Nearly half of physicians (47%) say that expected salary “heavily” or “somewhat” influenced their choice of specialty, according to a recent Doximity poll of 2,818 physicians. That figure rises to 65% for physicians under 40 years old, suggesting increasing significance of salary in recent years.
With several years of staggering inflation and increasing costs of medical education, more physicians may be considering expected salary when selecting their medical specialty. On average, 16% of physicians say that expected salary “heavily” influenced their choice of specialty, and 31% say that it “somewhat” influenced their decision.
Younger physicians are the most likely to say that expected salary “heavily” or “somewhat” influenced their choice of specialty: 64% of physicians ages 25 to 29, 67% for ages 30 to 34, and 65% for ages 35 to 39. Physicians under 40 are much more likely to “heavily” or “somewhat” consider expected salary at 65%, versus just 36% of physicians older than 40.
The cost of becoming a doctor has increased 750% since the 1960s. Medical school graduates today have an average of $200,000 in student loans, which may motivate younger physicians to consider their expected salary more than physicians in the past. One study showed that 31% of medical students intended to go into primary care during their first year of medical school but decided to switch to a higher-paying field by the end of their fourth year.
To alleviate the shortage of primary care physicians in the country, some states have made medical students eligible to have their tuition waived if they commit to working in primary care or in an underserved area. Medical schools have also followed this trend, using donations and grants to waive tuition for all medical students in a graduating class, with the hope that this would encourage more students to go into primary care. Even with these programs, it’s been difficult to convince medical students to stay in primary care.
The poll results reinforce the trend that physicians who pursue primary care are least motivated by salary, as surgeons and specialists are more likely than primary care physicians to say they were “heavily” or “somewhat” influenced by expected salary. The specialties where physicians are most likely to say that expected salary “heavily” or “somewhat” influenced their choice are gastroenterology (72%), anesthesiology (70%), cardiology (65%), urology (64%), and ENT (63%). Almost all of the specialties where a majority of physicians were “heavily” or “somewhat” influenced by expected pay are in the top 20 specialties with the highest average annual compensation.
In contrast, primary care physicians are among the least likely to say that expected salary influenced their decision. These specialties historically have lower salaries than more specialized or surgical fields. Physicians in pediatrics (19%), family medicine (23%), and internal medicine (37%) are among the least likely to say that expected salary “heavily” or “somewhat” influenced their decision.
Men are more likely than women to consider expected salary when selecting their medical specialty. The poll shows that 52% of men were “heavily” or “somewhat” influenced by expected salary when selecting their specialty, versus just 29% of women. Some of the specialties predominated by women, such as pediatrics and med/peds, are also among the specialties with the lowest average annual compensation.
Deciding on a medical specialty is a balancing act between many critical factors, including not only expected salary and work-life balance but also setting preferences, research opportunities, and level of patient interaction. “What influenced me way more [than expected salary] was control over schedule and quality of life factors,” said James Thomas Murphy III, MD, an ophthalmologist in Connecticut.
While a specialized or surgical field requires additional training, the higher associated salary may attract physicians concerned about the rising cost of living and paying off their student loans. However, a higher salary does not necessarily make up for other factors, such as long work hours and high caseloads. As burnout rates rose to almost 63% among physicians post-pandemic, expected pay may not be as crucial as other lifestyle factors for some physicians in deciding on their medical specialty.
The growing cost of medical education has presented young physicians with the illusion of choice. Should they go into a higher-paying field to achieve financial security or follow their passion or lifestyle preferences, regardless of the expected salary?
Many physicians have gravitated toward specialties that fit their lifestyle, personality, or academic interests — or perhaps above all, specialties that allow them to fulfill their passion for helping others. “Research shows doctors do not enter medicine as a decision driven solely by financial reward,” said Ahimsa Porter Sumchai, MD, an emergency medicine physician in San Francisco. “Many are authentically and idealistically motivated to heal and serve!”
What was the most important factor in deciding your medical specialty? Let us know in the comments below.
