RICH DOC, POOR DOC

Why do the most important kinds of doctors earn the least money? 

- NATHAN KOHRMAN

FOR NEARLY THREE years of med school, I teased my friends who wanted to specialize in surgery. I'd heard stories of tantrums in the operating room, of residents too tired to be friendly, much less teach. But the first time I sutured a jumbled gash into a thin, smooth line, I knew I wanted to be a surgeon.

All medical students tell a version of this story, most of us acting as if our hero's journey has nothing to do with the money. But everything in medicine is about the money in some way or another. The higher a specialty's salary, the more people want to do it and the more competitive it becomes. As medical burnout has become practically universal, flexible specialties like radiology are becoming more popular, as students flee specialties like emergency medicine that put them on the front lines of American poverty and, more recently, a flat-footed pandemic response. Pediatrics, family medicine, and primary care do more than other specialties to extend patients' lives and keep them out of the hospital, but they tend to be the lowest-paid specialties in medicine. Medical students know it, and we vote with our feet. Between 2013 and 2020, the number of positions unfilled in pediatrics has more than quintupled. This past March, nearly 600 residency positions in family medicine went unfilled. By contrast, virtually every residency spot in radiology and plastic surgery in the United. States got filled.