Most doctors make a healthy living, but health care reform and efforts to control medical costs are affecting the way they do business. The annual Medscape from WebMD physician compensation survey highlights a number of trends and disparities in the medical field.
The survey of more than 19,600 doctors in 26 specialties found the average compensation for a specialist in 2014 was $284,000, while primary care physicians made an average of $195,000
That reflects a "modest" increase over previous years, Medcape reports, and some specialties fared better than others.
"Definitely, people coming out of medical school are looking at specialties as opposed to primary care, and money is a big factor," Leslie Kane, director of Medscape's Business of Medicine, told CBS News. "Forty-one percent of doctors age 40 to 44 are still paying off medical school debt. Sixteen percent of doctors in their 50s are still paying of debt. So that has a lot to do with which specialty are you going to go into, when you start seeing figures like that."
The survey also found a significant pay gap between male and female physicians and between doctors in different regions of the country.
Top dollar: Orthopedics
Orthopedics remained the top-paying medical specialty for the third year in a row. The Medscape survey found orthopedists earned an average of $421,000 for patient care in 2014.
In addition, orthopedists earned more than any other type of physician for non-patient care activities such as speaking engagements, product sales, and serving as expert witnesses -- another $29,000 a year, on average.
Cardiology was the second-highest paying medical specialty in 2014, with average compensation of $376,000 for patient care plus $19,000 in non-patient care earnings.
While medical specialties like this remain lucrative, Kane says the economic incentives in medicine are shifting.
"Everything is happening because all of the efforts to lower the cost of health care to society and keep Medicare payments down," she said. "There's an effort to move from fee-for-service, where a doctor gets paid for each visit or procedure, to different types of payments structures like bundled payments for episodes of care. So for example if a patient is in hospital for heart attack, and lots of doctors work on that patient, many people are involved, but the hospital gets one payment for that patient and that has to be divvied up among many people."
Gastroenterology moved up a notch to #3 on the list, with average compensation of $370,000 for patient care and another $14,000 in additional earnings.
Anesthesiologists made an average of $358,000, making this the fourth-highest earning specialty on the list.
Plastic surgery rounds out the top 5 highest paying specialties, with average earnings of $354,000 for patient care and another $26,000 for non-patient care activities. The specialty has steadily moved up from tenth place on the list five years ago.
Down towards the bottom of the list, family medicine practitioners remain among the lowest paid physicians, averaging $195,000 a year. However, they've seen an increase of about 10 percent since 2013.
"Because of the Affordable Care Act, there was a 10 percent bonus in Medicare payments to primary care physicians, basically to help elevate their pay because they expected a lot more patients going into the system once the exchanges were set up," Medcape's Leslie Kane said. "But primary care pay is still down there, it's still one of the lower paying fields."
Out of 26 medical specialties surveyed, pediatrics was the lowest paid, with an average compensation of $189,000.
Male physicians continue to make more than their female counterparts -- an average of $284,000 for men compared to $215,000 for women. The pay gap has narrowed slightly since 2011.
What's behind the disparity? "We do know that women work shorter hours and fewer weeks, we know that from our survey," Kane said. "Maybe by their choice, but that's one factor."
In addition, the survey found women are more likely to go into pediatrics and primary care rather than higher paying specialties. "Only 9 percent of of orthopedic surgeons are women, only 12 percent of cardiologists are women, 14 percent of gastroenterologists -- so they're in different specialties and that makes an overall difference." Male doctors are also more likely to be self-employed, which tends to be more lucrative.
"And another factor," Kane notes, is that "some women physicians say there is still discrimination in salaries."
The Northeast and Mid-Atlantic states had the lowest average physician salaries at $253,000-$254,000, while the best paying region was the Northwest at $281,000.
"The top earning states are North Dakota, Alaska -- they're trying to get doctors to come there," Kane said. Pay tends to be lower in major metropolitan areas where there are more doctors competing for jobs.
A major trend seen in the Medscape survey is that more doctors are opting out of having their own practices.
"Being employed, as opposed to having your own practice, is growing by leaps and bounds. Right now in our survey, 64 percent of physicians are employed. Five years ago that was like 25, 30 percent. It's completely flipped over," Kane said.
Doctors who work for themselves tend to make more money, but there are trade-offs. "For a lot of physicians in private practice, it's hard to afford electronic health records, there's much more paperwork involved. You need to be connected to other practices. A lot of doctors have said, with all this paperwork, this is not what I went to medical school for."