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Future Salary and Medical Student Specialty Choice

William Hueston, MD
JAMA. 2009;301(8):826-827. doi:10.1001/jama.2009.161
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To the Editor: The Research Letter by Dr Ebell1 suggested that US senior medical student interest in specialties is related to mean specialty salary. However, Ebell used as his measure of interest the US senior fill rate in each specialty in the match program. In my view, this is an incorrect metric of interest because it depends entirely on the denominator (how many positions are offered within a specialty). The number of positions available in a specialty has nothing to do with student interest but rather reflects local needs of hospitals, specialty interests, and other factors unrelated to students.

A better gauge of student interest is the numerator (how many students selected the specialty). For example, in looking at the Figure in the study by Ebell, it may appear that no one is going into family medicine. However, more US seniors chose this residency specialty than all but 2 other specialties (internal medicine and pediatrics).

Replotting the Table data in the study by how many US seniors entered training in each specialty compared with mean overall salary (Figure), there appears to be very little correlation; if any, it seems to be negative. Perhaps more students would choose the higher-salary specialties if more positions were available, but that argument only illustrates the difficulty of trying to gauge the rationale for difficult personal decisions using aggregated data.

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Figure. Number of Residency Positions Filled With US Seniors vs Mean Overall Income by Specialty
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ENT indicates otolaryngology; Ob/gyn, obstetrics/gynecology.

AUTHOR INFORMATION

Financial Disclosures: None reported.

REFERENCES

Ebell MH. Future salary and US residency fill rate revisited.  JAMA. 2008;300(10):1131-1132
PubMedCrossRef

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Figure. Number of Residency Positions Filled With US Seniors vs Mean Overall Income by Specialty
Grahic Jump Location

ENT indicates otolaryngology; Ob/gyn, obstetrics/gynecology.

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Ebell MH. Future salary and US residency fill rate revisited.  JAMA. 2008;300(10):1131-1132
PubMedCrossRef
February 25, 2009
Mark H. Ebell, MD, MS
JAMA. 2009;301(8):826-827.
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