ScienceWeek

SCIENCE POLICY: MEDICAL SPECIALTIES AND MEDICAL INCOMES

The following points are made by E.R. Dorsey et al (J. Am. Med. Assoc. 2003 290:1173):

1) Many factors influence the career specialty decisions that medical students make.(1-5) These factors range across a wide spectrum from individual characteristics such as personality(1) to anticipation of specialty-related income.(2-5) Recently, specialty-related lifestyle has drawn increased attention as US medical students have applied in increasing numbers to radiology and anesthesiology programs and in decreasing numbers to general surgery and family practice programs. Studies have suggested that a so-called controllable lifestyle has become a determinant in students' specialty selection criteria. In the context of the medical specialties, these studies have defined a controllable lifestyle by the following characteristics: personal time free of practice requirements for leisure, family, and avocational pursuits and control of total weekly hours spent on professional responsibilities. This is related to the amount of time remaining for activities independent of medical practice and is a reflection both of total hours worked and number of nights on call. In a study of 346 medical students from 9 US medical schools, it was found that students were most inclined to select specialties that had fewer number of practice work hours per week, allowed adequate time for the pursuit of avocational activities, and seemed to have a decreased number of call nights. These aspects of lifestyle were found to be more influential than more traditional motivators, such as remuneration, prestige, and length of training.

2) US Income Characteristics of Selected Medical Specialties

Specialty Average Income

Anesthesiology $225,000

Dermatology 221,000

Emergency Medicine 183,000

Family Practice 132,000

Internal Medicine 158,000

Neurology 172,000

Obstetrics & Gynecology 224,000

Ophthalmology 225,000

Orthopedic Surgery 323,000

Otolaryngology 242,000

Pathology 202,000

Pediatrics 138,000

Psychiatry 134,000

Radiology (diagnostic) 263,000

Surgery (general) 238,000

Urology 245,000

Average for the above 208,000

3) The authors conducted a study to determine whether and to what degree controllable lifestyle and other specialty-related characteristics are associated with recent (1996-2002) changes in the specialty preferences of US senior medical students. Specialty preference was based on analysis of results from the National Resident Matching Program, the San Francisco Matching Program, and the American Urological Association Matching Program from 1996 to 2002. Specialty lifestyle (controllable vs uncontrollable) was classified using earlier research.

4) The authors conclude: Perception of controllable lifestyle accounts for most of the variability in recent changing patterns in the specialty choices of graduating US medical students.

References (abridged):

1. Kiker BF, Zeh M. Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice. J Health Soc Behav. 1998;39:152-167

2. Choice of specialty: it's money that matters in the USA. JAMA. 1989;262:1630

3. Kassebaum DG, Szenas PL. Factors influencing the specialty choices of 1993 medical school graduates. Acad Med. 1994;69:163-170

4. Burack JH, Irby DM, Carline JD, Ambrozy DM, Ellsbury KE, Stritter FT. A study of medical students' specialty-choice pathways: trying on possible selves. Acad Med. 1997;72:534-541

5. Fincher RM, Lewis LA, Rogers LQ. Classification model that predicts medical students' choices of primary care or non-primary care specialties. Acad Med. 1992;67:324-327

J. Am. Med. Assoc. http://www.jama.com

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