Share this article on:

Economic Impact of a Primary Care Career: A Harsh Reality for Medical Students and the Nation

Palmeri, Martin MD, MBA; Pipas, Catherine MD; Wadsworth, Eric PhD, MBA; Zubkoff, Michael PhD

doi: 10.1097/ACM.0b013e3181f5b754
Primary Care Careers

Purpose The ranks of U.S. medical students choosing careers in primary care (PC) are declining even as the demand for new PC physicians is increasing. Although the decision to choose a career in PC is multifactorial, financial security in the setting of rising medical student debt is often cited as a reason to pursue other medical specialties. The authors sought to quantify the financial factors associated with a career in PC.

Method The authors used economic modeling, which employs a variety of factors, to develop a net income and expense model. They attempted to account for the variability of factors by looking at best, worst, and average expense scenarios. They used published retrospective data from the Bureau of Labor Statistics, the 2007 Physician Compensation Survey, the National Association of Realtors, the College Board, and U.S. News and World Report regarding medical student debt, physician reimbursement, retirement planning, college savings, and cost-of-living expenses to develop their models.

Results PC salaries, in contrast to other subspecialties, result in an initial budgetary deficit and decreased discretionary spending. This gap closes as PC physician income rises in the first few years of practice. Only under scenarios of optimal low cost assumptions or no debt do a PC physician's initial earnings exceed predicted expenses.

Conclusions PC physicians, in the first three to five years following residency, will have expenses that exceed earnings. This reality greatly increases the financial disincentive for pursuing a career in PC compared with other fields of medicine.


Dr. Palmeri is fellow and instructor, Department of Hematology/Oncology, Dartmouth–Hitchcock Medical Center, Dartmouth Medical School, Hanover, New Hampshire.

Dr. Pipas is associate professor and vice chair, Department of Community and Family Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, New Hampshire, assistant dean, Dartmouth Medical School, Hanover, New Hampshire, and director, Dartmouth–Hitchcock Regional Primary Care Center, Lebanon, New Hampshire.

Dr. Wadsworth is assistant professor, Dartmouth Institute for Health Policy & Clinical Practice, and director of professional education and outreach, Dartmouth College, Hanover, New Hampshire.

Dr. Zubkoff is professor and chair, Department of Community and Family Medicine, Dartmouth–Hitchcock Medical Center, Dartmouth Medical School, professor of health economics and management, Tuck School of Business, and director of the MD/MBA program, Dartmouth College, Hanover, New Hampshire.

Correspondence should be addressed to Dr. Palmeri, Dartmouth–Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756; telephone: (603) 650-6312; fax: (603) 653-0610; e-mail:

Supplemental digital content is available for this article at Clickable links to the material are provided in the HTML text and PDF of this article on the journal's Web site (

© 2010 Association of American Medical Colleges