Is cost of urology fellowship training worthwhile?

In terms of total career earnings, urology ranks in the top quartile among 15 specialties evaluated in a recent study, but the study’s findings raise questions about the long-term financial value of urology fellowships.

In calculating value of career earnings (VCE), urologists from the University of North Carolina, Chapel Hill found that the VCE was slightly more than $3.5 million for urologists in private practice and $3.2 million for academic urologists. This differential in value between private practice and academic careers in urology ($335,000) was the lowest among the specialties studied, according to the findings, which are in press in the Journal of Urology (published online Oct. 3, 2013).

The VCE for pediatric urologists was lower than that of their non-fellowship-trained peers, at just over $2.9 million, the study found. Pediatric urology and colorectal surgery were found to be the only two specialties in which the net value of a fellowship was not positive.

“In these instances, not only was the fellowship very costly, but the long-term value of the fellowship was negative,” wrote the authors, led by Raj S. Pruthi, MD.

“From a purely financial standpoint, fellowships in pediatric urology and colorectal surgery were among the most expensive and had the least value-added to a career financially. While salary data were only available for pediatric urology, it is reasonable to extrapolate this principle to other subspecialties in urology.”

The researchers paired the economic concept of net present value with available data from the Medical Group Management Association and American Association of Medical Colleges to calculate VCE based on variation in choice of specialty, academic versus private practice career path, and fellowship choices.

General orthopedic surgery and orthopedic surgery (sports medicine) commanded the highest VCEs at $4.8 million and $5.3 million, respectively. Cardiology and trauma surgery were also near the top in VCE at $3.8 million and $3.6 million, respectively. The lowest VCEs were for non-surgical specialties: general internal medicine/private practice ($2.2 million) and general internal medicine/academic ($2.1 million).

“Appropriate compensation is necessary for the recruitment and retention of talented individuals, and these data show a wide variability among specialties and subspecialties,” the authors wrote. “While financial compensation is only once piece of the puzzle, we must remain diligent in understanding the current state of physician compensation to fully understand trends in physician career choices.”

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