While a neurosurgeon earns over $750,000 a year, the vast majority of medical specialties do not come with such a high salary. In fact, the difference between the lowest-paid and the highest-paid medical specialties is more than $400,000.

Let’s break down the eight lowest paying specialties.

But first, note that our list does not include the pediatric versions of the specialties, because otherwise this would just be a list of pediatric specialties. From 10 lowest paying medical careers from Doximity dataeight were pediatric versions of internal medicine specialties.

8. Internal medicine

It is in 8th place internal medicine (IM) at an average annual income of $312,526.

Internal medicine doctors, also known as internists, are the generalists of generalists, responsible for treating a colossal range of medical conditions, be they complex or simple, acute or chronic, common or rare.

Internal medicine is harder to categorize than other specialties because it is so broad, and it also has more membership options than any other specialty, including cardiology, gastroenterologyand hematology/oncology.

It should also be noted that IM subspecialties do much more than the average internist. Cardiologists, for example, earn an average of $565,485 per year, making cardiology the seventh highest paying medical specialty.

Generally speaking, internists have a good work-life balance. He may work a regular 9-5 in the clinic as a primary care doctor or it is common for hospital doctors to have a 7 days on and 7 days off pattern. If you admit to being on call, you may work 12 or more hours a day, but this will not happen every day.

If you no longer specialize, internal medicine is the shortest residency at 3 years, tied with pediatrics, family medicine, genetics and preventive medicine.

7. Rheumatology

In 7th place is rheumatology at $305,502 per year.

Rheumatology is a subspecialty of internal medicine that focuses on diseases of the joints, musculoskeletal system, and connective tissue. Rheumatologists see a wide range of diseases, including musculoskeletal diseases like osteoporosis and autoimmune diseases like rheumatoid arthritis.

Despite relatively low salaries, rheumatologists have a good work-life balance because they see very few emergencies and don’t have to worry about being called to work in the middle of the night.

To become a rheumatologist, you will need to complete 2 years of fellowship training after a 3-year residency in internal medicine. You can also add an extra year of training to become double board certified in rheumatology and allergy and immunology.

This means that after 2 to 3 years of additional training beyond the initial 3 years of internal medicine residency, rheumatologists earn, on average, $7,000 less per year than IM physicians who chose not to specialize. This is where personal preference and interest come into play. You don’t go into rheumatology for the money.

For additional context, after the same 6 years of residency, plastic surgeons earn $619,812 per year, which is over $300,000 more than rheumatologists. That said, surgical residencies and the attending surgeon lifestyle are more demanding, and the specialty is more competitive to get into — but that’s a discussion for a separate video.

6. Family medicine

In 6th place is family medicine, with $300,813 per year.

Family doctors (MF). they are the center of primary care and have a lot in common with internal medicine physicians. One of the main differences is that IM doctors focus on adults, while family medicine doctors treat the widest range of conditions and patients, from newborns to the elderly and everything in between. They are not limited to a single disease, organ or age range.

Family medicine offers great flexibility and a healthy work-life balance. FM Doctors work regular 9 to 5 office hours with minimal, if any, calls. However, note that because the FM is so flexible, if you choose to specialize in hospital medicine or emergency medicine, your hours they will be closer to what is normal for that specialty.

To become a family medicine doctor, you must complete a family medicine residency, which lasts 3 years. In addition to being one of the shortest residencies, family medicine is also consistently the least competitive medical specialty to follow

Check out Med School Insiders video with the least competitive specialties and download the full Specialty Competitiveness Index.

5. Endocrinology

In fifth place is endocrinology at $291,481 per year.

Endocrinology it involves diseases of the endocrine system, which consists of the body’s glands, such as the thyroid, adrenal glands, and pancreas, and the hormones they secrete. This intricate network of glands secretes hormones into the bloodstream to regulate a variety of processes, including metabolism, reproduction, growth and development, sleep, and mood. Endocrinologists commonly see diseases such as diabetes, obesity, hyperthyroidism and hypothyroidism, as well as cancers related to the endocrine system.

Endocrinologists tend to have a good work-life balance due to their regular and reasonable hours. Even if they have inpatient duties and are on call, these duties are usually not intense or high volume.

