Want to know what medical residents think about their residency training? Just ask them.
That's what Medscape, a Web-based resource for physicians and other health care professionals, did when it surveyed more than 1,700 residents in training programs -- and fellows in postgraduate training programs -- that together represent 24 medical specialties. (The report referred to all survey respondents as residents.)
The survey asked a wide range of questions about salaries, debt load, work environment, and the quality and relevance of training provided in respondents' programs. The answers to those questions and many more are revealed in the report(www.medscape.com) titled "Residents Salary & Debt Report 2015: Are Residents Happy?"
Respondents -- all of whom were enrolled in U.S. residency programs -- completed the online survey from May 14 through June 22.
Key findings are presented in an easy-to-digest slide format and, when applicable, are compared with 2014 responses. Some slides also refer to findings from a separate 2015 Medscape report on physician compensation.(www.medscape.com)
- Medscape recently released the 2015 iteration of its resident salary and debt report that asks residents questions about issues pertaining to their residency training, including salary, debt burden and satisfaction with their training program.
- Only about half of residents were "somewhat satisfied" with their residency training experience, and some said they wanted more interaction with their attending faculty.
- About 63 percent of residents surveyed said relationships with patients were the most rewarding part of their job, and 84 percent were satisfied with their career choice.
Sorting Salary Data
As soon as the report posted online, many current and soon-to-be residents likely looked at the salary data, which indicated that in 2015, the average annual salary of survey respondents was $55,400 -- just $100 more than in 2014.
Income rankings among medical specialties remained unchanged from 2014. For instance, respondents in critical care programs again drew the highest annual salary, at $62,000, followed by oncology and pulmonary medicine ($61,000) and cardiology ($60,000). Those in internal medicine and family medicine programs earned the least ($53,000).
Men made slightly more than women: $56,000 versus $55,000. And salaries varied by location, with respondents in the Northeast region topping the list at $62,000. At $51,000, those in the Southeast were paid the least.
Even so, 62 percent of respondents said they were paid a fair wage.
Comments told the story behind the dollar signs, and for some, potential earnings clearly influenced specialty choice. "Compensation is not the most important factor, but it is certainly one of the top three," wrote one respondent.
"I don't want to finish nearly 15 years of training, be a decade behind my friends, and still be net-negative for the next decade," said another.
"I got into medicine because I want to help people. However, I now have $200,000 in loans to pay off. So, yes, money is now a factor," wrote a third.
Medical school debt clearly weighed on respondents, with 37 percent owing more than $200,000 and 22 percent having debt of between $100,000 and $200,000.
As other researcher have suggested, the combination of a heavy debt load and the prospect of an income at the lower end of the physician salary spectrum continue to put the primary care pipeline at risk.
Indeed, report authors noted that 56 percent of primary care survey respondents said they planned to switch to other specialties.
Challenging the Money Myth
In an interview with AAFP News, AAFP Senior Vice President of Education Clif Knight, M.D., commented on a few survey items particularly pertinent to family medicine.
The income gap was first on his list.
"There is this myth out there in the physician world that if you just made more money, you'd be happier," said Knight. "I feel strongly that family physicians are underpaid relative to other physicians, and that needs to improve, but I also feel strongly that just making more money doesn't make people happier."
Knight said he often speaks to residents on behalf of the Academy, and he recalled a recent presentation he made to residents at the Community Health Network East Family Medicine Residency Program in Indianapolis. He shared a few slides with them from the 2015 Medscape resident survey as well as the physician compensation survey.
A slide from that 2015 compensation report depicts average physician income by specialty: Orthopedics tops the list at $421,000; family medicine hovers near the bottom at $195,000.
"I like to show that slide first" when speaking to residents, said Knight. "And then I show them the next slide that asks if physicians feel fairly compensated."
That second slide is telling, said Knight, because it shows that 48 percent of family physicians said they were fairly paid for their services compared to just 42 percent of orthopedic physicians.
"If it was all about money making physicians happy, the orthopedic surgeons should be the happiest doctors out there. They are not," said Knight.
The point he makes to residents is this: "Income is important, but it's not what sustains your happiness and satisfaction in your career. It really is the relationships and sense of accomplishment that come with improving the lives of patients," said Knight, who provided clinical care to patients for 25 years.
It seems many residents would agree; in fact, 63 percent of respondents to the Medscape survey said relationships with patients were the most rewarding part of their job.
Rating the Learning Experience
Some 32 percent of respondents were very satisfied with the learning experience their residency program provided. But 49 percent were only somewhat satisfied, 7 percent slightly so and 2 percent not at all satisfied.
"Clinical teaching is the most critical part of residency. You can always read, but you will never have the opportunity to learn under the direct supervision of an attending. In my residency, it's lacking," said one respondent.
"Attending presence is limited. Most didactic teaching is being done by other residents," said another.
"Our attendings are invested more in their practices than in resident education," commented a third.
"As an educator, it concerns me that half of residents are only 'somewhat satisfied' with their learning experience," said Knight. "You would expect the learners to be very much satisfied with the learning experience if we were doing a good job."
Knight challenged those working in the education community to ensure that resident experiences matched what educators were trying to accomplish in residency training. "Based on the survey comments, what I'm hearing is that residents want more human interaction with their faculty -- with their attendings," he said.
Realigning Work Settings
A full 70 percent of survey respondents reported that they worked in hospital settings. "This was a survey of residents across all specialties," said Knight. "If you look at subspecialties such as anesthesiology and radiology, a majority of those residents train in hospitals, and that makes sense.
"However, in family medicine, we recognize that training residents in the clinical settings where they'll likely be practicing is most important, and that's why we're seeing a shift away from training family medicine residents in hospitals in favor of community-based settings," he said.
Finally, Medscape asked survey respondents if they still looked forward to being a doctor in practice.
"Many practicing physicians believe that medicine is rife with problems and frustrations," wrote the authors. "And residents are far from starry-eyed optimists. … But despite all of the complaints they've probably heard from practicing physicians, fully 84 percent of residents are still looking forward to being a doctor." Just 11 percent were having second thoughts and 4 percent said they made the wrong career choice.
"It was good to see that overwhelming 84 percent," Knight said, but there's still work to be done. "The challenge for the medical community -- and for those involved in training physicians -- is to figure out how to keep burnout at bay so that no physician will ever regret his or her decision to become a physician," he asserted.
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