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Future Salary and US Residency Fill Rate Revisited
To the Editor: In 1989, a study described a linear correlation between the median income of physicians in a specialty and the percentage of residency positions for that specialty filled with US graduates (r = 0.85).1 Since that time, decreasing numbers of graduates of US medical schools are choosing primary care specialties (family medicine, pediatrics, and general internal medicine), the disparity in income between primary care and subspecialties persists, and student debt has risen to a median of $140 000 for the class of 2007.2 Because of these trends, this study examined whether there is an association between specialty selection and anticipated income using contemporary data.
Methods
The percentage of US allopathic medical school graduates choosing a particular specialty in 2007 was obtained from the results of the National Residency Match Program.3 The mean annual salary in 2007 for physicians in different specialties (overall mean and starting salary) was obtained from the annual American Medical Group Association survey of physician salaries, which includes both osteopathic and allopathic physicians.4 The analysis was limited to specialties offering at least 100 postgraduate year 1 positions to allow adequate precision for the estimates of salary and fill rate. Pearson product moment correlation coefficients were calculated using OpenStat version 3.23.08 (http://www.statpages.org/miller/openstat).
Results
The total number of positions, fill rates overall and for US medical school graduates, and mean starting and overall salary for each specialty were tabulated (Table). There was a strong direct correlation between higher overall salary and higher fill rates with US graduates (r = 0.82; P = .001) (Figure). Primary care specialties generally have a lower salary and fill rate; family medicine had the lowest mean salary ($185 740) as well as the lowest fill rate with US seniors (42.1%). Orthopedic surgery and radiology had the highest salaries and fill rates, with a ratio between the mean salary of a radiologist and that of a family physician of 2.2. Emergency medicine, otolaryngology, and pediatrics had slightly higher fill rates than would be predicted for their salaries. The starting salary was also directly associated with the fill rate (r = 0.68; P = .03), although the relationship was not as strong as for overall mean salary. The ratio between radiology and family medicine mean starting salaries was 2.7.
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Table. Salary and Residency Match Data, 2007a
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Comment
The association between physician salary and residency fill rate described in 1989 has persisted. County, state, and international comparisons have consistently shown that having a greater percentage of physicians in primary care specialties is associated with better population health outcomes, including reduced all-cause, cardiovascular, infant, and cancer-specific mortality.5 However, rising levels of student debt, considerably lower salaries in primary care specialties, and a perception that primary care may have a less rewarding lifestyle have led to a potential workforce crisis given the aging US population. Addressing disparities in salary by specialty may need to be part of a solution to this problem.
Author Contributions: Dr Ebell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosures: Dr Ebell reported being paid a stipend by the American Academy of Family Physicians for being deputy editor of American Family Physician from 2002 to the present and being paid a stipend by John Wiley and Sons for editorial services.
Funding/Support: None.
Mark H. Ebell, MD, MS
ebell{at}uga.edu
University of Georgia
Athens
1. Ebell MH. Choice of specialty: it's money that matters in the USA. JAMA. 1989;262(12):1630.
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2. Medical student education: cost, debt, and resident stipend facts (March 2008). Association of American Medical Colleges Web site. http://www.aamc.org/programs/first/debtfactcard.pdf. Accessed July 8, 2008.3. Data and reports. National Residency Match Program Web site. http://www.nrmp.org/data/index.html. Accessed June 24, 2008.4. Physician/healthcare executive compensation data: 2007 physician compensation survey, by the American Medical Group Association (AMGA). http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm. Accessed June 24, 2008.5. Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37(1):111-126.
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Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2008;300(10):1131-1132.
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