赚钱的关键因素使学生从初级保健职业中驱动学生

Primary care physicians are at the heart of health care in the United States, and are often the first to diagnose patients and ensure those patients receive the care they need. But researchers from North Carolina State University, East Carolina University (ECU) and the Albert Einstein College of Medicine of Yeshiva University in New York have found that many students are choosing to pass up a career in primary care because those physicians make substantially less money than specialists, such as dermatologists or radiologists.

“我们发现，高收入溢价的学生和预计拥有大量学生债务的学生更有可能从事高薪医学专业，而不是成为初级保健医生，” Lori Foster Thompson博士说。北卡罗来纳州立大学心理学教授和描述研究的论文的合着者。“即使对于进入医学院的学生来说，这也是如此，目的是成为初级保健医生 - 他们经常在毕业前转向高薪专业。”

The study, published online this week inMedical Education, surveyed more than 2,500 medical students attending New York Medical College and the Brody School of Medicine at ECU between 1993 and 2012. Students were surveyed at the beginning of their first year of medical school and just before graduation four years later. The survey asked the students what sort of medical career they planned to pursue, to estimate their final student loans and to rate the value they place on income.

然后，研究人员研究了那些计划从事初级保健职业的学生，​​以及那些计划根据2010年的薪水数据追求每年中位收入超过300,000美元的专业中的任何一个学生。相比之下，初级保健医师的中位收入为每年不到20万美元。初级保健由内科，家庭医学和儿科组成。

The study found that anticipated debt was a significant factor in the students’ career decisions. Graduating students who pursued high-paying specialties were facing average student loans of approximately $104,000, whereas those who chose primary care faced an average debt of less than $94,000. Students facing higher debt were also more likely to switch to high-paying specialties – including more than 30 percent of students who had expected to become primary care physicians when they entered medical school.

一年级,毕业的学生选择聚氨酯rsue one of the high-paying specialties also rated income as being significantly more important than students who chose to pursue primary care. In addition, those graduating students who felt income was more important than they had as first-years were more likely to have switched to a high-paying specialty.

其他因素指导学生关于哪些专业的决定包括父母或同伴压力，生活方式的欲望以及一旦学生到达医学院的专业，但对更多专业的暴露，尽管这项研究并未具体研究这些问题。

“The other major factor in choosing a primary care career is a service commitment – wanting to help others,” adds Dr. Dale Newton, a professor of pediatrics at ECU. “Measuring such a commitment in a research setting is very difficult, however.”

该研究表明，应探讨措施，以鼓励初级保健职业，例如激励薪酬，债务宽恕，额外的奖学金和对初级保健服务的更高补偿，以满足日益增长的需求。

此外，牛顿说：“如果目前的医疗改革努力继续进行，那么未来几年的初级保健医生的收入应有所改善。初级保健必须在新的医疗保健范式中发挥重要作用。”

The study’s findings come as the Association of American Medical Colleges projects a shortage of 63,000 physicians by 2015, the vast majority of those in primary care.

The paper, “Payback Time: The Association of Debt and Income with Medical Student Career Choice,” was published online Sept. 19 in the journalMedical Education并由阿尔伯特·爱因斯坦医学院的玛莎·格雷森（Martha Grayson）博士合着。研究时期，格雷森在纽约医学院。

- 船员 -

给编辑的注释：The study abstract follows.

“回报时间：债务和收入与医学学生职业选择的关联”

Authors: Martha S. Grayson, Albert Einstein College of Medicine; Dale A. Newton, East Carolina University; Lori Foster Thompson, North Carolina State University

Published: online Sept. 19 inMedical Education

Abstract:背景：随着美国即将进行的医疗改革，必须增加选择初级保健职业的学生人数。需要研究以更好地了解经济因素在医学学生职业选择中的作用。这项研究的目的是通过比较计划初级保健职业（PC）的学生与渴望获得超过300,000美元超过300,000美元的十二个非主要护理领域的学生（PC）来检查债务，收入和职业选择之间的关系非主要护理HPNPC）。方法：调查（回应率= 81％）是针对计划在1996年至2012年之间毕业的第一年（M1）学生，以及1993年至2010年之间毕业的学生。受访者是纽约医学院和学院的学生East Carolina University’s Brody School of Medicine. Analyses focused on the 2674 M1 respondents choosing a PC (N=1437; 54%) or HPNPC (N=1237; 46%) career, and the 2307 M4 respondents intending to pursue PC (N=992; 43%) or HPNPC (N=1315; 57%). Longitudinal analyses examining changes in career goals during medical school were based on students who completed both M1 and M4 surveys. The outcome measures studied were self-reported debt, anticipated income, and the self-rated value placed on income. Results: Relative to their PC counterparts, students intending to pursue HPNPC careers anticipated an average of $24,904(M4) – $29,237 (M1) greater debt, placed a higher importance value on income, and anticipated an average of $58,463(M1) – $89,909(M4) more in annual income after graduation. Debt was associated with the value placed on income when choosing a career and the amount of future income anticipated. Students who valued income highly were especially inclined to switch out of PC during medical school. The switch away from PC was associated with debt as well as a marked increase in anticipated income. Conclusions: Debt and income are important concerns which may shape the future supply of primary care physicians.