One of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual — and to many of his colleagues — inexplicable decision. Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.” Many view his choice of primary care as ill-advised, largely because family medicine is one of the least competitive fields and ranks at the bottom for income of all medical specialties.
Until his third year, Gohil had planned to pursue orthopedic surgery, which is considerably more difficult to get into than family medicine. In 2014, the average score on step 1 of the U.S. Medical Licensing Exam for students entering family medicine was 218, while for orthopedic surgery it was 245 (the overall average is 230). Average annual salary levels diverge even more widely, at $122,000 for family physicians and $488,000 for orthopedic surgeons.
Many students evidently see additional drawbacks to primary care. The Council on Graduate Medical Education has estimated that such fields comprise about 35 percent of all practicing physicians — a number that needs to reach 40 percent — yet they have been attracting fewer than 20 percent of U.S. medical graduates. “One problem,” Gohil says, “is the escalating debt of graduates,” which averages nearly $180,000 per student. “Inevitably,” he says, “this turns away many students from lower-paying fields.”