Nearly 1 in 5 third-year medical residents say they wouldn't choose medicine as a career if they could start over again, according to the 2019 Survey of Final-Year Medical Residents of Merritt Hawkins, a physician recruiting firm.

The 19% of residents who had a downbeat view of their profession represents an improvement in outlook from the 2015 Merritt Hawkins survey, in which 25% of respondents said that medicine no longer appealed to them.

Both the residency experience and the young doctors' uncertainty about the future contribute to their pessimism, Kurt Mosley, vice president of strategic alliances, Merritt Hawkins and Staff Care, told Medscape Medical News.

To begin with, he noted, residency training is still a grind, even though residents are now limited to working 80 hours a week. In addition, they're being mentored by older faculty members who tend to be more burned out than ever, he said.

Specialists are looking at another 3 or 4 years of fellowship training, during which they will continue to receive only small stipends. In the Merritt Hawkins survey, Mosley observed, only 71% of surgical specialists felt positive about medicine, compared with 83% of internists, family physicians, and ob/gyns.

The poll turned up a bigger difference in attitudes between US medical graduates (USMGs) and international medical graduates (IMGs): 21% of USMGs said they wouldn't choose medicine as a career again, and just 13% of IMGs did. In Mosley's view, this is related to the fact that IMGs usually have less medical school loans to pay off.

Fifty-seven percent of IMGs said they carried no educational debt, compared to 22% of US graduates. Although about a quarter of IMGs owed $200,000 or more, 48% of USMGs did — a daunting prospect for a young doctor who will have to start paying back those loans as soon as he or she leaves residency.

Why has the percentage of final-year residents who doubt their career choice declined from 1 in 4 in 2015 to 1 in 5 today? "People who are now going into medicine know what they're getting into," Mosley replied. "If you go back 15 years, [unrestricted] fee for service was still part of the equation. Now doctors get out and they're paid partly on patient satisfaction, citizenship, and so on. They have to deal with MIPS [Merit-based Incentive Payment System] and bundled payments."

Besides being more educated about the new business reality, young doctors have another advantage over physicians who are bit older than they are: they're not resistant to electronic health records, because they grew up with computers.

"Our new residents are savvy at that, so it's not an issue for them," Mosley says.

Treated Like "Blue Chip Athletes"

Satisfied or not, though, there are plenty of available jobs. The residents who responded to the survey said they were being inundated with recruiting offers. Two thirds of them had received 51 or more recruiting offers, and 45% had received more than 100.

"Physicians coming out of training are being recruited like blue chip athletes," said Travis Singleton, executive vice president of Merritt Hawkins, in a news release. "There are simply not enough new doctors to go around."

Geographic location was the number one priority of residents who were considering a practice opportunity, followed by a good financial package and the availability of personal time. Only 1% of the respondents (compared to 3% in 2015) said they preferred to practice in a town of 25,000 people or less.

Private practice is not on the agenda of final-year residents. The great majority of residents (91%) would prefer to be an employee of a hospital, medical group, or other facility. Specifically, 45% would like to work for a hospital; 20% want to become an employee of a single-specialty group; 16% want to be employed by a multispecialty group; 7% prefer to partner with another physician; and 3% would like to work for a community health center.

Thirty-eight percent of residents said they were unprepared to handle the business side of medicine, and 53% said they had received no formal training in business matters, such as contracts, compensation arrangements, and reimbursement methods.

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