title: Economic impact of a primary care career: a harsh reality for medical students and the nation.
abstract: OBJECTIVE
  The ranks of U.S. medical students choosing careers in primary care (PC) are declining even as the demand for new PC physicians is increasing. Although the decision to choose a career in PC is multifactorial, financial security in the setting of rising medical student debt is often cited as a reason to pursue other medical specialties. The authors sought to quantify the financial factors associated with a career in PC.
  
  
  METHODS
  The authors used economic modeling, which employs a variety of factors, to develop a net income and expense model. They attempted to account for the variability of factors by looking at best, worst, and average expense scenarios. They used published retrospective data from the Bureau of Labor Statistics, the 2007 Physician Compensation Survey, the National Association of Realtors, the College Board, and U.S. News and World Report regarding medical student debt, physician reimbursement, retirement planning, college savings, and cost-of-living expenses to develop their models.
  
  
  RESULTS
  PC salaries, in contrast to other subspecialties, result in an initial budgetary deficit and decreased discretionary spending. This gap closes as PC physician income rises in the first few years of practice. Only under scenarios of optimal low cost assumptions or no debt do a PC physician's initial earnings exceed predicted expenses.
  
  
  CONCLUSIONS
  PC physicians, in the first three to five years following residency, will have expenses that exceed earnings. This reality greatly increases the financial disincentive for pursuing a career in PC compared with other fields of medicine.
authors.affiliation: Department of Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Hanover, New Hampshire, USA. martin.palmeri@hitchcock.org
authors.forename: Martin
authors.initials: M
authors.lastname: Palmeri
authors.forename: Catherine
authors.initials: C
authors.lastname: Pipas
authors.forename: Eric
authors.initials: E
authors.lastname: Wadsworth
authors.forename: Michael
authors.initials: M
authors.lastname: Zubkoff
mesh_terms: D002321:Career Choice; D006801:Humans; D007182:Income; D018803:Models, Economic; D058007:Physicians, Primary Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000191:economics*; D013337:Students, Medical; D014481:United States; D000078329:Workforce