Survey: Final-year Residents Seeking High Salaries but Receiving Fewer Job Offers

Aine Cryts

May 19, 2021

Final-year medical residents expect high salary offers in their first roles as physicians, but that could be a mismatch for health systems still reeling from COVID-19.

According to the 2021 Survey of Final-Year Medical Residents, conducted by Merritt Hawkins, earning a good income was very concerning or somewhat concerning for 93% of residents. That's up from 88% in 2019. Since 1991, the Dallas-based physician search and consulting firm has surveyed physicians in their final year of residency training to discover their career choices, plans, and expectations.

In addition, a gender disparity exists between the expectations of male and female residents. Seventy-six percent of male residents expect to earn $251,000 or more during their first year of practice, whereas only 38% of female residents expect to draw that annual salary.

Janis Orlowski, MD, chief healthcare officer at the Association of American Medical Colleges (AAMC), recommended that final-year residents put aside, for the short term, their mounting medical school debt. Most residents don't realize the hours they'll need to work to earn $300,000 a year, she says. New doctors aren't thinking about this in terms of relative value units, whereas practices and hospitals do have this in mind in setting salaries.

The question residents should ask is this: How hard do I want to work to earn that $300,000?

"There's some balancing between this salary and how hard you work...and your lifestyle. They'll start to make these choices [as they continue in their careers]," said Orlowski.

Female Residents Get More Job Offers but Expect Lower Salaries

Although salary demands by new doctors are high, the offers are on the decline. Overall, only 62% of final-year residents received 26 or more recruiting offers during their training in 2020, down from 82% a year prior.

Seventy percent of female residents received 26 or more job solicitations during their training. By comparison, only 54% of their male colleagues received that number. Still, female residents expect to draw lower salaries than male residents, according to the survey.

Orlowski encourages women to conduct research on salaries. She also says female residents have to get comfortable asking for a salary that's higher than they're offered. Orlowski said residents should consult benchmarks such as Merritt Hawkins' Review of Physician and Advanced Practitioner Recruiting Incentives and physician compensation data from Medical Group Management Association and the American Medical Group Association.

In addition, female and male final-year residents should ask the healthcare organization how the compensation package they're offered compares with that offered to physicians with a similar level of experience, she said.

Residents Don't Want to Practice in Rural Areas

Hospitals and practices in rural areas will need to think creatively about ways to attract young doctors. According to the survey, none of the medical residents wanted to live in a community of 10,000 people or fewer. Only 3% would prefer to live in a community of 25,000 people or fewer.

Orlowski has two pieces of advice for hospitals and practices in rural areas that want to attract these young doctors.

First, build a team-based approach to care, if it doesn't already exist. Final-year residents are used to working in teams alongside other doctors, social workers, nurses, and dietitians.

Employers should also wrap the community around these young physicians. Doctors starting in their first jobs will be interested in the school district and job opportunities for their spouses, says Orlowski. It's also important to welcome the new doctor's family to their new community, which means inviting them and their children to baseball games and community events.

Michael Belkin, divisional vice president of recruiting at Merritt Hawkins, which conducted the survey, advises rural healthcare organizations to emphasize loan forgiveness programs. These programs typically require the physician to remain with the healthcare organization from 4 to 5 years, during which time they receive an average of $20,000 in loan forgiveness annually. According to AAMC, the mean educational debt after medical school is $207,003, up 3% from 2019, when the survey was last conducted.

Quality-of-Life Issues Drive Job Choice

Fifty-eight percent of medical residents experienced feelings of burnout sometimes, often, or always during their training, according to the survey. That experience appears to drive main concerns when choosing a job. Factors include geographic location (80%), having adequate personal time (75%), and lifestyle (73%).

To prevent burnout, Belkin advises new physicians to think about their "true priorities." For example, he tells them to think beyond the desire to spend time at the beach or live in a big city. Some quality-of-life options to consider are a 4-day work week or the ability to live near family. "Self-awareness is key to not getting caught into the trap that will lead to burnout," he said.

"Young doctors don't think about it when they're getting inundated with so many job opportunities, and they're thinking about the shiniest financial offer in the best-looking city. They realize too late that job expectations are an important consideration," added Belkin.

Fewer Final-Year Residents Responded This Year

Merritt Hawkins received a lower response to the 2021 survey than it did in 2019, the last year the survey was conducted. In 2019, the recruiting firm received 391 responses, whereas 103 final-year residents responded to this year's survey. As a result, this year's survey is a "nonscientific 'pulse' survey," and caution should be taken when trying to extrapolate the survey results to all final-year medical residents.

The drop in responses may be due, in part, to the disruption by COVID-19 on medical residents and professionals throughout the US healthcare system, according to the company. Residents received the survey by email in February and March. The results were compiled in April, and a report about the survey was released in May.

Aine Cryts is a veteran health IT and healthcare writer based out of Boston.

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