On the downside, it takes a long time to become an endocrinologist, given their relatively low medical salary. You will need 3 years of residency in internal medicine, followed by 2 to 3 years of endocrinology fellowship, for a total of 5 to 6 years of post-medical training.

4. Geriatrics

At No. 4 is geriatric medicine at $289,201.

Geriatric medicine focuses on the unique medical needs of older patients, including chronic conditions as well as vulnerabilities such as risk of falls.

Geriatric medicine has a similar work-life balance to family medicine due to regular 40- to 50-hour work weeks. There are relatively few emergencies. If an elderly patient has a fall or an urgent health problem, they will be referred to the appropriate doctor to help them, such as an emergency physician or orthopedic surgeon.

To enter geriatric medicine, you must complete a 3-year FM or IM residency, followed by a 1 Year Geriatric Medicine Fellowship.

Again, this is a case where if you continue to major after IM or FM, you will actually earn less. However, there is a high demand for geriatricians due to the aging population of the US

3. Preventive Medicine

In third place is preventive medicine, with $282,011 per year.

Preventive medicine focuses on preventing health problems and diseases before they seriously affect the quality of life of their patients. It is often used by primary care physicians who work directly with their patients on prevention methods such as improving sleep quality, stress levels, diet and exercise. They also watch for early warning signs of health problems through blood tests, screenings and fitness monitoring.

Obviously, there are few emergencies in preventive medicine, because the specialty is about treating health problems before they occur. This translates into a healthy work-life balance and little to no responsibilities.

There are several paths to becoming a preventive medicine doctor. In general, most programs require at least 1 year of training in a primary care setting followed by a 2-year fellowship in preventive medicine, for a total of 3 years.

2. Pediatrics

The second lowest paying medical specialty is pediatrics at $259,579.

Pediatricians provides care for babies, children and adolescents from birth to age 25. Pediatrics is essentially internal medicine, but for younger patients.

Pediatrics is a difficult specialty to generalize because, like internal medicine, it is an enormous field with a wide range of subspecialties.

Residency in pediatrics is 3 years, although there are several fellowship options, many of which are also 3 years, such as pediatric hematology/oncology, pediatric nephrology, pediatric endocrinology, and more.

Unfortunately, this additional training does not result in additional payment. In fact, these specialists earn even less than pediatric generalists, with pediatric hematology/oncology, for example, earning $251,483 — about $8,000 less than regular pediatricians.

This low payment is partly because many children are on Medicaid, which has lower reimbursement than commercial insurance. The US healthcare system operates on a fee-for-service model, meaning that payments are made directly based on the amount of services patients receive, regardless of the quality of those services.

Children generally require fewer interventions than adults, which means less money for hospitals. Unfortunately, this results in adult majors earning higher salaries.

I’ve broken down how fee-for-service payment model works, as well as how it compares to value-based care, in a previous video linked in the description.

1. Medical genetics and genomics

The No. 1 lowest-paying medical specialty is medical genetics and genomics at $244,517.

Medical geneticists focus on the relationship between genes and health. They specialize in the assessment, diagnosis, management, treatment and counseling of patients of all ages with hereditary clinical disorders using modern molecular genetic, cytogenetic, biochemical and genomic testing.

Even though they are the lowest paid, medical geneticists work 40 to 50 hours per week, which translates into a reasonable work-life balance.

In addition, there is variety and flexibility in their daily lives. No 2 days are the same for clinical geneticists. They may be involved in direct patient care, clinical research, teaching, as well as administrative and supervisory activities. They also get to work with patients of all ages, from babies to children to adults to the elderly. This includes preconception, such as whether expectant parents are interested in understanding reproductive risks related to their personal or family history.

The career path is also tied for the shortest residency at 3 years. To enter a medical genetics residency, you must have at least 1 year of residency in a primary specialty accredited by the Accreditation Council for Graduate Medical Educationsuch as pediatrics or internal medicine, followed by 2 years of residency training in medical genetics and genomics. Combined medical genetics and genomics programs are also available with internal medicine, reproductive endocrinology, and infertility and pediatrics.

If you are an aspiring doctor but don’t know what specialty you want to pursue, “So you want to be“The video series will help you navigate the pros and cons of each medical pathway to help you choose the one that’s right for you. Plus, check out the Med School Insiders guide to the highest paying medical specialties.

This post appeared on Doctors inside the school.