What specialties do doctors choose?

Very few women go into orthopedic surgery. Very few men choose obstetrics and gynecology. The 2018 AAMC Physician Specialty Data Report looks at the distribution of physicians across specialties, revealing some surprising trends in the future doctor workforce.

The number of physicians training to be cardiologists is increasing, yet fewer residents are going into geriatric medicine. The primary care specialties of internal medicine, family medicine and pediatrics remain the most popular, while orthopedic surgery is the least popular among women residents. 

These are just a few of the findings from the AAMC’s 2018 Physician Specialty Data Report, which highlights the distribution of physicians among 44 of the largest specialties — as well as the numbers of residents and fellows training in those specialties. 

As in previous years, the report found that while some specialties have seen an influx of new physicians, others seem to be shrinking. That could be problematic as more patients require services from those in-demand specialties. 

Also as in years past, the report revealed gender disparities in certain specialties, which studies show can have a negative effect on patient outcomes. David A. Acosta, MD, chief diversity and inclusion officer at the AAMC, says researchers are starting to explore “where the pivot points are” that influence specialty choice by women – or men – so that leaders in academic medicine can develop meaningful interventions. “We are seeing some specialties and subspecialties recognize the value of diversity,” Acosta says, “and create diversity task forces to address recruitment and hiring practices.”

Here are some additional findings from the 2018 Physician Specialty Data Report — and the implications for the physician workforce and patients:

  • Primary care remains the most popular specialty. The specialty with the largest number of active physicians in 2017 was internal medicine, which comprised about 12.9% of the total population of practicing physicians. Family medicine/general practice and pediatrics were second and third with 12.7 percent and 6.5 percent. Combined, the three subfields make up 32.1% of the workforce.

Future doctors seem to be heeding the call for more primary care physicians, as 21.6% of first-year residents and fellows chose internal medicine. An additional 8.5% chose family medicine/general practice and 6.3% chose pediatrics, bringing the total percentage of first-year residents and fellows training in these three primary care specialties to 36.4%.

However, it is important to remember that there is still a primary care physician shortage, says Michael Dill, AAMC’s director of workforce studies. An AAMC report published in April 2018 found that by 2030, there will be a shortage of between 14,800 and 49,300 primary care physicians, as well as a shortfall of between 33,800 and 72,700 non-primary care physicians. “There may be more primary care physicians than in other specialties, but we need a lot,” Dill says. 

  • Fewer male residents are choosing obstetrics and gynecology. An AAMC specialty data report from 2008 found that 57% of active OB/GYNs were male. By 2015, females made up 55% of the specialty. Today, 82.9% of OB/GYN residents are female, the 2018 report found. 

The rise in female OB/GYNs could be caused by patient preference, says AAMC Chief Health Care Officer Janis M. Orlowski, MD, MACP. “It used to be that patients preferred male gynecologists,” Orlowski says, but now the opposite is true. A 2016 report in Obstetrics and Gynecology found that 8.3% of patients preferred a male OB/GYN, while 50.2% preferred a woman; 41.3% had no preference.

  • Interventional cardiology sees growth. The five-year period from 2012 to 2017 saw notable growth in the number of active interventional cardiologists, whose numbers grew 58.0%, from 2,435 to 3,847. That certification has only existed since 1999.

Orlowski said it is difficult to explain this portion of the data. “Interventional cardiology grew probably 20 or 30 years ago with the advent of catheterization,” Orlowski says. With the rise in lifestyle interventions and medications, interventional cardiologists may be less in demand in the future, though. 

  • Dearth of female residents entering cardiology. Despite the growth in the interventional cardiology field, those residencies are mostly filled by male students — only about 10.2% of trainees are female.

Those disparities can have a harmful impact on patients. A 2018 study examined two decades of medical records from Florida emergency rooms and found women who suffered heart attacks were more likely to die when treated by male doctors, compared to either men treated by male doctors or women treated by female doctors.

  • Geriatrics takes a hit. The number of residents choosing to study geriatric medicine continues to decline, despite an increasing number of older adults who may need their specialized services. Between 2012 and 2017, the number of first-year ACGME residents and fellows studying geriatrics declined 14.3%. Between 2010 and 2015, the number of fellows and residents choosing geriatric medicine decreased by 21.1%. And yet by 2029, more than 20% of the total U.S. population is projected to be over the age of 65, according to Census.gov.

Orlowski said the downward trend can be attributed in part to the relatively low pay of geriatricians. “It’s of concern, because I think the need is actually rising,” she said. The average annual salary of a geriatrician in 2014 was $220,000, less than half of a cardiologist’s income, according to the Medical Group Management Association. 

  • Orthopedics remains male-dominated. The percentage of female physicians in orthopedic surgery remains astonishingly low, at 5.3%, the report found. That number has stayed the same since 2016. 

According to a study published in Clinical Orthopeadics and Related Research, 71% of those who choose orthopedic surgery do so because of enjoyment of manual tasks. The most common reasons cited for why women might veer from orthopedics included perceived inability to have a good work-life balance, perception that too much physical strength is required, and lack of strong mentorship somewhere in the school pipeline.