General Surgery Residents Struggle With Deep Educational Debt and Low Pay

By Reuters Staff

May 16, 2022

NEW YORK (Reuters Health) - General-surgery residents in the U.S. often face deep educational debt with small salaries to cover living expenses and loan repayment, a new survey finds.

Responses from more than 400 general-surgery residents show they had median salaries of $60,000 to $65,000 and a median medical educational debt of $200,000 to $250,000, researchers report in the American Journal of Surgery.

"The take-home message is that our surgical trainees expect and deserve fair compensation," said study coauthor Dr. Gentian Kristo, general-surgery-residency site director at the VA Boston Healthcare System/Brigham and Women's Hospital and an assistant professor of surgery at the Harvard Medical School. "Their salaries do not reflect the number and intensity of hours worked, are not comparable to those of other medical staff, and do not take into account their financial and personal sacrifices to achieve an advanced medical education."

"Fair compensation of our residents is important not just because it is the right thing to do from a moral and labor perspective, but also improving the financial situation of our surgical trainees is an important intervention to help reestablish the surgical profession as a sustainable career option for our medical students and to ultimately improve an already serious surgeon shortage," Dr. Kristo told Reuters Health by email.

To explore what general-surgery residents thought about their financial situations, he and his colleagues conducted a nationwide survey-based assessment of the financial support and salary expectations of general-surgery residents. The questions in the survey came from a list of possible questions generated from interviews with 20 residents from different institutions. The final questionnaire consisted of 30 questions (19 multiple choice, eight yes or no, and three open ended).

The survey was distributed by the Association of Program Directors in Surgery (APDS) to their membership in May of 2020. Participation in the survey was voluntary and no compensation was provided.

Overall, 419 residents completed the survey, the majority of whom were aged 30-34, with the next-most populous group being those aged 25-29. The researchers found that most of the respondents (54%) were male and white (63%); 8% were Black/African American and 9% Hispanic/Latino.

About half were single (54%) and the remainder were married or in a domestic partnership; 51% of the latter had children and 0.9% were divorced. The majority lived in the Northeast (47%) and Midwest (29%), while a small number came from the South (12%), Southwest (7%) and West (5%).

A majority (60%) were concerned that their incomes were not meeting their financial needs. Most (89%) felt they were not being appropriately compensated for their work because the salary did not reflect the number of hours worked (92%), did not reflect the required level of skill (70%), was not comparable to that of other medical staff, such as physician assistants or nurses (66%), was not adequate to pay for student loans (50%) or did not meet their cost of living (38%).

Many were getting help from family (42%) and some from spouses' income (32%).

Many residents reported incurring more debt (46%), reducing socializing outside of work (45%) delaying marriage (26%) or children (44%), deferring routine or specialty medical care (32%) or pursuing private practice instead of an academic career (21%).

Many (41%) also said they were moonlighting or planned to during their dedicated research years.

"Medical education requires huge personal sacrifice and financial commitments," said Dr. Ge Bai, a professor of accounting at the Johns Hopkins Carey Business School and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

"As young physicians' financial burden increases, integrated systems (with their greater financial stability) become a more attractive option than small independent practices," Dr. Bai, who was not involved in the survey, told Reuters Health by email. "This is an overlooked reason for the decline of independent physician practice across the country."

SOURCE: American Journal of Surgery, online May 5, 2022.