Neurosurgeons make $750,000 a year, the highest average salary in medicine. But after accounting for the number of hours worked per week, do neurosurgeons still come out on top?
When you factor in a doctor’s work hours, which for some specialties is up to 70 per week, the rankings completely change. And some specialties you’d never expect end up near the top.
Let’s start with number 5: dermatology at $235 per hour.
Dermatologists diagnose and treat conditions of the skin, hair, and nails. The specialty blends medical dermatology—think psoriasis, eczema, and skin cancer screenings—with cosmetic procedures like Botox and laser treatments.
At $508,000 annually with an average of just 44 hours per week, dermatology offers one of the best combinations of compensation and lifestyle in all of medicine. Plus, training is only a 4-year residency, which is one of the shorter paths in medicine for this level of compensation.
But here’s the catch: dermatology is currently the most competitive specialty to match into. It tops our competitiveness index with a 70.5% match rate and the highest average Step 2 CK score, tied with orthopedics at 257. By the way, all of this data is available for free at specialtyrank.com.
At number 4 is radiology. It’s essentially tied with dermatology at $235 per hour.
Diagnostic radiologists interpret imaging studies like X-rays, CT scans, MRIs, and ultrasounds to diagnose disease. They’re the doctors other doctors rely on to figure out what’s actually going on inside a patient.
At $572,000 annually with around 50 hours per week, radiology offers strong compensation with a predictable lifestyle. Most radiologists work regular daytime hours with limited call responsibilities.
Training is a 5-year residency, during which many radiologists subspecialize in areas such as neuroradiology, musculoskeletal imaging, or breast imaging.
One thing worth noting is that interventional radiology pays almost identically at $573,000 but requires significantly more hours and overnight call. It didn’t make this list because the hourly rate drops considerably.
At number 3 is plastic surgery at $243 per hour.
Plastic surgeons perform both reconstructive and aesthetic procedures, everything from cleft palate repairs to breast augmentations and facelifts. Aesthetic-focused surgeons typically out-earn their reconstructive colleagues.
At $621,000 annually with around 52 hours per week, plastic surgery offers elite compensation without the grueling hours of some other surgical fields. Call isn’t bad for aesthetics, but reconstruction can be more demanding. Most procedures are scheduled rather than emergent.
But matching into plastic surgery is another story. It consistently ranks among the top 3 most competitive specialties, and across the past decade of match data, it comes out as the single most competitive specialty in all of medicine. We’ll be covering the decade ranking of all specialties soon in a future video, and if you want to see it, make sure you subscribe.
Successful applicants in plastics now average nearly 35 research items, an increase of over 15 in just 4 years. Residency is 6 years for the more competitive and desirable integrated path, which includes dedicated plastic surgery training, but there is a backup option of going into general surgery residency first for 5 years and then doing a plastic surgery fellowship afterward for 3 years, totaling 8 years.
If you’re serious about matching into competitive specialties like plastic surgery or dermatology, go to SpecialtyPredictor.com. It uses the most up-to-date NRMP match data to show you exactly where you stand and what you need to improve.
At number 2 is neurosurgery at about $247 per hour.
Neurosurgeons operate on the brain, spinal cord, and peripheral nerves. The work is technically demanding, and the stakes couldn’t be higher.
At $749,000 annually, the highest gross salary in medicine, you’d expect neurosurgery to dominate this list. But neurosurgeons are notorious for brutal schedules. They work 60 to 70 hours per week, which significantly lowers their hourly rate.
Using a conservative estimate of 62 hours per week, neurosurgery lands at roughly $247 per hour; impressive, but not number one.
Neurosurgery also has the longest residency at 7 years and is currently the second most competitive specialty to match into, with applicants averaging 37 research items, the highest of any specialty.
And at the top of our list is orthopedic surgery at $262 per hour.
Orthopedic surgeons treat the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles. Whether it’s sports injuries, joint replacements, or trauma, ortho covers it all.
At $680,000 annually with around 53 hours per week, orthopedics offers the rare combination of top-tier pay without the extreme hours of neurosurgery or thoracic surgery.
The ortho lifestyle varies by subspecialty. Sports medicine and joint replacement tend to be more predictable, while trauma call can be demanding. Training is a 5-year residency, and ortho consistently ranks among the top 5 most competitive specialties.
For a deep dive into these specialties, as well as dozens of other doctor career paths, check out our So You Want to Be playlist.
We’re ranking all 22 specialties by the percentage of positions filled by US MD seniors. This is lowest to highest fill rate for US MD seniors, starting with the most accessible specialties up to the hardest.
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