1. NOW How Much Would You Pay? Salaries, Benefits and Incentives for Family Medicine Residency Programs Erik Lindbloom, MD; Erika Ringdahl, MD; Kristen Deane, MD Dept. of Family and Community Medicine, University of Missouri

2. Disclosures None

3. Today: Overview of FM’s Recruitment Problem Review of Data Discussion

4. Overview of the Problem The pool of outstanding candidates for U.S. Family Medicine residency programs lags far behind the # of available positions We are all competing for the same small group of outstanding applicants

5. NRMP 2014 http://www.nrmp.org/2014-nrmp-main-residency-match-results/

6. Spots filled with USMGs http://www.nrmp.org/2014-nrmp-main-residency-match-results/

7. % of choice by rank and type of applicant

8. If You Pay Them, Will They Come? AAFP lists financial incentives, including loan forgiveness, first in its policy statement on increasing student choice of family medicine http://www.aafp.org/about/policies/all/student-choice.html

9. Does Loan Forgiveness Matter? Macy Foundation/Graham Center: Two student groups least likely to consider Family Medicine are those without student debt and those with more than $250,000 –Former group does not need forgiveness –Latter group is probably considering higher- salary specialties http://macyfoundation.org/docs/macy_pubs/pub_grahamcenterstudy.pdf

10. Applicants’ Self-Reported Priorities in Selecting a Residency Program 9669 applicants to 2 academic medical centers surveyed annually 2004-2012 65% response Did not survey FM residents Only long term study of residency applicant priorities JGME, March 2015

11. Applicants’ Self-Reported Priorities in Selecting a Residency Program 3 least important factors: –Child care –Call rooms –Program website JGME, March 2015

12. Applicants’ Self-Reported Priorities in Selecting a Residency Program Applicants rated health care benefits higher than they did salary –? Reflect high cost of health insurance –? Reflect growing # of applicants with dependents JGME, March 2015

13. Applicants’ Self-Reported Priorities in Selecting a Residency Program 5 factors with highest ratings of importance: –Ability to prepare residents for future practice –Resident esprit de corps –Faculty availability/involvement in teaching –Depth and breadth of faculty –Variety of patients and clinical resources JGME, March 2015

14. Data collection and analysis Used the AAFP/STFM online residency directory and individual program websites Categorized reimbursement packages and benefits for all US Family Medicine residency programs Noted program characteristics –Size –Academic affiliation –Geographic location

15. Demographics 481 programs 82.4% Community 15.2% University 2.4% Military

16. Demographics Programs by geographic region Programs by size Programs filling in Match

17. Program Size Number of Residents in Program Number of Programs

18. Salary range R1s: $42.5K to $65.5K R3s (or R4s): $45.2K to $69.5K Median: $50.5K No clear predictor of high/low salaries

19. Loan Repayment Only 3% of programs list this as a benefit Another 1-2% list reimbursement, unclear whether debt relief or tuition assistance

20. Moving Expenses? Reimbursement: 45% of programs –Range: $500 to $11,000 –Sometimes provided as actual expenses reimbursed, but often a lumped sum “signing bonus” No assistance: 45% –Handful of these offer a housing allowance No info: 10%

21. Housing Allowance? 4.3% offer a monthly or yearly housing allowance –Range: $2.4K to $10K –One program provides on-campus single-family homes to all residents, including all expenses “Your house is provided, your lawn is cared for, your snow is shoveled, utilities provided, membership in a fantastic health center is paid for, anything broken is fixed, and all meals (if you want them!) are provided. Plus… there is a truly fantastic Day Care Center next door to the hospital (and therefore nearly next door to your house!)

22. Meals Less than 4% of programs specifically stated that no food allowance or meals were provided Among those with listed meal benefits, range from $4.54 per on-call meal to completely free, unlimited, 24/7

23. Insurance Costs Residents share cost: 53% Fully paid by institution: 32% “Available,” not enough info on cost sharing: 15%

24. Child Care On-site: 22% –16% of those on-site also list subsidized/ discounted rates) No: 60% (but handful will subsidize) Not enough info:18%

25. Fitness Center or Membership No (or no mention): 70% Among 30% with fitness center benefit: –At least 24% offer free memberships –At least 33% are on site, or at least on campus

26. Vacation Variability in reporting –Some include holidays in total –Some include weekends Lowest reported: 7 days per year Highest reported: 28 days plus additional 10 “emergency” days

27. CME time/support At least 76% provide time and/or professional expenses (24% do not mention) Among those listing specific figures, median days = 5 and median annual funding = approximately $1K (varies by PGY)

28. Tech/Book/Educational Support Roughly half of programs list some sort of book fund, educational fund, and/or tech items –Dollar amounts generally in hundreds –Laptop, smartphone or Apple devices most common tech items –Some programs have the gall to list “beeper provided” as a benefit…

29. Memberships, Licensing, Exams At least 22% of programs pay some combination of above expenses Memberships most commonly AAFP and state AFP

30. Free Parking? Yes: 89% Anecdotal accounts of parking fees being a negative factor for residency selection and for resident morale

31. Other Interesting Perks (from websites and personal accounts) Adoption assistance Generous paternity leave Bilingual bonus pay Adult day care services Retirement plans (hey, never too early to think about it…)

32. Does Any of This Correlate with Match Success? Program benefits divided into categories –Salaries: quartiles –Other benefits: two groups, yes or no Compared to NRMP data over past few years There may be some associations, but multifactorial and cannot prove cause/effect

33. Summary and Discussion Salaries and benefits vary widely among Family Medicine residencies No clear predictive factors for more or less generous benefits, such as rural/urban, region of country, university/community, etc. Thoughts on what has worked for your program, or what you hear from applicants? Will we see more variation in future?

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