Residents: Will They Ever Pay Off Medical School Debt?

Carol Peckham

|Disclosures|August 05, 2014
 

How Much Do Residents Make?

The Medscape 2014 Residents Salary & Debt Report is based on an extensive survey of more than 1200 US residents representing 25 specialties. The focus of the survey was not just on what residents make but also on their debt after medical school. The average resident salary is $55,300, but there is a wide range depending on the specialty chosen. Essentially, the specialty pattern of salary range follows that of physician compensation, with residents in specialties earning the highest salaries, and residents in family and internal medicine at the bottom of the list.

Of course, salaries also increased over time, from an average of $51,000 in the first year after medical school to over $60,000 after the fifth year.

Even with this increase, resident income has not kept pace with rising costs over the past few decades. When adjusted for inflation, resident compensation has been unchanged for 40 years. In fact, given housing costs and debt, salaries are slightly less. Training hospitals share data and use it to set wages, which keeps salaries low and consistent among them, triggering some efforts by residents to take a stand.[1]

There is also some controversy about how government funds are really used for graduate medical education, specifically for residency training, and whether keeping skilled residents at these low wages actually makes money for academic medical centers.[2-4] Authors of a commentary in the New England Journal of Medicine, however, found no empirical evidence to support this and said, "The cost of training has increased substantially in recent years owing to a series of unfunded mandates, including more stringent educational requirements, decreased duty hours, and strict supervision requirements."[5]

Gender Disparity Among Residents: Not So Bad

As in most professions, salaries for women in residency are less than those for men ($54,000 and $56,000, respectively). This equates to a 4% disparity, compared with a 24% disparity 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. Regardless of any disparities, far more female residents (57%) are satisfied with their compensation compared with their male counterparts (48%). However, Ileana Piña, MD, a Medscape advisor and Associate Chief of Cardiology at Montefiore Einstein Vascular and Cardiac Center in the Bronx, New York, commented, "Women are not happy about salary disparities when they find out. For instance, salaries in universities are often secret, so you may never know. If you don't know, you can't complain. Now, I ask upfront for salary levels."

It appears that once residents have completed training, the disparity in gender compensation increases in some locations. A 2012 article in Health Affairs on New York starting salaries after residency found that newly trained men earned $16,819 more than women, a compensation gap greater than that in 1999, which was only $3600.[6] One reason given for this increase is that more women are entering primary care, although some statistics dispute that fact.

Given our current cultural environment, the authors of the Health Affairs study did not believe that discrimination plays much of a role in the increasing income disparities that they observed over recent years, writing, "It is possible that the continued influx of women into medicine has reached a tipping point, and physician practices may now be offering greater flexibility and family-friendly attributes that are more appealing to female practitioners but that come at the price of commensurately lower pay."

Location, Location, Location

The highest average resident salary, $71,000, is 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 region ($52,000), with the remaining regions at $54,000, below the general average salary of $55,300. One reason for these regional differences may be Medicare subsidies for graduate medical education (GME), with the states in the Northeast, West, and Northwest being among the largest beneficiaries of resident payments, and those in the Southeast, Southwest, and South Central region, where salaries are below average, receiving lower subsidies for paying residents.[7] For example, in 2007, the average GME per-resident payment to New Hampshire was $146,499 but was only $43,532 for programs in New Mexico.[6] The Institute of Medicine issued a report in July intended to overhaul GME. Among its recommendations are reforms in the payment methodology to replace these regional discrepancies with a single national, per resident amount.

 
1 of 7
 
 

References

  1. Sunshine J. The residents rise up. Medical Examiner Slate.com http://www.slate.com/articles
    /health_and_science/medical_examiner/2014/05
    /medical_residents_pay_doctors_in_training_are_organizing_for_collective.html
    Accessed July 15, 2014.

  2. Chandra A, Khullar D, Wilensky GR. The economics of graduate medical education. N Engl J Med. 2014;370:2357-2360. http://www.nejm.org/doi/full/10.1056/NEJMp1402468?query=featured_home Accessed July 15, 2014.

  3. Direct Graduate Medical Education (DGME) Centers for Medicare and Medicaid Services. CMS.gov. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dgme.html Accessed July 15, 2014.

  4. Rich EC, Liebow M, Srinivasan M, et al. Medicare financing of graduate medical education. J Gen Intern Med. 2002;17:283-292. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495035/ Accessed July 15, 2014.

  5. Grover A, Slavin PL, Willson P. The economics of academic medical centers. N Engl J Med. 2014;370:2360-2362 http://www.nejm.org/doi/full/10.1056/NEJMp1403609 Accessed July 30, 2014.

  6. Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30:193-201. http://content.healthaffairs.org/lookup/pmid?view=long&pmid=21289339 Accessed July 30, 2014.

  7. Mullan F, Chen C, Steinmetz E. The geography of graduate medical education: imbalances signal need for new distribution policies. Health Aff (Millwood). 2013;32:1914-1921. Abstract

  8. Youngclaus J, Fresne JA. Physician education debt and the cost to attend medical school, 2012 update. Association of American Medical Colleges. February 2013. https://www.aamc.org/download/328322/data/statedebtreport.pdf Accessed July 15, 2014.

