Purpose: The physician payment system is a focus of potential reform in the United States. The authors explored the effects of the military's method of physician payment on physicians' returns on educational investment for several specialties.
Method: This retrospective, observational study used national data from 2003 and standard financial techniques to calculate the net present value—the current value of an expected stream of cash flows at a particular rate of interest—of the educational investments of medical students in ten 30-year career paths: either military or civilian careers in internal medicine, psychiatry, gastroenterology, general surgery, or orthopedics.
Results: At a 5% discount rate, in the civilian world, the lowest return on an educational investment accrued to psychiatrists ($1.136 million) and the highest to orthopedists ($2.489 million), a range of $1.354 million. In the military, the lowest returns accrued to internists ($1.377 million) and the highest to orthopedists ($1.604 million); however, the range was only $0.227 million, one-sixth that found in the civilian sector. The authors also found that most military physicians do not remain in the military for their full careers.
Conclusions: Choosing a military career substantially decreases the net present value of an educational investment for interventionalists, but it does so only modestly for primary care physicians. Further, a military career path markedly diminishes specialty-specific variation in the net present values of educational investment. Adopting a military structure for engaging medical students might help reverse the current trend of declining interest in primary care.
Dr. Cronin is a recent graduate, Dartmouth Medical School and Tuck School of Business, Hanover, New Hampshire; he is completing a transitional internship at Naval Medical Center, San Diego, California.
Ms. Morgan is in her last year of the MD/MBA program, Dartmouth Medical School and Tuck School of Business, Hanover, New Hampshire.
Dr. Weeks is associate professor and core faculty member, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
Correspondence should be addressed to Ms. Morgan, Dartmouth Medical School, 466 Kellogg Building, Hanover, NH 03755; e-mail: Jessica.email@example.com.