Which health care careers produce the most earnings over 20 years after subtracting education costs? This page ranks health care careers by 20-year net earnings—total income minus tuition and forgone wages. Surgical specialties and nurse anesthetists lead because high salaries compound over two decades, even after accounting for long training periods and six-figure education costs.
Editorial Team
Health care education is expensive, and the sticker prices keep climbing. But the real question isn't "how much does it cost?"—it's "how much do you earn back, and how quickly?" A $60,000 master's program that leads to a $125,000 salary looks good until it's compared to a $5,000 certificate program that starts paying $48,000 twelve months sooner.
This analysis ranks health care careers (including physician specialties) by 20-year net earnings: total income minus total investment. Total investment includes tuition plus opportunity cost—wages forgone during education. For physician specialties, residency years earn ~$65k/yr, reducing the opportunity cost penalty. The data comes from BLS median salary figures and U.S. Department of Education College Scorecard program-level costs.
If you're comparing within a specific education level, see our tier breakdowns: Certificates (fastest path, highest per-dollar ROI), Associate's Degrees (best balance of cost and salary ceiling), and Graduate Programs (CRNA-vs-physician debate, NP vs PA). If you're optimizing for take-home pay instead, see our Highest-Paying rankings.
Bubble size = overall score. Upper-right combines stronger growth with greater AI resilience.
Careers with the highest return on educational investment over 20 years.
Sortable table with 20-year net earnings, growth rates, and education requirements.
| Rank ↑ | Career ↕ | 20-Year Net ↕ | Salary ↕ | Growth ↕ | Education ↕ | |
|---|---|---|---|---|---|---|
#1 | Orthopedic Surgeon | $2.5M Strong | $451k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#2 | Certified Registered Nurse Anesthetist (CRNA) | $2.5M Strong | $223k/yr Exceptional | 9.0% Fast | Doctoral Degree | View Details |
#3 | Emergency Medicine Physician | $2.3M Strong | $321k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#4 | Cardiologist | $2.1M Strong | $432k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#5 | General Surgeon | $2.0M Strong | $355k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#6 | Anesthesiologist | $1.9M Strong | $337k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#7 | Internal Medicine Physician | $1.9M Strong | $263k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#8 | Family Medicine Physician | $1.8M Strong | $257k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#9 | Psychiatrist | $1.7M Strong | $269k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#10 | Radiation Therapist | $1.7M Strong | $98k/yr High | 1.2% Below Average | Associate Degree | View Details |
#11 | Dental Hygienist | $1.6M Strong | $94k/yr High | 6.9% Average | Associate Degree | View Details |
#12 | Registered Nurse | $1.6M Strong | $94k/yr High | 6.2% Average | Associate Degree | View Details |
#13 | Nuclear Medicine Technologist | $1.6M Strong | $93k/yr High | 3.2% Average | Associate Degree | View Details |
#14 | Nurse Practitioner | $1.6M Strong | $129k/yr Very High | 40.0% Very Fast | Master's Degree | View Details |
#15 | Dermatologist | $1.6M Strong | $281k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#16 | Certified Nurse-Midwife (CNM) | $1.6M Strong | $129k/yr Very High | 11.0% Fast | Master's Degree | View Details |
#17 | Pediatrician | $1.5M Strong | $222k/yr Exceptional | 3.0% Average | Doctoral Degree | View Details |
#18 | Physician Assistant | $1.5M Strong | $130k/yr Very High | 28.0% Very Fast | Master's Degree | View Details |
#19 | Ultrasound Technician | $1.5M Solid | $85k/yr High | 10.2% Fast | Associate Degree | View Details |
#20 | Diagnostic Medical Sonographer | $1.5M Solid | $85k/yr High | 10.2% Fast | Associate Degree | View Details |
The 20-Year Net Earnings figure is calculated using a year-by-year model starting from enrollment. During education years, income is $0. For physician specialties, residency years earn ~$65k/yr. After training, salary follows a trajectory from entry-level (BLS 25th percentile) through mid-career (50th percentile) to experienced (75th percentile). The net figure is total income minus average education cost over the 20-year window. Rankings are sorted by absolute 20-year net earnings—the total dollar return after subtracting all education costs. This favors high-salary careers; for per-dollar return comparisons, see our tier breakdowns.