By Leslie Kane, MA; Carol Peckham
AUGUST 6, 2014 – [MEDSCAPE] – Medical school debt is a hot topic, so Medscape set out to focus more closely on medical residents’ salary, debt, and their overall experiences in residency. More than 1200 residents across 25 specialties took part in an online survey; the recruitment period ran from June 20, 2014 through July 7, 2014. All participants were enrolled in a US medical resident program.
Highlights of the Report Include:
- Although many physicians who have been in practice for years have become discontent with the industry, residents are still positive and optimistic about their careers. Eighty-three percent of residents look forward to practicing as a physician. (This percentage did not vary significantly by years after medical school or by gender.) Only 5% were not looking forward to practicing, and 13% were undecided.
- The average resident salary is $55,300. This accounts for the higher earnings among various specialties and the lower salaries in rheumatology and primary care.
- Although nearly three-quarters (73%) of residents work in hospitals, other programs are also available for training residents. Recently, for example, GME funding was made available for community-based teaching sites, intended to produce more primary care physicians, although at this time there are very few residents in this program.
- Residents in specialties earned the highest salaries; family and internal medicine resident salaries are at the bottom of the list, which is similar to their ranking in the Medscape 2014 Compensation Report, in which income levels for family medicine and internal medicine were second and fifth from the bottom, respectively. Of interest, although 28% of residents who responded to the survey were in either internal medicine or family medicine programs, only half of them planned to go into primary care; the others were planning to subspecialize. Respondents said that lower salaries and less respect within the residency programs are important reasons for such choices. About three quarters of medical schools are now implementing initiatives to encourage careers in primary care.
- Salaries for women in residency are lower than those for men ($54,000 and $56,000, respectively). The gender disparity in residents, however, is only 4% compared with a disparity of 24% among all physicians, according to the latest Medscape Physician Compensation report. The much smaller difference among residents is most likely due to their work in the hospital setting, where salaries are consistent. But disparity seems to be a continuing problem. A 2012 article in Health Affairs on New York starting salaries after residency found that men earned $16,819 more than women, a greater compensation gap than in 1999. Still, “as increasing numbers of doctors start working regular set hours for large health systems, there’s little variance in income based on sex,” notes Judy Aburmishan, partner in FGMK, LLC, a Chicago firm that represents physicians and other providers.
- At $71,000, the highest resident salaries are in the Northwest, with the Northeast and West following at $61,000 and $57,000, respectively. The lowest salaries are found in the Southeast ($50,000) and North Central ($52,000), with the remaining regions, at $54,000, below the general average salary of $55,000. One reason for these regional differences may be Medicare subsidies for graduate medical education, with the states in the Northeast, West, and Northwest being among the largest beneficiaries for resident payments, and those in the Southeast, Southwest, and South Central (where salaries are below average) receiving lower subsidies for paying residents.
- Although 25% of residents have no debt, over a third (36%) still owe more than $200,000 after five years in residency. The Association of American Medical Colleges (AAMC) reports that the median four-year cost to attend medical school for the class of 2013 is $278,455 at private schools and $207,868 at public ones. Given these high tuitions, resident indebtedness has risen much more rapidly than inflation or resident compensation. According to the AAMC, medical school debt has increased by 6.3% since 1992 compared with the Consumer Price Index increase of 2.5%.
- The amount of medical school debt incurred does not change significantly over the course of a residency period. Although more than half of residents have debt exceeding $100,000, about a quarter have none. Some residents are able to reduce their debt by serving in the military or in underserved areas, including via the Peace Corps. Suggestions for reducing debt institutionally include freezing costs or prorating debt according to potential earnings in the chosen specialty. The AAMC provides a fact card that gives sample repayment schedules and amounts depending on various factors.
- When asked about relationships with nurses and physician assistants, there was very little difference in the opinions of male and female residents, with 62% of women and 66% of men saying that their relationships were very good to excellent. The most common complaint among write-in comments from residents with poorer relationships was the lack of respect paid to them by nurses. A small study of pairs of residents and nurses found a lack of shared perception and expectations. Nurses in particular considered themselves to be more autonomous than residents did. The study authors concluded that leadership was necessary, but only if the leader or both members of a pair had sufficient autonomy. They also observed that the present generation of residents and nurses may be open to models of interdisciplinary interactions that are more positive and collaborative than in previous decades.
- On average, about half of all residents who responded spend 60 hours or more per week in the hospital, but the percentages trend significantly down over time, from 66% in the first year out of medical school to only 34% in the fifth year.
- Thirty-seven percent of residents were very satisfied with the quality of their learning experience, but 45% were only somewhat satisfied and 18% were either neutral or very dissatisfied. In a study of surgical residents, more than a quarter found that the time available for learning and education was insufficient. In a recent study of internal medicine trainees, nearly two-thirds (64.3%) believed that their time for learning activities was insufficient or minimal. Another study on internal medicine house staff suggested that the reduced hours from the 2011 regulations resulted in decreased availability for teaching conferences. Among the write-in responses to this survey, one resident backed up this latter study: “I feel like the new work hours mean we are expected to learn the same amount of information and see the same amount of patients, now just in less time.”
- More women than men are on call 1 to 4 nights per week (44% versus 37%), but fewer are on call 5 to 10 nights (37% versus 45%, respectively). In this survey, female residents also tend to work fewer hospital hours per week. Both factors may contribute to their slightly lower salaries. Some evidence suggests that female residents greeted reduced duty hours more positively than male residents and that women may respond to fatigue more negatively. In a study on post-call (being at work the day after having spent the entire previous day and night working), female residents felt less competent, less productive, and less energetic; male post-call residents felt more challenged and busier, although also more demoralized.
- A number of studies have found a decline in idealism among medical students beginning as early as the second year of school. The Medscape survey suggests that idealism declines further during residency. In comparing responses by residents in post-med school years 1-4 with years 5-8, a shift occurred, with fewer residents finding patient gratitude rewarding in the later years (61%) compared with in their early years (67%), and more residents in later years looking to make “good money” (43% versus 36%). Authors of a 2014 study commented that as “students make choices in their medical careers, such as specialty choice or consideration of primary care, the influences of job security, student debt and social status increasingly outweigh idealistic motivations.”