  9. Association of American Medical Colleges. Medical school education: debt, costs, and loan repayment fact card. October 2013. https://www.aamc.org/download/152968/data/ Accessed July 15, 2014.

  10. Chen P. Tackling the Problem of medical student debt. The New York Times. December 13, 2012. http://well.blogs.nytimes.com/2012/12/13/tackling-the-problem-of-medical-student-debt/ Accessed July 15, 2014.

  11. McMullen L. 10 least expensive public medical schools for in-state students. May 1, 2012. US News and World Report. http://www.usnews.com/education/best-graduate-schools/the-short-list-grad-school/articles/2012/05/01/10-least-costly-public-medical-schools-for-in-state-students?s_cid=rss:10-least-costly-public-medical-schools-for-in-state-students Accessed July 31, 2014.

  12. Which medical school graduates have the most debt? Best Grad Schools 2015. US News and World Report. http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/debt-rankings/page+4 Accessed July 31, 2014.

  13. Association of American Medical Colleges. US medical schools' ongoing efforts to meet physician workforce needs. Analysis in Brief. June 2013;13(4). https://www.aamc.org/download/347038/data/june2013analysisinbrief-usmedicalschoolsongoingeffortstomeetphy.pdf Accessed July 15, 2014.

  14. US Department of Health and Human Services. The physician workforce: projection and research into current issues affecting supply and demand. December 2008. http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf Accessed July 15, 2014.

  15. Accreditation Council for Graduate Medical Education. Resident duty hours in the learning and working environment: comparison of 2003 and 2011 standard. https://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-ComparisonTable2003v2011.pdf Accessed July 15, 2014.

  16. Antiel RM, Reed DA, Van Arendonk KJ, et al. Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns. JAMA Surg. 2013;148:448-455.

  17. Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg. 2014;259:1041-1053. Abstract

  18. Desai SV, Feldman L, Brown L. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med. 2013 22;173:649-655.

  19. Fletcher KE, Reed DA, Arora V. Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules. J Gen Intern Med. 2011;26:907-919. Abstract

  20. Rosenbaum L. Why doesn't medical care get better when doctors rest more? The New Yorker. August 20, 2013. http://www.newyorker.com/online/blogs/elements/2013/08/hospital-residency-hour-limits-problem-with-medical-care.html Accessed July 15, 2014.

  21. George BP, Probasco JC, Dorsey ER, Venkatesan A. Impact of 2011 resident duty hour requirements on neurology residency programs and departments. Neurohospitalist. 2014;4:119-126.

  22. Zonia SC, LaBaere RJ 2nd, Stommel M, Tomaszewski DD. Resident attitudes regarding the impact of the 80-duty-hours work standards. J Am Osteopath Assoc. 2005;105:307-313. http://www.jaoa.org/content/105/7/307.full Accessed July 16, 2014.

  23. Liu CC, Wissow L. How post-call resident doctors perform, feel and are perceived in out-patient clinics. Med Educ. 2011;45:669-677. Abstract

  24. Desai SV, Feldman L, Brown L, et al. Effect of the 2011 vs 2003 duty hour regulation-compliant models on sleep duration, trainee education, and continuity of patient care among internal medicine house staff: a randomized trial. JAMA Intern Med. 2013;17:3649-655.

  25. Borman KR, Biester TW, Jones AT, Shea JA. Sleep, supervision, education, and service: views of junior and senior residents.J Surg Educ. 2011;68:495-501. Abstract

  26. Shea JA, Weissman A, McKinney S, Silber JH, Volpp KG. Internal medicine trainees' views of training adequacy and duty hours restrictions in 2009. Acad Med. 2012;87:889-894. Abstract

  27. Centor R. What is scutwork? DB's Medical Rants. December 4, 2008. http://www.medrants.com/archives/3970 Accessed July 16 2014.

  28. Petrany SM. Meaningful scut work. Fam Med. 2013;45;580-581. http://old.stfm.org/fmhub/fm2013/September/Stephen580.pdf Accessed July 16, 2014.

  29. Muller-Juge V, Cullati S, Blondon KS, et al Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality. PLoS One. 2014;9:e96160. doi: 10.1371/journal.pone.0096160. eCollection 2014.

  30. Smith JK, Weaver DB. Capturing medical students' idealism. Ann Fam Med. 2006;4 Suppl 1:S32-S37 http://www.annfammed.org/content/4/suppl_1/S32.long Accessed July 30, 2014.

  31. Mader EM, Roseamelia C, Morley CP. The temporal decline of idealism in two cohorts of medical students at one institution. BMC Med Educ. 2014;14:58. doi: 10.1186/1472-6920-14-58.

  32. Viola KV, Bucholz E, Yeo H, Piper C, Bell RH Jr, Sosa JA. Impact of family and gender on career goals: results of a national survey of 4586 surgery residents. Arch Surg. 2010;145:418-424. Abstract

Authors and Disclosures

Author

Carol Peckham

Director, Editorial Services, Art Science Code LLC

Disclosure: Carol Peckham has disclosed no relevant financial relationships.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.