Wednesday, February 11, 2009

Would More Medical Students Choose Primary Care if They Received Specialist Salaries?

This is a guest post by James over at

Fewer and fewer medical students are choosing to go into primary care fields despite the emphasis and growing need for more internists and family practitioners. When choosing a medical specialty, medical students have many factors to consider: lifestyle, personality match, competitiveness, length of training, and salary (compensation) are some of the major considerations. Let's break down each of the considerations a poor medical student must make when choosing a career: 

Lifestyle: The generalist's lifestyle, while not the greatest, is also not the worst.  In terms of hours worked, it is not as demanding as something like surgery or obstetrics.  

Personality: All sorts of personalities could fit into a primary care field such as family practice, internal medicine, or pediatrics.  Wasn't the whole reason for going to medical school was so you could help patients?

Competitiveness: If you choose not to go into family practice because of competition, you probably never should have made it into medical school.

Length of Training: With generalist training only needing three years as opposed to the five plus years required of specialists, this should be considered an incentive to go into primary care.

Salary (Compensation): The average earnings of a primary care doc is about 55% of the average earnings for all other non-primary care specialties.  Here, I think we've identified a reason for the primary care shortage.

There are many reasons why fewer med students are choosing to go into primary care, but the financial aspect must be a huge consideration.  If I'm graduating with $180,000 of medical student loans, having deferred gratification by going to college, med school, and then residency, and am looking to buy a house and raise a family in the near future, why would I go into primary care, when I could make double or even triple as much as a specialist?

According to the AAMC, family practitioners can expect to make about $142,200 after three years of residency where as a radiologist's salary can see $325, 438 after five years of residency. Sure, the training to become a radiologist is two years longer, but for those extra two years, you can potentially see more than a doubling of your income. 

The fact is, medical training is long and grueling.  Individuals pursuing a medical degree have made huge investments into our futures and hope to see a good return on investment or ROI.  Specializing takes just a few more years and produce greater returns; I've already come this far, what's a few more years?  Show me the money!  So to answer the question posed in the title of this article, YES more medical students would choose primary care if they were compensated better!

The American College of Physicians in their "State of the Nation's Health Care 2009" said:
Medical students and young physicians should make career decisions based on their interests and skills, instead of being influenced to a great extent by differences in earnings expectations associated with each specialty. Yet there is extensive evidence that choice of specialty is greatly influenced by the under-valuation of primary care by Medicare and other payers compared to other specialties.
As the old adage goes, "Do what you love and the money will follow."  I wonder how much in student loans that guy must have had or how long he spent in school.  While I enjoyed my family practice and pediatrics rotations in medical school, I also enjoyed radiology and orthopedic surgery.  But after evaluating what was most important to me, I decided that spending time with and supporting my family would bring me the most fulfillment.  Luckily, I loved radiology and so far it has happened to be a perfect fit.

James, a radiology resident, runs, a website dedicated to providing financial tips and other practical advice to medical students, residents, and fellows. If you're interested in reading more about the situation with primary care, check out Why Incentives Matter (Even For Physicians), A Shortage of Primary Care Physicians?, and Why Primary Care Matters.


  1. I have to agree. I think medical branches (general and special) should be similarly compensated. We need more primary cares to handle the aging population.

    I'm a specialist, and I work 80-90 hours a week. I don't think this is any more or less than most of my local PCP's when you factor in time spent doing doctor/business work (dictation, reviewing labs, returning calls, etc.).

  2. The family docs I spoke with who enjoy their professional lives said that after about $150K per year, the salary doesn't really matter and that professional satisfaction matters a lot.

    Many people went to med school to end up becoming doctors who see patients -- this is satisfying for them. I feel that only particular personality types could be happy in radiology or pathology...even if you are extremely smart, such cush, high-paying fields may not be for you!

    Avaron's classmate

  3. I've heard that statement that after about $150K per year, the salary doesn't really matter several times by FP and IM residents across the country and I'm glad that there are people that feel that way. But I disagree with the statement.

    Sure, you are not going to starve on $150K per year, but depending on which part of the country you live in, whether you're married or not, how many kids you have, student loans, malpractice insurance... you can easily find yourself barely getting by on a modest lifestyle with a $150K salary.

    Location is a huge factor. If you live in New York city, you have to make $123,000 to have the same standard of living as someone in Houston making $50,000!

  4. I agree. The FP & IM people I know who enjoy their work and feel in Houston!

    Certainly, your freedom of location is increased as you earn more money.

    Avaron's classmate

  5. I'm a self employed gastroenterologist. I do very well. Its not what you make, its what you spend. I believe the new health care policy should include minimum wages for primary care physicians and that should be $249K. God forbid hitting the higher tax bracket.
    We physician have taken far to less for far to long. Physician income is the problem with health care, its far to low! Ask a hospital CEO what they make, and them ask them what they did all day and perhaps last night

  6. It is striking how our incentive structure compares to other professions. Imagine if we had all become lawyers instead of physicians. There, you own your time and can set whatever rate you want. If you're good/successful, you are compensated accordingly. Here, quality actually suffers in some sense because a physician has no incentive to do "better"; at best, they have an incentive to do "more" and a fairly lousy incentive at that.

  7. The growingly heavy influence on non-physician providers in primary care also plays a role. Who wants to train for a minimum of 11 years to work alongside nurse practitioners and physician assistants with little to no distinction between the physician and non-physician workers? With the expansion of a federal health insurance program, this trend will only become worse. In the minds of insurance companies, non-physician providers = cheap, and the insurance companies can push their profits even higher by pushing more non-physician workers in primary care.



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