Economic Impact of Training and Career Decisions on Urological Surgery

• Published in: The Journal of urology Vol. 191; no. 3; pp. 755 - 760
• Main Authors: Langston, Joshua P, Kirby, E. Will, Nielsen, Matthew E, Smith, Angela B, Woods, Michael E, Wallen, Eric M, Pruthi, Raj S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2014; Elsevier
• Subjects: Biological and medical sciences; Career Choice; Education, Medical - economics; Fellowships and Scholarships - economics; Female; health care reform; Humans; Income; internship and residency; Internship and Residency - economics; Male; Medical sciences; Nephrology. Urinary tract diseases; Private Practice - economics; salaries and fringe benefits; Specialization - economics; Urology; Urology - economics; Urology - education; value of career earnings; internship and residency; AAMC; Medical Group Management Association; Association of American Medical Colleges; MGMA; health care reform; career choice; NPV; urology; net present value; VCE; salaries and fringe benefits; Nephrology; Choice; Decision making; Health; Urinary tract; Decision; Care; Urology; Treatment; Urinary system; Surgery; Economic aspect; Economic impact; Formation
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2013.09.060

Purpose Medical students and residents make career decisions at a relatively young age that have significant implications for their future income. While most of them attempt to estimate the impact of these decisions, there has been little effort to use economic principles to illustrate the impact of certain variables. Materials and Methods The economic concept of net present value was paired with available Medical Group Management Association and Association of American Medical Colleges income data to calculate the value of career earnings based on variations in the choice of specialty, an academic vs a private practice career path and fellowship choices for urology and other medical fields. Results Across all specialties academic careers were associated with lower career earnings than private practice. However, among surgical specialties the lowest difference in value between these 2 paths was for urologists at only $334,898. Fellowship analysis showed that training in pediatric urology was costly in forgone attending salary and it also showed a lower future income than nonfellowship trained counterparts. An additional year of residency training (6 vs 5 years) caused a $201,500 decrease in the value of career earnings. Conclusions Choice of specialty has a dramatic impact on future earnings, as does the decision to pursue a fellowship or choose private vs academic practice. Additional years of training and forgone wages have a tremendous impact on monetary outcomes. There is also no guarantee that fellowship training will translate into a more financially valuable career. The differential in income between private practice and academics was lowest for urologists.