Question: What are America’s 20 highest-paid jobs? 

Answer: Doctor. 

It’s pretty much true: Of the 20 U.S. occupations with the highest average pay, according to the Bureau of Labor Statistics, 16 are some kind of doctor. 

Pediatric surgeons earn $449,320 a year, on average, as of 2023, according to federal data. Cardiologists make $423,250. Orthopedic surgeons get $378,250. 

Only four of the 20 highest-paid professions are not doctors. They are dentists. (And orthodontists, dental surgeons and specialists.) 

Doctors earn more than any other broad category of worker, according to federal data: More than engineers. More than computer scientists. More, even, than lawyers.  

To find a better-paid group than doctors, economists say, you have to drill down to elite subcategories, such as corporate CEOs and law partners. The average partner at a large firm earns more than $1 million a year. The typical S&P 500 CEO collected $16.3 million in 2023, according to the Associated Press.  

American doctors are so conspicuously well-paid that a group of economic researchers spent years trying to figure out why. 

Here’s what they found. 

Lots of school, lots of hours 

As any medical-school applicant knows, you have to study for a very long time to become a doctor: college, then med school and years of post-graduate residency training.  

And the hours are long. The typical doctor’s workweek runs anywhere from 40-plus hours to 60 or more, the researchers found, depending on specialty. 

“There is a lot of training and long work hours that go into the job, and that is naturally associated with higher earnings,” said Joshua Gottlieb, a University of Chicago economist involved in the research.  

Gottlieb and his colleagues found that, within the medical profession, doctors tend to earn more in specialties that require more training and longer hours. Each extra year of training, for example, translates to $143,000 in additional annual income. 

But education and work hours don’t tell the whole story. Farmers and ranchers work long hours, an old federal report shows, and they don’t earn doctor pay.  

As for training: Many of Gottlieb’s own colleagues in academia spend as many years in school as doctors. And most professors earn less than $100,000 a year.  

“My brother is an emergency room physician, and I was in school longer than he was,” said Teresa Ghilarducci, chair of economics at The New School for Social Research in New York. She was not involved in Gottlieb’s study. 

Doctors like money 

Gottlieb and his cowriters drew flak from doctors for saying it, but their research found that physicians seek out higher-paying jobs. 

The average doctor earned $350,000, as of 2017, the researchers reported in a 2023 working paper, which is awaiting publication in the Quarterly Journal of Economics. The top 1% of physicians earned more than $1.7 million a year.   

Researchers found that doctors from the best medical schools flock to the highest-paying specialties. Doctors also favor procedures that yield more profits.  

Some medical specialties are eye-poppingly well-paid. Here are some top 2017 salaries for doctors in their peak earning years, ages 40 to 55, according to Gottlieb and his peers: 

• Neurosurgery: $920,500 
• Orthopedic surgery: $788,600 
• Dermatology: $655,200 
• Cardiac surgery: $607,300 
• Ophthalmology: $597,000 

“We do see people attracted to specialties where the pay increases,” Gottlieb said, much like salary-conscious workers in any field. “I think it’s the human way.”  

Maria Polyakova, an associate professor at Stanford medical school, joined Gottlieb in the research. She notes that med-school graduates tend to be exceptional students with lots of career choices. 

“For the most part, they are top students in the country who could have pursued other opportunities that pay similarly well,” she said. 

The American Medical Association noted, in a statement to USA TODAY, that doctors often spend 12 to 15 years in training, typically exiting medical school with more than $200,000 in debt. Elevated salaries help them get out of debt and catch up on years of missed work.  

There aren’t enough doctors 

The United States has fewer doctors per capita than most other developed nations, according to the Organization for Economic Cooperation and Development: 2.7 per 1,000 potential patients, as of 2021, compared to 3.4 in France and 4.5 in Germany. 

A big reason, the researchers say, is that the medical industry and federal government keep a lid on the number of seats in American medical schools, and on residencies in hospitals. 

The shortage stems from an era when health-industry leaders believed we had too many doctors, leading to caps on med-school enrollments and residencies. Ironically, the same groups now warn of a doctor shortage.   

The medical association says its changing stance reflects the evolving state of the industry, noting that the current crop of doctors is aging and coping with burnout. 

“We have sort of an artificially constrained supply of doctors,” said Andrew Biggs, a senior fellow at the right-leaning American Enterprise Institute, who was not involved in Gottlieb’s research. “That’s what economists call barrier to entry,” he said, and it drives up doctor salaries.  

The American Medical Association “is acting like a union for doctors” by limiting their numbers, Biggs said. “The point of it is to keep salaries high.” 

The government sets prices 

One basic reason why doctors earn a lot is that medical care costs a lot, researchers say. And the federal government largely sets those prices. 

Medicare, the federal insurance program, establishes prices for medical services. The prices are high enough that healthcare spending represents at least 17% of the nation’s gross domestic product. 

“The government has decided, policy has decided, to devote a very large share of society’s resources to healthcare,” Gottlieb said. 

Customers – patients – have little say in the cost of their medical care.  

“It’s not like you’re going to compare prices on surgeons,” Biggs said. 

That setup, economists say, makes the healthcare sector almost unique among American industries. 

“In some ways, the medical industry is like a defense contractor,” Ghilarducci said. “Their main customer,” the federal government, “has deep pockets.”