Specialty Profiles

Altruism and specialty choice: What's the connection?

Values are a big part of why people choose to practice medicine. When it comes to medical specialty choice, new research is exploring the link between a medical student’s values and specialty choice, in comparison with factors such as test scores, parental income and student-loan debt.

The AMA’s Specialty Guide is designed to simplify medical students’ specialty selection process, highlight major specialties, detail training information, and provide access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®. Published in the Journal of Health Economics, the study, “Plastic surgery or primary care? Altruistic preferences and expected specialty choice of U.S. medical students,” measures how medical student altruism affects which field one pursues.

Money as a motivator

The data that measures altruistic preferences was derived from asking more than 500 medical students nationwide to do “a set of computer-based revealed preference decision problems, which ask the experimental subjects to allocate real money between themselves and an anonymous person,” said the study, written by Jing Li, PhD, assistant professor of health care policy and research at Weill Cornell Medical College. Students who gave away more money were deemed more altruistic.

“There’s no external reasons for them to give any money away,” Li said. “They don’t know that person. They do this in strict confidence.”

Altruism and specialty choice

In addition to the altruism portion of the experiments, students were asked to list up to three preferred medical specialty choices from the same list the Association of American Medical Colleges uses in its survey of graduating seniors.

The population of medical students studied came from all phases of their medical school careers, so about a quarter were undecided about specialty choice. Of the students who had specialty preferences, the split was roughly equal among those who were interested in going into specialties the study deemed high-income—paying more than $300,000 per year, according to physician compensation data—and those with incomes below that threshold.

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In terms of the relation to belief systems and specialty choice, “the half of the sample who behaved less altruistically in the experiment are on average about 20 percentage points more likely than their counterparts to choose high-income specialties,” the study said.

What about primary care?

Even among students who measured as altruistic, primary care specialties proved to be less popular than others. Of all students surveyed, only about 15 percent indicated desire to pursue a primary care specialty.

“It’s about incentives,” Li said. “The current incentives aren’t aligned with the need for more primary care physicians. We know they don’t make as much in compensation as their specialist counterparts. The narrative is that you go into primary care, you do so because you cannot get into higher-paying or better specialty. It’s a perception of prestige, which runs counter to the nation’s need for primary care physicians.”

Here are some other nuggets of interest.

According to this study, a respondent’s altruism scores appeared to be a more reliable predictor of choosing a high-income medical specialty than a number of other characteristics, such as parental income, student-loan amount and Medical College Admission Test (MCAT) score.

Those who favored higher-income specialties were more likely to be male, have grown up in the suburbs and have higher MCAT scores.

This study also found that altruism was a significant predictor of a student’s desire to practice in an underserved area. In total, when asked if they would consider practicing in an underserved area, more than half of study participants said they were very likely or somewhat likely to do so. This proportion dropped to about one-third among those who said they wanted to go into high-income specialties.