title: Effect of financial remuneration on specialty choice of fourth-year U.S. medical students.
abstract: OBJECTIVE
  To investigate whether financial incentives could reverse the trend of declining interest in primary care specialties among U.S. medical students.
  
  
  METHODS
  An electronic survey was sent to all U.S. fourth-year MD and DO medical students in 2009 with a Department of Defense service obligation. Students not selecting a primary care residency were asked if a hypothetical bonus paid before and after residency or an increase in annual salary of attendings in primary care specialties would have resulted in these students selecting primary care. Logistic regression was used to determine student characteristics associated with accepting a financial incentive.
  
  
  RESULTS
  The survey response rate was 56% (447/797). Sixty-six percent of students did not apply for a primary care residency. Of these, 30% would have applied for primary care if they had been given a median bonus of $27,500 (interquartile range [IQR] $15,000-$50,000) before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000 (IQR $150,000-$200,000). Students who considered primary care but chose a controllable lifestyle specialty (e.g., radiology) were nearly four times more likely to name an influential hypothetical salary than were students who did not consider primary care and chose a noncontrollable lifestyle specialty (e.g., surgery) (67% versus 17%, P < .0001).
  
  
  CONCLUSIONS
  U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.
authors.affiliation: Department of Medicine, Uniformed Services University, Bethesda, Maryland 20814, USA. kent.dezee@us.army.mil
authors.forename: Kent J
authors.initials: KJ
authors.lastname: DeZee
authors.forename: Douglas
authors.initials: D
authors.lastname: Maurer
authors.forename: Ross
authors.initials: R
authors.lastname: Colt
authors.forename: William
authors.initials: W
authors.lastname: Shimeall
authors.forename: Renee
authors.initials: R
authors.lastname: Mallory
authors.forename: John
authors.initials: J
authors.lastname: Powers
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Durning
mesh_terms: D000328:Adult; D002321:Career Choice; D003430:Cross-Sectional Studies; D006801:Humans; D007396:Internship and Residency; D008019:Life Style; D011320:Primary Health Care / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics*; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States