05/22/2026    Paul Kesselman, DPM

Salary Raises for Physicians

Here in the Northeast, the largest commuter
railroad strike ended after 3.5 days. Union
workers prior to the strike were paid a median
wage of over $140K. With overtime, one train
engineer is hauling in a salary of more than
$350,000. These figures do not include other
benefits, including shift differential, health and
disability insurance and vacation pay. With their
new contract they are expected to gain an average
of increase of approximately 4% compared to a few
years ago from when their previous contract
expired. The raises will continue for the next
several more years.

Similarly many LIRR non-union executives have
salaries well over $300K. The same is true for our
utility executives with hundreds exceeding
$500,000 and some deferring payments of well over
$185,000 until they retire. Note that many of the
union laborers have no college degree and perhaps
the executives have at most an MBA.

This week, the NY Times also published a story
about the median wage for NYC hotel housekeepers
who will earn over $100,000 under a new contract.
Think about a married couple employed as hotel
housekeepers now garnering a $200,000 salary plus
other benefits. Think about the tip you are
leaving at the end of your hotel stay, because you
feel these folks because are not compensated
fairly.

Note that the NY subway workers as well as other
public transit employees around the country will
be looking at the NY contract to obtain similar
wage increases. Hence this is not limited to a NY
issue.

How does this compare to the newly graduated
podiatric physician who has paid for 8 years of
college and podiatric medical training and then
received a small stipend during their three-year
residency? The same can be said of other
physicians or health care workers who endure long
training periods.

During this 11-year or longer time period, the
physician may have accumulated $500K in debt for
tuition alone, while the average LIRR worker has
earned more than $1.5M. These dollar estimates do
not include other living expenses which the
medical student may need to borrow to pay for,
raises for those working or interest charges on
the loan amounts or loss of interest on the money
potentially earned, ability to purchase a home an
accumulate more wealth by those employed by the
railroad, utility or hotel. Nor do this dollar
estimates include the value of contract perks,
including but not limited to health insurance,
paid maternity or paternity leave, etc. All the
while the medical student is driven further into
debt while their employer (hospitals) make huge
amounts from Medicare per residency slot (net of
approximately $50K-$100K after residency
salaries).

To add insult to injury the practicing physician
has been punished with no real raise from Medicare
in over at least a decade, with reimbursements for
some procedures decreasing year to year, along
with inflation, increased costs of doing business,
all making it more difficult to financially
survive. Over the last twenty years, some
insurance plans have gone from 125% of Medicare to
65% of Medicare. One Medicaid managed care plan in
NY is now offering contracts at 65% or less of the
Medicaid fee
schedule.

It may be illegal to unionize and collaboratively
work together to force payers to recognize our
value to society. Why can nurses and resident
physicians unionize effectively, while independent
physicians cannot? For now that is off the table,
but the logic behind that defies me, leaving this
argument for another day.

How long can we afford this to go on? Who will be
willing to sacrifice their retirements, only to be
paid wages which are far below minimum. One must
be responsible for the survival of their own
practice and be able to look in the mirror and say
I just won’t take this anymore, without worrying
that their colleague down the block may jump on
the insurance companies’ bandwagon.

When I was a kid, the joke was that bus drivers in
the Soviet Union made more than physicians. It
appears the jokes now on us. Medical providers now
have much in common with Rodney Dangerfield, as we
get no respect. Has the U.S now become the Soviet
Union?

Paul Kesselman, DPM, Oceanside NY

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