Baimas-George Maria, Fleischer Brian, Slakey Douglas, Kandil Emad, Korndorffer James R, DuCoin Christopher
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
J Surg Educ. 2017 Nov-Dec;74(6):e62-e66. doi: 10.1016/j.jsurg.2017.06.027. Epub 2017 Jul 10.
It is believed that spending additional years gaining expertise in surgical subspecialization leads to higher lifetime revenue. Literature shows that more surgeons are pursuing fellowship training and dedicated research years; however, there are no data looking at the aggregate economic impact when training time is accounted for. It is hypothesized that there will be a discrepancy in lifetime income when delay to practice is considered.
Data were collected from the Medical Group Management Association's 2015 report of average annual salaries. Fixed time of practice was set at 30 years, and total adjusted revenue was calculated based on variable years spent in research and fellowship. All total revenue outcomes were compared to general surgery and calculated in US dollars.
The financial data on general surgeons and 9 surgical specialties (vascular, pediatric, plastic, breast, surgical oncology, cardiothoracic, thoracic primary, transplant, and trauma) were examined.
With fellowship and no research, breast and surgical oncology made significantly less than general surgery (-$1,561,441, -$1,704,958), with a difference in opportunity cost equivalent to approximately 4 years of work. Pediatric and cardiothoracic surgeons made significantly more than general surgeons, with an increase of opportunity cost equivalent to $5,301,985 and $3,718,632, respectively. With 1 research year, trauma surgeons ended up netting less than a general surgeon by $325,665. With 2 research years, plastic and transplant surgeons had total lifetime revenues approximately equivalent to that of a general surgeon.
Significant disparities exist in lifetime total revenue between surgical subspecialties and in comparison, to general surgery. Although most specialists do gross more than general surgeons, breast and surgical oncologists end up netting significantly less over their lifetime as well as trauma surgeons if they do 1 year of research. Thus, the economic advantage of completing additional training is dependent on surgical field and duration of research.
人们认为，花费更多时间在外科亚专业领域积累专业知识会带来更高的终身收入。文献表明，越来越多的外科医生正在寻求专科培训和专门的研究时间；然而，尚无数据研究考虑培训时间时的总体经济影响。据推测，考虑延迟执业时，终身收入会存在差异。
数据收集自医疗集团管理协会2015年的平均年薪报告。设定固定执业时间为30年，并根据在研究和专科培训中花费的可变年数计算总调整后收入。所有总收入结果均与普通外科进行比较，并以美元计算。
研究了普通外科医生以及9个外科亚专业（血管外科、小儿外科、整形外科、乳腺外科、外科肿瘤学、心胸外科、胸外科、移植外科和创伤外科）的财务数据。
在接受专科培训且无研究经历的情况下，乳腺外科和外科肿瘤学的收入显著低于普通外科（分别低1,561,441美元和1,704,958美元），机会成本差异相当于大约4年的工作收入。小儿外科医生和心胸外科医生的收入显著高于普通外科医生，机会成本分别增加5,301,985美元和3,718,632美元。有1年研究经历时，创伤外科医生最终的净收入比普通外科医生少325,665美元。有2年研究经历时，整形外科医生和移植外科医生的终身总收入大致与普通外科医生相当。
外科亚专业之间以及与普通外科相比，终身总收入存在显著差异。尽管大多数专科医生的总收入确实高于普通外科医生，但乳腺外科和外科肿瘤学医生一生的净收入显著较低，如果创伤外科医生进行1年研究，其净收入也会显著降低。因此，完成额外培训的经济优势取决于外科领域和研究时长。
