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Lower salaries, higher burnout rates discourage primary care residency applications

Specialty medicine fields are 1.5 times more competitive than primary care specialties, but have nearly double the earning potential, according to data published in JAMA Internal Medicine.

Researchers suggested that fewer medical students are interested in primary care fields because of the discrepancies in salary and comparatively high rates of burnout.

David A. Faber, BA, from the University of Miami Miller School of Medicine, and colleagues noted a previous association between physician salary and specialty competitiveness.

"These findings, along with others, underlie efforts to encourage medical students into primary care specialties (family medicine, general internal medicine, and general pediatrics), which tend to be less rewarding financially," they wrote. "At the same time, physician burnout has risen in recent years, with more than half of U.S. physicians now experiencing at least one symptom of professional burnout."

To study any trends in specialty competitiveness and salaries, as well as associations between lifestyle factors and field selection, Faber and colleagues analyzed data from the National Registry Match Program, the Medical Group Management Association, the Medscape Lifestyle Report and the American Association of Medical Colleges.

Results showed that nonprimary care specialties have higher mean salaries than primary care specialties ($413,915 vs. $228,684) and higher rates of competitiveness (73% vs. 53%).

Faber and colleagues reported neurosurgery had the highest median salary at $747,066 and otorhinolaryngology had the highest competitiveness at 94%, compared to family medicine, which had the lowest median salary and competitiveness at $221,419 and 43%, respectively.

There was a positive correlation between specialty salary and competitiveness of residency spots (r = 0.71) and a negative correlation between competitiveness and burnout (r = – 0.16).

In addition, there were positive but weak correlations between competitiveness and lifestyle factors, including happiness at and outside of work (r = 0.34), hours worked per week (r = 0.18) and severity of burnout (r = 0.13).

"Since our original analysis in 1989, the ratio of specialty to primary care competitiveness has risen from 1.15 to 1.39, while the ratio of average specialty salary to primary care salary has risen from 1.63 to 1.81," Faber and colleagues wrote. "The divergence is clear: nonprimary care fields are now nearly 1.5 times as competitive as primary care specialties, while primary care specialties have roughly half as much earning potential. These results may suggest that primary care fields attract fewer U.S. medical students owing to their comparatively low salaries and high rates of burnout and bias. Policy makers would be well served to understand these forces to encourage increased commitment to primary care specialties." – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.