Inclan Paul M, Hyde Adam S, Hulme Michael, Carter Jeffrey E
Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Am Surg. 2016 Sep;82(9):794-800.
Surgical residents cite increased income potential as a motivation for pursuing fellowship training, despite little evidence supporting this perception. Thus, our goal is to quantify the financial impact of surgical fellowship training on financial career value. By using Medical Group Management Association and Association of American Medical Colleges physician income data, and accounting for resident salary, student debt, a progressive tax structure, and forgone wages associated with prolonged training, we generated a net present value (NPV) for both generalist and subspecialist surgeons. By comparing generalist and subspecialist career values, we determined that cardiovascular (NPV = 698,931), pediatric (430,964), thoracic (239,189), bariatric (166,493), vascular (96,071), and transplant (46,669) fellowships improve career value. Alternatively, trauma (11,374), colorectal (44,622), surgical oncology (203,021), and breast surgery (326,465) fellowships all reduce career value. In orthopedic surgery, spine (505,198), trauma (123,250), hip and joint (60,372), and sport medicine (56,167) fellowships improve career value, whereas shoulder and elbow (4,539), foot and ankle (173,766), hand (366,300), and pediatric (489,683) fellowships reduce career NPV. In obstetrics and gynecology, reproductive endocrinology (352,854), and maternal and fetal medicine (322,511) fellowships improve career value, whereas gynecology oncology (28,101) and urogynecology (206,171) fellowships reduce career value. These data indicate that the financial return of fellowship is highly variable.
外科住院医师将增加收入潜力作为追求专科培训的一个动机，尽管几乎没有证据支持这种看法。因此，我们的目标是量化外科专科培训对财务职业价值的财务影响。通过使用医疗集团管理协会和美国医学院协会的医生收入数据，并考虑住院医师工资、学生债务、累进税制以及与延长培训相关的工资损失，我们计算了普通外科医生和专科外科医生的净现值（NPV）。通过比较普通外科医生和专科外科医生的职业价值，我们确定心血管（NPV = 698,931）、儿科（430,964）、胸科（239,189）、减肥（166,493）、血管（96,071）和移植（46,669）专科培训提高了职业价值。相反，创伤（11,374）、结直肠（44,622）、外科肿瘤学（203,021）和乳腺外科（326,465）专科培训都降低了职业价值。在骨科手术中，脊柱（505,198）、创伤（123,250）、髋关节和膝关节（60,372）以及运动医学（56,167）专科培训提高了职业价值，而肩肘（4,539）、足踝（173,766）、手部（366,300）和儿科（489,683）专科培训降低了职业净现值。在妇产科，生殖内分泌学（352,854）和母胎医学（322,511）专科培训提高了职业价值，而妇科肿瘤学（28,101）和女性盆底医学（206,171）专科培训降低了职业价值。这些数据表明专科培训的财务回报差异很大。
