Puri Pranav, Landman Natalie, Smoldt Robert K, Cortese Denis
Alix School of Medicine, Mayo Clinic, Scottsdale, USA.
Center for Healthcare Delivery and Policy, Arizona State University, Phoenix, USA.
Cureus. 2021 Feb 10;13(2):e13272. doi: 10.7759/cureus.13272.
Background The factors influencing medical student clinical specialty choice have important implications for the future composition of the US physician workforce. The objective of this study was to determine the career net present values (NPVs) of US medical students' clinical specialty choices and identify any relationships between a specialty's NPV and competitiveness of admissions as measured by the US Medical Licensing Examination (USMLE) Step 1 scores. Methodology NPVs were calculated using the results of the 2019 Doximity Physician Compensation report, a survey of 90,000 physicians. Mean USMLE Step 1 scores for matched US allopathic seniors in the 2018 National Resident Matching Program were used as a measure of clinical specialties' competitiveness of admissions. We calculated a composite measure of NPV and annual work-hours by dividing each specialty's NPV by the reported average number of hours worked per year. Results In our analysis, orthopedic surgery had the highest NPV ($10,308,868), whereas family medicine had the lowest NPV ($5,274,546). Dermatology and plastic surgery had the highest mean USMLE Step 1 scores (249 for both), whereas family medicine had the lowest (220). Clinical specialties' NPVs were positively associated with mean USMLE Step 1 scores (Pearson's r = 0.82; p < 0.001). Conclusions In this study, we describe associations suggesting that medical students respond to financial incentives in choosing clinical specialties and that these decisions are mediated by USMLE Step 1 scores. This underscores the importance of titrating and aligning incentives to improve the allocation of medical students into clinical specialties.
背景 影响医学生临床专业选择的因素对美国医生劳动力的未来构成具有重要意义。本研究的目的是确定美国医学生临床专业选择的职业净现值（NPV），并确定专业的NPV与美国医师执照考试（USMLE）第一步成绩所衡量的录取竞争力之间的关系。方法 使用2019年Doximity医生薪酬报告（对90,000名医生的调查）结果计算NPV。2018年全国住院医师匹配计划中匹配的美国全科医学高年级学生的USMLE第一步平均成绩用作临床专业录取竞争力的衡量标准。我们通过将每个专业的NPV除以报告的每年平均工作小时数来计算NPV和年工作小时数的综合指标。结果 在我们的分析中，骨科手术的NPV最高（10,308,868美元），而家庭医学的NPV最低（5,274,546美元）。皮肤科和整形外科的USMLE第一步平均成绩最高（均为249分），而家庭医学的成绩最低（220分）。临床专业的NPV与USMLE第一步平均成绩呈正相关（Pearson's r = 0.82；p < 0.001）。结论 在本研究中，我们描述的关联表明医学生在选择临床专业时会对经济激励做出反应，并且这些决定由USMLE第一步成绩介导。这强调了调整和调整激励措施以改善医学生在临床专业中的分配的重要性。
