Despite a workday filled with “too many rules and regulations” and hours spent on paperwork, nearly 8 in 10 U.S. physicians would choose medicine again as a career, according to the results of the 2017 Medscape Physician Compensation Report. Medscape’s annual analysis of how compensation influences career considerations and satisfaction finds that the percentage of physicians who would opt for a career in medicine if they had a chance to do it over again (77 percent) is the largest increase since the survey was first conducted in 2010, and 13 points higher than in 2016.

Now in its seventh year, the report has been used by more than 400,000 physicians in the U.S. to assess information on salary, hours worked, time spent with patients, and what they find most rewarding — and challenging — about their jobs.

“We see that more physicians this year are satisfied with their career choice, which we think has important and positive implications for the future of the profession,” says Leslie Kane, MA, Senior Director, Medscape Business of Medicine. “While doctors continue to deal with many work-related frustrations, there has also been an increased emphasis on physician wellness, team care, and other aspects of medical practice that may be making it more rewarding to be a physician.”

This year’s survey finds that salaries average $294,000 per year, with specialists earning about $100,000 per year more than primary care doctors ($316,000 vs $217,000). Orthopedists are the highest paid, at $489,000, and family physicians and pediatricians the lowest ($209,000 and $202,000, respectively). Most physicians saw their salaries increase in 2016, with plastic surgeons experiencing the biggest jump (24 percent to $354,500). Pediatricians saw a decrease of 1 percent. Regardless of salary, 41 percent of primary care doctors and 33 percent of specialists feel they should earn more, with nearly one in five stating that they are working longer hours for less money.

“The increase in paperwork in the past five years is striking,” said Michael Smith, M.D., medical director and chief medical editor, WebMD/Medscape. “In 2012, the majority of physicians (53 percent) spent between one and four hours per week on paperwork and administrative tasks. Today, nearly 40 percent report spending between 10 and 20 hours per week. It represents a major change in physicians’ responsibilities.”

Still, this year’s report shows that physicians remain committed to their profession. More than half (53 percent) spend between 30 and 45 hours per week seeing patients, compared with 31 percent in 2012, and it’s where physicians gain their greatest satisfaction and sense of purpose. More than 60 percent cite their patient relationships and their ability to find answers to their medical concerns as the most rewarding parts of the job.

Gender Disparities Remain, with Hint of Improvement

Male physicians continue to make more money than female physicians, although the gap in pay is shrinking somewhat in primary care. Male primary care physicians made 15 percent more than women in 2016, compared with 20 percent more in 2012. The gap in specialty salaries has barely budged, with male specialists making 31 percent more than women, versus 33 percent more in 2012. However, the gap in salary is narrowing among younger physicians. While male physicians between ages 55-69 make 27 percent more than women, the gap shrinks to 18 percent in physicians under age 34.

Racial Disparities May Fuel Dissatisfaction

African-American physicians earn 15 percent less than Caucasian physicians, ($303,000 vs. $262,000), according to the survey, and they are less likely to feel fairly compensated (57 percent of white physicians say their compensation is fair, versus 50 percent of black physicians and 49 percent of Hispanic/Latino physicians).

Salaries Higher in More Rural States

Practicing in a less populated state may mean higher compensation. According to the survey, physicians in North Dakota are the highest paid in the U.S. ($361,000), followed by Alaska ($359,000), South Dakota ($354,000), Nebraska ($346,000), and New Hampshire ($337,000).

Compensation is lowest in Washington, D.C. ($235,000), followed by Maryland ($260,000), Rhode Island ($261,000), New Mexico ($261,000), and Delaware ($268,000). New York ($277,000) and Virginia ($272,000) also rank among the lowest.

Geographic supply and demand continue to play a role in compensation. Uneven distribution of physician-to-patient volume, particularly in primary care, has been a problem for decades in rural and poor communities. Numerous government policies are aimed at improving access to physicians in these areas, which can result in higher incomes.