Direct cost, meaning the clinical labor, supplies and equipment a practice pays for each hour a physician sees patients, averages $42.56 across specialties, according to the American Medical Association's 2024 Physician Practice Information Survey. It runs from $9.25 per hour in psychiatry to $109.62 in hematology/oncology, a gap of 11.9 times.
Clinical labor makes up most of that cost in nearly every specialty. Supplies and equipment decide which specialties sit at the top of the range.
What the AMA counted as direct cost
The AMA's Table 1 reports practice expense per hour of direct patient care. The 2024 data covers 831 practices and departments, which together represent 18,086 physicians across 18 broad specialty groups. The average physician in the table spends 1,936 hours a year in direct patient care.
Total practice expense averages $133.61 per hour. The AMA splits it into direct cost of $42.56 and indirect cost of $91.04, so direct cost is 31.9% of the total. The table adds $194.32 of physician work and $6.95 of liability insurance per hour on top of that.
Direct cost has three lines. Clinical labor averages $33.02 per hour, or 77.6% of direct cost. Supplies average $6.77 (15.9%) and equipment averages $2.77 (6.5%). Clinical labor is the pay for medical assistants, nurses and other staff who work with patients. Billing and front-desk pay falls under indirect cost, which this post does not cover.
Direct cost per hour by specialty
Hematology/oncology has the highest direct cost at $109.62 per hour, followed by dermatology at $103.82 and ophthalmology at $96.83. Vascular surgery comes next at $87.96. At the low end, psychiatry reports $9.25 and hospital-based medicine reports $6.61, the lowest of the 18 groups.
| Specialty group | Clinical labor | Supplies | Equipment | Total direct |
|---|---|---|---|---|
| Hematology/Oncology | $92.73 | $13.98 | $2.90 | $109.62 |
| Dermatology | $80.52 | $15.52 | $7.78 | $103.82 |
| Ophthalmology | $70.32 | $13.64 | $12.87 | $96.83 |
| Vascular Surgery | $44.00 | $38.33 | $5.63 | $87.96 |
| Cardiology | $56.94 | $13.57 | $7.04 | $77.55 |
| Obstetrics/Gynecology | $48.48 | $10.35 | $2.74 | $61.57 |
| Radiology | $39.45 | $7.40 | $11.95 | $58.79 |
| Gastroenterology | $50.24 | $3.51 | $0.56 | $54.31 |
| Primary Care | $38.85 | $7.60 | $2.10 | $48.55 |
| Orthopaedic Surgery | $29.17 | $9.75 | $2.73 | $41.65 |
| Psychiatry | $8.57 | $0.53 | $0.15 | $9.25 |
| All specialties | $33.02 | $6.77 | $2.77 | $42.56 |
Source: American Medical Association, Table 1, Results from the 2024 Physician Practice Information Survey (831 practices and departments, 18,086 physicians). Dollars are per hour of direct patient care.
Where clinical labor sets the cost
In gastroenterology, clinical labor is $50.24 of the $54.31 direct total, or 92.5%. Psychiatry is nearly identical at 92.6%, with $8.57 of $9.25. Neither specialty buys much in the way of supplies or equipment, so the staff schedule is almost the whole direct bill.
Hematology/oncology reaches 84.6% labor, and its $92.73 per hour is the highest labor figure in the table. Primary care sits at 80.0%, with $38.85 of $48.55. Dermatology matches the all-specialty average share of 77.6%, though its labor dollars are 2.4 times the average, at $80.52 against $33.02.
Orthopaedic surgery pays $29.17 per hour for clinical labor, below the $33.02 average. Labor is 70.0% of its direct cost.
For a practice manager, this means the clinical staffing ratio drives direct cost in most specialties. A medical assistant added to a primary care team moves a line that is already 80.0% of direct cost.
Where supplies and equipment drive the bill
Vascular surgery is the outlier. Supplies cost $38.33 per hour, which is 43.6% of its direct cost and 72.3 times the $0.53 that psychiatry reports. Clinical labor in vascular surgery is $44.00, and the two lines are close to equal.
Orthopaedic surgery spends 23.4% of direct cost on supplies, at $9.75 of $41.65. Cardiology spends 17.5% ($13.57 of $77.55) and obstetrics/gynecology spends 16.8% ($10.35 of $61.57).
Equipment matters most in two specialties. Ophthalmology reports $12.87 per hour, or 13.3% of its direct cost. Radiology reports $11.95, which is 20.3% of its direct cost and the highest equipment share in the table. Every other group reports $7.78 or less.
Nurse practitioners and physician assistants
The AMA also reports direct cost for clinicians who are not physicians. Nurse practitioners carry $38.03 per hour of direct patient care, made up of $25.19 of clinical labor, $7.58 of supplies and $5.25 of equipment. Physician assistants carry $32.59, with $26.98 of labor, $4.87 of supplies and $0.74 of equipment.
Both are below the $42.56 physician average. The mix differs, though. Labor is 66.2% of the nurse practitioner total and 82.8% of the physician assistant total. Nurse practitioners show an equipment share of 13.8%, against 2.3% for physician assistants.
These rows rest on fewer reports. The table shows 89 nurse practitioner departments covering 2,774 clinicians and 79 physician assistant departments covering 2,184. Nurse practitioners average 1,509 direct care hours a year and physician assistants average 1,583, against 1,936 for physicians.
Turning the hourly figures into annual cost
Multiply the hourly figure by the annual direct care hours in the same table to get a yearly direct cost per physician. Primary care physicians average 1,851 hours, so $48.55 per hour comes to about $89,866 a year. Dermatologists average 1,636 hours, so $103.82 comes to about $169,850.
Direct cost is a different share of total practice expense in each specialty. It is 41.5% in dermatology ($103.82 of $250.46) and 33.3% in primary care ($48.55 of $145.70). In psychiatry it is 24.3% ($9.25 of $38.10), because $28.84 of the $38.10 is indirect cost.
A practice can compare its own ledger to these rows. Add clinical staff pay, medical supplies and equipment costs for a year, then divide by the hours clinicians spent with patients. If a primary care group lands well above $48.55, check clinical labor first, since it carries $38.85 of that figure. The AMA table is a national average, and a small practice with a different payer mix or staff model can sit above or below it.
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