Here’s the core tension at the graduate level: higher salaries come with longer training paths, bigger tuition bills, and years of forgone earnings. An orthopedic surgeon earns $451,000 but needs 13 years and $250,000. A CRNA earns $223,000 after 10 years and $100,000—and earns full RN wages during the bridge years. Over 20 years, CRNA nets roughly $2.3M versus the surgeon’s $1.7M. The higher salary doesn’t always win.
We ranked 26 graduate-level health care careers by 20-year net earnings: total income minus education costs. This includes bachelor’s, master’s, and doctoral careers, plus 10 physician specialties. Salary data comes from BLS Occupational Employment and Wage Statistics (OEWS), May 2024. Physician salaries use BLS mean wages because the BLS does not publish medians above $239,200. Education costs come from College Scorecard and AAMC tuition data. For physician specialties, we account for residency wages (~$65,000/year), reducing the opportunity cost during those years.
We include physician specialties here because the comparison is the point. If you’re deciding between medical school, PA school, or an NP program, you deserve to see the numbers side by side—including the years of your life each path requires. Unlike our Highest-Paying rankings (which exclude physicians), this page focuses on the net return after all costs.
A word of caution that matters more at this level than any other: graduate programs are expensive enough and long enough that choosing wrong is costly. An athletic trainer with a master’s degree earns $60,000. A CRNA with roughly the same years invested earns $223,000. The education level is similar; the outcomes are not. Read the career descriptions carefully before letting the numbers drive your decision.
This is part of our Best ROI Health Care Careers series. Also see: Certificates | Associate’s Degrees
Key Findings
- •The winner isn’t who you’d expect: CRNA nets roughly $2.3M over 20 years—beating every physician specialty. The trick: you earn full RN wages ($94,000) during bridge years, so the 10-year path includes several years of paid work. A $223,000 median salary on top of that is what pushes CRNA past surgeons earning twice as much per year.
- •Physicians still dominate—but not at the top: Eight of the top 10 are physician specialties. Surgical fields (orthopedics, cardiology, general surgery) produce the highest absolute returns despite 13-year paths and $250,000 bills. But CRNA, with shorter training and paid bridge years, beats them all on net return.
- •Every year in school costs you roughly $46,000 in lost income: Opportunity cost is the variable most people forget. Each year in school or residency means $46,000 you didn’t earn (offset by ~$65,000 residency pay for physicians). This hidden cost is why an 8-year NP path can rival an 11-year physician path despite a lower salary.
- •NP demand is growing faster than any other health care career: Nurse practitioner at 40% growth isn’t just popular—the demand is structural. Primary care physician shortages, expanding NP scope-of-practice laws, and rural health care gaps all fuel it.
- •PA offers the best balance of salary, growth, and flexibility: Physician assistant at 28% growth and $130,000. The unique PA advantage: you can switch specialties without additional residency training—something physicians can’t easily do.
Education Cost vs Median Salary
Each bubble represents a graduate-level career. X-axis = estimated education cost. Y-axis = median salary (or BLS mean for physicians) from BLS OEWS (May 2024). Bubble size = 10-year growth rate from BLS Employment Projections (2024–34).