JAMA: Radiologists make more money, less involved with research
Since 1989, decreasing numbers of graduates of U.S. medical schools are choosing primary care specialties (family medicine, pediatrics, and general internal medicine). The disparity in income between primary care and subspecialties persists, while student debt has risen to a median of $140,000 for the class of 2007, according to a research letter that appeared in the same issue of JAMA from Mark H. Ebell, MD, from the University of Georgia in Athens.
The study found that 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 U.S. seniors (42.1 percent). 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.
Ebell said that he conducted the study to draw renewed attention to the role of salary disparities in the primary care shortage and to encourage policymakers to enact meaningful reforms to increase the percentage of primary care physicians.
"The problem of salary disparities is not something that anyone is going to solve locally,” Ebell said. “This is something that will require reform at a national level."
He said one possible reform is expanded debt relief for students who choose primary care practices and in particular those who choose to practice in underserved areas. He notes that the average debt for a medical school graduate has quadrupled—from $35,000 to $140,000—in the nearly 20 years since his original study. When students graduate with the equivalent of a mortgage in debt, he said, they can't help but be drawn to high-paying specialties rather than primary care.
Ebell concluded that the broad knowledge base of primary care can be intimidating to students, so creating information technology systems to manage information will be important.
In a separate study in the same issue of JAMA, Dorothy A. Andriole, MD, of Washington University School of Medicine in St. Louis, and colleagues conducted a study to identify factors associated with MD/PhD program graduation among recent medical graduates.
Of the 79,104 respondents with complete questionnaire data (71.7 percent of all 2000-2006 graduates), 1,833 (2.3 percent) were MD/PhD program graduates.
Compared with planned training in internal medicine, the researchers found that MD/PhD graduation was positively associated with planned training in dermatology, neurology, ophthalmology, pathology, pediatrics or radiology.
The investigators also found that ophthalmology and radiology were among the specialty choices associated with a lower likelihood of planned substantial career involvement in research among MD/PhD program graduates.
Andriole and colleagues concluded that compared with graduates of other MD degree programs, MD/PhD graduates tend to be less demographically diverse, have a lower debt burden, favor different medical specialties and have greater planned career involvement in research.