There has been an ongoing debate in JAMA for quite some time on the topic of specialty choice by graduating seniors in U.S. medical schools. Many of the letters written in have come from concerned physicians in the specialties of family practice or internal medicine, who describe the future of their specialties as grim. They see graduating seniors increasingly choose more competitive residencies such as radiology and emergency medicine over theirs, and attribute this to the increased pay received by those specialties.

Dr. William Hueston of the Department of Family Medicine at the Medical University of South Carolina has, I believe, finally “hit the nail on the head” as it were. Taking these previous claims to task, and using their same data set, he has demonstrated that the relationship between medical student interest and mean salary is a specious one at best. As you might be able to see from the graph provided above (From Hueston’s letter):

A better gauge of student interest is the numerator (how many students selected the specialty). For example, in looking at the Figure in the study by Ebell, it may appear that no one is going into family medicine. However, more US seniors chose this residency specialty than all but 2 other specialties (internal medicine and pediatrics).

He ends his letter by positing that perhaps more students would choose the competitive specialties if more positions were available, but this simply isn’t the case – it isn’t reality. And this fact demonstrates the difficulty of determining motive for specialty choice from aggregated data. When the number of available positions is not equal for every specialty, how do you go about teasing apart the gold diggers from the legitimately “in debt up to my eyeballs” MDs?