds, on average, approximately $143,000 to annual income.

However, education and workload don't fully explain the situation. Farmers and herders also work long hours, but their incomes are nowhere near those of doctors. And many scientists study for as many years as doctors, yet most professors earn less than $100,000 a year.

"My brother is an emergency room physician, and I studied longer than he did," said economist Teresa Ghilarduzzi of the New School for Social Research in New York.

Doctors are guided by income

The authors of the study faced criticism from doctors, but concluded that doctors are actively choosing more profitable areas.

A 2024 study found that graduates from leading medical schools are more likely to enter the highest-paying specialties. Furthermore, doctors prefer procedures that generate higher income.

Some specialties offer particularly high salaries. According to researchers (the figures are from 2017 and may be higher today), during their peak income years—between the ages of 40 and 55—doctors earn:

• neurosurgery - $920,500
• Orthopedic surgery - $788,600
• dermatology - $655,200
• cardiac surgery - $607,300
• ophthalmology - $597,000

"We see that people gravitate toward higher-paying specialties," Gottlieb emphasized. "This is common human logic."

Study co-author Maria Polyakova, an associate professor at Stanford University School of Medicine, argues that medical school graduates tend to be very strong students with a wide range of career options.

“In most cases, these are the best students in the country who could have chosen other high-paying professions,” she added.

The American Medical Association noted that doctors spend 12 to 15 years studying and typically graduate from medical school with approximately $200,000 in debt. High salaries allow them to pay off their debts and compensate for years of inactivity.

There are not enough doctors

According to the Organization for Economic Co-operation and Development, the United States has fewer doctors per capita than most developed countries: 2,7 doctors per 1000 potential patients in 2022, compared to 3,8 in France and 4,6 in Germany.

One of the reasons cited by researchers is the restrictions on the number of places in medical schools and residencies, which are set by industry bodies and federal authorities.

This situation arose back when the healthcare system believed there were too many doctors in the country. Now, on the contrary, those same organizations are warning of a staffing shortage.

The American Medical Association explains the shift in position by saying the system has changed: today's doctors are aging and facing burnout.

Prices are set by the state

Another reason for doctors' high incomes is the high cost of medical care in general, researchers note. The government plays a significant role in setting these prices.

The federal Medicare insurance program sets rates for medical services. They are so high that healthcare costs account for approximately 18% of the US gross domestic product.

"Public policy has effectively cemented the decision to direct a very large share of society's resources to health care," Gottlieb stated.

At the same time, patients themselves have almost no influence on the cost of services.

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Economists say this model makes healthcare a unique sector of the American economy.

"In some ways, the healthcare industry is like a defense contractor," Ghilarduzzi concluded. "Its primary customer—the federal government—has virtually unlimited financial resources."

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