Money prevents medical students from choosing primary care as a career

Money prevents medical students from choosing primary care as a careerThere are plenty of reasons why medical students aren’t choosing primary care as careers.

Lack of role models.  Perception of professional dissatisfaction.  High burnout rate among generalist doctors. Long, uncontrollable hours.

But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial.  After all, the average medical school debt exceeds $160,000, so why not go into a specialty that pays several times more, with better hours?

Thanks to Robert Centor, there’s a study published in Medscape that shows how money affects career choice among medical students.

Here’s what they found:

Sixty-six percent of students did not apply for a primary care residency. Of these, 30% would have applied for primary care if they had been given a median bonus of $27,500 before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000.

And in conclusion,

U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.

Money matters. There should be no shame for new doctors to admit that. After all, they’re human too, and respond to financial incentives just like anyone else. And when most medical students graduate with mortgage-sized school loans, salary should be a factor when considering a career.

Of course, primary care’s plight has been well documented during the health reform debate. And, to the Affordable Care Act’s credit, it gives a token increase to generalist provider reimbursement. But it’s nowhere near enough to overcome the fiscal disparity when compared to most specialists’ salaries, and thus, will make little impact going forward.

Combined with the fact that primary care continue to struggle under weight of worsening bureaucratic obstacles, time pressures, and the prospect of seeing tens of millions of newly insured patients in 2014, there’s little hope that the current generation of medical student will stem the tide of primary care’s demise.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://drpullen.com medical blog

    Did anyone really think otherwise?

  • http://futureoffamilymedicine.blogspot.com mdstudent31

    Not a surprise.

    Loan forgiveness programs are not shown to help either – some specialists can make the amount offered over 4-6 years in 1-2 year max.

    Look no further than COGME’s 20th Report “Advancing Primary Care”

    The COGME report calls for “dramatic” policy changes that would have “immediate effect,” and it proposes five recommendations:
    1. Increase the number of primary care physicians from the current level of 32 percent of U.S. physicians to at least 40 percent through new policies and programs.
    2. Raise the average incomes of primary care physicians to at least 70 percent of the median income for all other physicians, and reward practices that change their infrastructure to improve chronic care and care coordination. According to data from the Medical Group Management Association cited in the report, primary care physicians’ median annual compensation was $186,044 in 2008 versus $339,738 for physicians practicing in other specialties.
    3. Require medical schools and academic health centers to develop “an accountable mission statement and measures of social responsibility to improve the health of all Americans,” and to alter their selection processes and educational environments to support the goal of producing a physician workforce that is at least 40 percent primary care physicians.
    4. Change graduate medical education regulations and significantly expand Title VII funding for community-based training to support the goal of producing a physician workforce that is at least 40 percent primary care physicians. This includes requiring more residency training in outpatient settings. The report acknowledges the Affordable Care Act Primary Care Residency Expansion (PCRE) Program, a new $168 million, five-year program aimed at expanding enrollment in primary care residency programs.
    5. Increase incentives for physicians to serve medically vulnerable populations throughout the country. The report cites the Affordable Care Act’s provision of $1.15 billion in funding for the National Health Service Corps to recruit more primary care physicians. COGME also recommends increasing funding for Title VII, section 747, to $560 million in Primary Care Medicine and Dentistry cluster grants and increasing funding for Community Health Centers and Area Health Education Centers.

    Our blog is running a 5 part series outlining each recommendation. If these recommendations were taken seriously, it could impact medical student choice for primary care:
    http://futureoffamilymedicine.blogspot.com/2011/01/how-will-cogmes-20th-report-affect.html

  • PAULMD

    Unsustainable “program” speak. You are in essence pandering to the feeble minded in trying to pick applicants that will willfully throw away a better future for themselves to go into primary care. The lesser will be lulled into staying in primary care and the others will attempt to break their “contract” and pursue something else.

    During my 3rd and 4th year in med school, the presidents of the primary care society matched in general surgery and ENT respectively. Often, the capable eventually see the light and get out of Dodge.

    For this to happen, there will have to be 2 types of medical schools in the good ole USA. One will be for primary care and the other for everything else. I bet more and better students sign up for the latter. Can’t fight a sustained fight with human nature, you will lose.

    Pay these PMDs more and it may sustain itself, otherwise blowing into your own sail never really moves the boat…if you know what I mean.

    • jsmith

      Feeble minded? Ouch. As a PCP, I resemble that remark. I read a article in which an ER doc cracked that anyone smart enough to get into med school is not likely dumb enough to go into primary care.
      Yup, it’s the money.

  • Bobbo

    Its not just the money, though that certainly matters. More and more primary care has become the mid-level manager of medical care, serving as a coordinator for specialists who provide the vast majority of care. Sure, in rural areas one can be a traditional FP that does everything from in-office procedures to delivering babies, but if you want to live in a remotely desirable city that won’t be possible.

    Primary care docs also want to see their services valued, and not just through money. When the vast trend of health care reform has pushed that NPs and DNPs are equal to PCPs, this devalues the PCP role and makes it less desirable.

  • http://www.drdialogue.com Juliet K. Mavromatis, MD

    I’m just beginning to host Emory third year medical students in my hybrid-concierge practice this month. I think it’s important to show students the full range of practice options in primary care. If anyone has thoughts or advice on this integration, or if you have had medical students in your concierge or hybrid practice I’d appreciate your advice.

  • Lola

    I’ve chosen not to have a primary care doctor for years. I no longer see the point. Primary care doctors have consistently given me the impression that it’s just as good to see a PA or nurse instead of the doctor. The doctor lost value to me, nor is he as available to see me as the PAs and nurses. I kept the specialists I already had, coordinate my own care, and use retail clinics for acute, minor issues. It has worked out very well.

    It’s hard to justify the primary care office experience when there’s a Minute Clinic nearby with those same mid-level providers with upfront costs, better hours, less hassle, and prescriptions filled right there.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      You haven’t found the right primary care doctor Yet. Your system works well if you are not sick with a complicated illness. It falls apart if you need coordination of care, an advocate and more critical thinking than 638 hours of supervised clinical training provides.

  • PAULMD

    @Juliet,
    This is a good move. The ship may have already sailed on primary care but for those that wish to continue to pound their heads against the wall and go into it, the entrepreneurial tact is the best option. Good luck!

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