Survey: Specialty Chosen by More Than Salary, Despite Debt

Alicia Ault

August 11, 2016

A common assumption is that medical students' selection of a specialty is heavily influenced by earnings potential. However, a new survey by Medscape shows that the choice is mostly driven by personal interest, despite concerns voiced by students about handling school debt.

In a wide-ranging survey of 2000 current students, almost evenly split between men and women, slightly more than half overall said they had not chosen a specialty yet. A quarter of fourth-year and more than half of third-year students were still thinking over their options. Most of those who had decided were fourth-year students. Almost half of third-year students had also selected their specialty.

About 70% overall said they honed in on a specialty primarily because of personal interest. That reason was especially strong among women, with 75% citing personal interest, compared with 63% of men.

The lifestyle offered by a particular specialty was the second-most-cited reason, but only by 19% of student respondents. Lifestyle was more of an influence for men than for women.

The students were not primarily motivated by career or research opportunities when it came to choosing a specialty. At the very bottom of reasons — cited by just 1% of students for each — were prestige and potential earnings.

Although future earnings may not have been the main reason for specialty choice, it still weighed heavily on many students' minds, in particular, on men's minds, perhaps because they anticipated having a higher debt load: Just over 40% said they would have more than $200,000 to pay back. When asked about the importance of potential future earnings and specialty choice, 41% of men said that income was extremely or very important, compared with only 28% of female students.

An almost equal number of men and women said income was moderately important (44% of men compared with 47% of women). Only 15% of male students said that future earnings did not come into play when choosing a specialty, compared with a quarter of women.

With 30% of students saying they were taking on $100,000 to $200,000 in debt and 38% taking on more than $200,000, it is not surprising future earnings are a concern. Although 43% of students said they felt prepared for their financial future, almost the same proportion said they were not ready. The anxiety was higher for students with more than $200,000 in loans, with more than half saying they did not feel like they would be financially equipped to handle that debt.

Among those who had chosen a specialty, the most popular was family practice and general medicine, selected by 12% of students. Pediatrics and obstetrics/gynecology were popular with women, whereas cardiology was more popular with male students. Plastic surgery and dermatology — both high-earning fields with potentially more favorable lifestyles — were selected by only 1% of students.

Geriatrics, hematology, nephrology, rheumatology, endocrinology, and pulmonary medicine were each selected by less than 1% of respondents.

Medicine a Calling

The vast majority of students had altruistic reasons for choosing medicine as a profession. Respondents said medicine was a way to help others in need and that it was a calling for them.

A large number also said they were attracted to medicine because of their personal interest in science. Prestige and compensation were also cited as motivating factors, more often by men than by women. However, having a physician in the family was only a small influence.

The decision to follow their heart to medicine was made early in life — before high school — for a quarter of the students. For the rest, the decision primarily came in high school or college.

The choice of where to go to school was proscribed for a third of respondents because they had been accepted by only one program. Location was the next most important reason, cited by a quarter of students.

Most students were satisfied with their learning experience and would recommend their program to others.

Stress and trying to find a balance between work and life were the biggest challenges cited. And although half of students said they sometimes felt symptoms of burnout, 80% said they had never, or had rarely, considered leaving medical school.

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