How Much Does It Cost Me To Work?

It’s that most wonderful time of the year, a time of celebrations, gift-giving and holiday discounts. Not to mention marshmallow toasting, caroling out in the snow, and scary ghost stories.

Unfortunately, it is also the time when many licenses and professional memberships need to be renewed. Additionally, if I want (need) to register for meetings or buy study guides, this is the time to pay for them–prices usually go up sometime in January.

This year I started feeling a little steamed, as I contemplated paying out quite a lot of money for these work-related costs. I started wondering: how much does it cost me to work?

Soon after I jumped down the rabbit hole of totaling up all the costs that I see, or can estimate, just to be able to keep working. I am not counting all the other expenses related to work, à la Your Money or Your Life (professional clothing, dry cleaning, massages or vacations to decompress), just the plain, required (and possibly reimbursable) ones that keep me eligible to work in medicine.

Not all of these costs and fees will be necessary for every doctor, I looked mostly at those that might reasonably be expected for an employed internist. If you are in private practice or not an internist, you may certainly have different considerations.

Note also that some memberships have discounts for residents, physicians in their first few years of practice, retired/inactive physicians, or even for paying early or for several years in advance. For the most part, I listed the full freight price: full time practicing physician, no discounts.

Professional requirements

DEA license

Recently the cost of a renewal was increased to $888. This is for 4 years, so this comes out to $222 per year.

State license

Looking into this was challenging, as states post (or don’t post) license renewal fees in all sorts of different spots.

Fees can differ by degree (MD vs DO), if you were late, if you renew electronically or by paper. I didn’t even get into the extra state licenses for prescribing controlled substances (required in addition to your Federal DEA license).

Some states hide their renewal fees (or at least make them extremely hard to find). Colorado, Delaware, New Hampshire, New Mexico, Nevada, Rhode Island, and South Dakota all fall in this category (in case you wonder why they aren’t listed below).

Fees are annual unless noted otherwise–please double check for yourself if you really need to know.

While these are the fees (what I could find) for license renewal, people might also be interested in the sources I found for initial license applications and CME requirements by state (with not only the hours needed, but the special topics that some states require).

ABIM Board Certification

This is for the Americal Board of Internal Medicine. It is officially not required that you be board certified to practice medicine in the United States. However, it is definitely required if you are on faculty at a medical school. Practically speaking, most insurance companies prefer to work with boarded physicians, so it can be harder to make a living if you aren’t.

Annual Maintenance of Certification (MOC) Fee: $165

10 year exam: $650 ($65 per year) vs 2 year MOC: $130 (also $65 per year)

Association dues

Belonging to a national or state medical association is not required, but I have found memberships quite useful over the years.

Some of these associations offer free or very cheap continuing medical education (CME) of good quality. State medical associations, in particular, will often offer affordable CME in subjects that are specially required by the state for license renewal.

Other perks include discounts for local or national meetings, journals, webinars.

I see offers to get in on bulk purchasing of PPE these days, which might help smaller practices without the (more) robust connections of a large hospital system.

National associations

I am probably missing some great national groups, but as an internist without sub-specialty training, these are the 4 national groups that I most often consider joining.

• ACP (American College of Physicians): $550 per year.
• SGIM (Society for General Internal Medicine): $405 per year.
• SHM (Society of Hospital Medicine): $455 per year.
• AMA (American Medical Association): $420 per year (there are discounts for the first 4 years in practice).

State Medical Associations

Just as with the state license renewal question, looking up dues was sometimes more challenging than I planned on dealing with. As you can see, there is a wide range of dues required, and the more local groups (county or region) also ask for membership fees.

There were quite a few states who did not publicly post their dues, requiring doctors to confirm their licenses or otherwise sign in. The state medical societies of Arizona, California, Delaware, Idaho, Maine, Michigan, New Jersey, New York, and Pennsylvania can continue to keep their dues secret, at least from this list.

Again, if you really need to know your state medical society’s dues, please check with them directly.

CME (Continuing medical education)

The options here vary tremendously. You can get free CME from hospital grand rounds or journals, or your local medical society.

