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Effect of Financial Remuneration on Specialty Choice of Fourth-Year U.S. Medical Students

DeZee, Kent J. MD, MPH; Maurer, Douglas DO, MPH; Colt, Ross MD, MBA; Shimeall, William MD, MPH; Mallory, Renee MD, MPH; Powers, John MD, MSS; Durning, Steven J. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e3182045ec9
Specialty and Career Choice

Purpose: To investigate whether financial incentives could reverse the trend of declining interest in primary care specialties among U.S. medical students.

Method: An electronic survey was sent to all U.S. fourth-year MD and DO medical students in 2009 with a Department of Defense service obligation. Students not selecting a primary care residency were asked if a hypothetical bonus paid before and after residency or an increase in annual salary of attendings in primary care specialties would have resulted in these students selecting primary care. Logistic regression was used to determine student characteristics associated with accepting a financial incentive.

Results: The survey response rate was 56% (447/797). Sixty-six percent of students did not apply for a primary care residency. Of these, 30% would have applied for primary care if they had been given a median bonus of $27,500 (interquartile range [IQR] $15,000–$50,000) before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000 (IQR $150,000–$200,000). Students who considered primary care but chose a controllable lifestyle specialty (e.g., radiology) were nearly four times more likely to name an influential hypothetical salary than were students who did not consider primary care and chose a noncontrollable lifestyle specialty (e.g., surgery) (67% versus 17%, P < .0001).

Conclusions: U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.

Author Information

Dr. DeZee is associate professor and general medicine fellowship director, Department of Medicine, Uniformed Services University, Bethesda, Maryland.

Dr. Maurer is family medicine residency program director, Carl R. Darnall Army Medical Center, Fort Hood, Texas.

Dr. Colt is deputy commander of clinical services, Vicenza Health Clinic, Vicenza, Italy.

Dr. Shimeall is internal medicine residency program director, National Naval Medical Center, Bethesda, Maryland.

Dr. Mallory is internal medicine attending physician, Walter Reed Army Medical Center, Washington, DC.

Dr. Powers is chief, Directorate of Medical Education, Office of the Surgeon General, Falls Church, Virginia.

Dr. Durning is professor, Department of Medicine, Uniformed Services University, Bethesda, Maryland.

Supplemental digital content for this article is available at

Correspondence should be addressed to Dr. DeZee, 4301 Jones Bridge Rd.–EDP, Bethesda, MD 20814; telephone: (202) 782-5603; fax: (202) 782-7363; e-mail:

© 2011 Association of American Medical Colleges