From 1980 through the early 2000s, salaries for physicians in academic medicine kept pace with inflation (1, 2). Salaries for psychiatry faculty and chairs, however, were lower than those of faculty and chairs in all clinical science departments (2). This study updates the Dial, Haviland, and Pincus analysis (2) by extending the years covered through the 2005–2006 academic year.

Data Source

Salary figures were taken from the Association of American Medical Colleges’ reports on medical school faculty salaries for the years 1980 to 2006 (3). These figures include pretax compensation and fixed plus variable (supplemental and bonus or incentive) components.

Participants

In the 27-year span, in psychiatry there were, on average in a given year, 92 chairs, 513 professors, 539 psychiatry associate professors, and 1,006 assistant professors. For all clinical faculty there were, on average in a given year, 1,353 chairs, 8,056 professors, 8,319 associate professors, and 14,259 assistant professors.

Analysis

We adjusted the salaries (constant 2006 dollars), graphed them, and computed both inflation-adjusted and raw compound annual growth rates (salary increases had they risen at a steady rate). We then compared 2006 salaries by rank for a group of lower and higher paying specialties.

Figure 1 shows the inflation-adjusted salaries by chair position and academic rank for psychiatrists and physicians in all specialties. Salaries for physicians in both psychiatry and all departments increased between 1980 and 2006. Compared with salaries for physicians in all specialties, those for psychiatrists were lower and the trend lines were flatter. Between 1980 and 2006, salary gaps between chairs and professors increased by a factor of almost 3.5 in real terms for all faculty, and just over 2.5 for psychiatry. In 1990, the average psychiatry full professor’s salary fell below the average for all associate professors, and the psychiatry associate professor average fell below the all-faculty assistant professor average. The national median salary in 2006 for psychiatrists largely in multi-specialty group practices was $185,957. There is not a comparable figure for all physicians, but the national median salary for one group of 17 specialties, which includes psychiatry, was $322,259 (4).

In psychiatry, the raw and inflation-adjusted compound annual growth rates are shown in Table 1 . For psychiatry chairs, they were 4.86 and 1.45, respectively, compared to 4.05 and 0.66 for professors; for all specialties, the rates for chairs were 5.71 and 2.27, respectively, and 4.65 and 1.24 for professors.

For comparative purposes, 2006 salaries for all faculty, psychiatry, neurology, pediatrics, general internal medicine, family practice, ophthalmology, and general surgery are shown in Table 2. Psychiatrist salaries are higher than those of family practitioners and comparable to those of general internists. They are lower than those for physicians in the other listed specialties. Across all categories, chair salaries are approximately 1.5 to 1.7 times higher than those of full professors.

Similar to previous reports (1, 2) salaries for academic physicians continue to rise. That the salary trends in academic psychiatry were lower and flatter is not especially surprising. As shown in Table 2 , this could reflect the generally lower compensation for “nonprocedural” medical specialties. More troubling, however, is that they also may reflect specific inequities and deficiencies in financing for mental health, which are well documented in the Surgeon General’s Report on Mental Health and the President’s New Freedom Commission on Mental Health (5, 6).

Some suggest that the dramatic rises in chair salaries and gaps between chairs and professors across all specialties are justifiable based on the clinical, research, and management (particularly, financial) skills now required of leaders in academic medicine and that academic medicine is looking more and more like “big business” (7). Future investigations might examine the effects of these salary trends on the recruitment and retention of academics and, particularly, clinician investigators in psychiatry (8).

A portion of this study was presented at the 2007 annual meeting of the American Psychiatric Association.

Dr. Pincus has provided full disclosure from several public and private sources that are available upon request. At the time of submission, Drs. Haviland and Dial disclosed no competing interests.