You might decide to pay more for review books, a study guide, a society meeting membership (local or national), or attend a meeting put on by a private company.

Here are a few options:

NEJM subscription (private): $159 online, $189 print.

MSKAP study guide: $359-$539 for ACP members ($599-$989 for non-members).

ACP 2021 (annual meeting, virtual in 2021): $780 for members, $1135 for non-members).

SGIM 2021 (annual meeting, virtual in 2021): $445 member, $865 non-member.

The fact that no one is attending meetings in person this year means that some of the other costs of attending (travel, hotels, meals) don’t have to be spent.

Other costs

There are some costs I just can’t estimate well, but a doctor will certainly need to address most of all of these.

Required

There is no getting around it, these are things that cost plenty of money. My employer pays these for me, so I never write a check. I still have to spend time dealing with the paper work, though. 🙁

Hospital privileges

A basic requirement of the job if you see patients in a hospital. Usually required even if you only do outpatient work. Probably on the order of $100-300 (repeated every 1 to 3 years).

Malpractice insurance

Apparently not required in all states, but I would never go without.

Per this slide from Medscape, the average cost of malpractice insurance for an internist is $14000.

Variable costs

Parking

Obviously, this can vary tremendously. I haven’t paid to park at work for years: my first job had free parking, and for my current one, I get a ride. I think in many cities where parking has to paid for, $50-$200 is probably fair. Maybe? I shudder to think what it could cost in NYC, Boston or SF.

Staff Gifts

Again, this amount can range widely. A large office might request a check to make sure that all employees get something of equal value. A small office might leave gift giving up to the individual; so you might pay less, or you may choose to give more expensive presents to your limited number of valued employees. Over the years, I have probably averaged $300 a year.

Requests for Donations

There always seems to be a worthy cause to support, and who better to ask for donations than the highly paid physician? Department chairs, events committees, student groups, medical clinics, community groups–I am sure some or all of them will reach out to ask you for support.

I just wrote last week about giving, so I obviously I think this is important. How much you choose to give is, of course, up to you.

My spending here is quite variable, depending on who and how many people ask in a year. I will estimate this is $200 a year, but this is really just a guess. I am not counting my regular giving through the United Way program that I have written about previously.

The Reckoning

Looking at all the fees, which can differ by state; your desire to join an association or two; and whether or not you go to a meeting (in non-pandemic years), obviously your annual grand total can vary significantly.

My annual spending looks something like this:

• DEA license: $222 per year.
• MOC: $230 per year ($165 for the annual fee + $65 annually for the exam).
• State license: $225 per year (range: $37.50-$600).
• 2 Medical Association memberships: $955 a year for ACP and SGIM. I would like to join the state medical society, but adding this in is usually too expensive.
• CME: though last year I attended 2 meetings, most years the choice is between the ACP meeting ($780 + travel) or MKSAP ($539). Travel costs obviously change with location and hotel choice. I would estimate that attending a meeting costs between $1300-$1500 when I go with Mr. PiN.
• Hospital privileges: $100 per year.
• Malpractice insurance: $14,000 per year.
• Variable costs: parking is about $0 (I will eat the occasional fee to use the parking garage when I drive in myself), staff gifts $300, and other giving at $200 a year.

The grand total comes to $16,771-$18,512 a year. Which is a significant percentage of my salary.

On the other hand, I don’t see the costs of getting/keeping hospital privileges or my malpractice insurance. That means that the costs I really see (and get steamed about) are only $2,631-$4,412 a year. This does not seem like a huge amount, and something that I am willing to pay out without too much grumbling. Especially if the higher cost includes going out of town with my husband.

I suspect one of the big issues is the “lumpiness” of the charges. I tend to have to pay multiple fees in November and December, and sometimes they are pretty high (think about paying for the DEA license and a biennial state fee at the same time as the staff holiday gifts–it adds up quickly).

As I start sending checks and running up the credit card bills this month, I will try to keep these numbers in mind. I don’t know if I will pay up with a smile, but hopefully I will feel less put-upon as my money goes sailing out the door.

I hope you found this exercise as educational as I did. Do you think you will look at your professional fees in a different light?