Background. Because of recent changes in physician reimbursement and managed care penetration, we wanted to examine the financial returns that medical students might anticipate when considering different careers. Methods. We used standard financial techniques to calculate the return on educational investment for 5 surgical specialties (general surgery, otolaryngology, ophthalmology, orthopedic surgery, and urology) and primary care medicine between 1992 and 1998. Results. The annual yield on specialty training fell for all specialties examined, from an average of 15% to 3% for primary care specialties, and from an average of 36% to 19% for surgical specialties. The difference in the average future hourly income between a given specialty and general practice decreased for all surgical specialties (for general surgery, from $12.03 in 1992 to $9.89 in 1998; otolaryngology, from $21.37 to $5.56; ophthalmology, from $14.12 to $7.15; orthopedic surgery, from $21.16 to $18.91), except urology (from $13.81 in 1992 to $14.84 in 1998). Returns became negative for primary care medicine, dropping from $1.72 to −$1.21. Conclusion. Efforts to create a “level playing field” within medicine have resulted in decreased returns on educational investment across all specialties. Financial returns and the incentives they create should be carefully considered as part of health care reform. (Surgery 2002;132:795-802.)
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Accepted: July 16, 2002
*The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government.
**Reprint requests: William B. Weeks, MD, MBA, Veterans Administration Medical Center (11Q), White River Junction, VT 05009.
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.