New doctors prefer to practice in cities

A recent survey indicates final-year resident physicians want to practice in urban areas because they believe the amenities are better for their families.

By Jay Greene, amednews stafff. Aug. 20, 2001.

More residents entering practice this year are shunning small towns and selecting larger metropolitan areas for lifestyle reasons, according to a new survey.

Starting salary expectations are also lower for residents than in previous years, according to the survey by Merritt, Hawkins & Associates, a recruiting firm based in Irving, Texas.

Only 11% of the residents surveyed said their top priority this year is a "good financial package" compared with 18% who said so in 1999. Nearly two-thirds of residents said geographic location/lifestyle is their most important factor when they select a job, said the survey, which polled 300 final-year primary care and specialty residents between January and May.

"What is troubling for small-town hospital administrators is that none of the residents said they want to practice in a town of less than 10,000," said Stephen Thomas, vice president of recruiting at Merritt's Irvine, Calif., office. "Residents are telling us they want to work and earn a decent living, but they are more interested in where they work than how much money they earn."

Signing bonus vs. loan forgiveness

In the survey, 25% of residents said a signing bonus of $12,000 would have no effect on their decision compared with 13% who felt that way in 1999. However, 58% said educational loan forgiveness would have some effect on their job decision compared with 31% in 1999.

"Residents are looking for ways to pay off their medical school debts of $100,000 or more," Thomas said. "But if they have a family, those concerns are less important. We try to educate both the physician and spouse about their practice location. More than 90% of physicians choose to practice near their hometown, their spouse's hometown or near their training site. There are other options."

The starkest survey statistic showed zero residents choosing communities of less than 10,000 population compared with 4% in 1999 and 8% in 1995. Some 25% of residents prefer to practice in communities with populations of 250,000 to 500,000 compared with 18%of respondents who said so in 1999.

"If I am unhappy working in a place I don't want to be for 10 years just to pay my debt off then it isn't worth it to be a doctor," said Michael Suk, MD, chair of the AMA's Resident and Fellow Section and an orthopedic resident at Montefiore Medical Center in New York City.

"The environment is no longer conducive to the axiom if you work harder you will be rewarded. This is why residents I talk with say quality of life is most important," he said.

Rural preference declining

The trend of residents choosing large cities over smaller towns also is reflected in surveys of medical students during the past three years. In 2000, 44.8% of graduating medical students who said they would practice in underserved areas indicated they would practice in rural areas compared with 50.5% in 1998, said the Assn. of American Medical Colleges.

"Physicians choosing location based on lifestyle preferences is a sociological issue more than anything else," said Michael Whitcomb, MD, AAMC's senior vice president for medical education. "With more physicians married and with working spouses, practice location is more a family decision."

As the numbers of female physicians and married physicians increase, Dr. Whitcomb said he believes fewer physicians will choose to practice in small towns and rural communities. Women accounted for 23% of practicing physicians in 1999 compared with 17% in 1990, according to the AMA.

"Women physicians want good schools for the kids, employment for spouses and other amenities most likely found in metropolitan areas," Dr. Whitcomb said. "This is a big change from in the past when male physicians made all the decisions and their wives didn't work."

The survey also found:

Seventeen percent of primary care residents expect to earn $126,000 to $150,000 in 2001 compared with 26% in 1999.
Three percent of primary care residents expect to earn $151,0000 to $175,000 in 2001 compared with 14% in 1999.
Twenty-five percent of residents have a significant level of concern about managed care compared with 13% in 1997.