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AAFP Members, Congressman Look for Ways to Ease Medical School Debt
By James Arvantes • Washington, D.C.
"We have put this 'jerry-rigged' system together to finance medical schools and residencies," said McDermott, a licensed psychiatrist and a longtime supporter of primary care. "It is a very complicated financial arrangement that works, but it does not work for students."
- Rep. Jim McDermott, D-Wash., and AAFP members agreed at a recent meeting that medical school debt is a serious issue because it discourages medical school students from pursuing careers in family medicine and primary care.
- AAFP members and McDermott talked about ways of alleviating medical school debt to make it easier for more medical school students to pursue careers in family medicine.
- AAFP members also said medical school environments tend to discourage students from seeking careers in primary care and family medicine.
"If you are 25 years old and you are $175,000 in debt, you make different choices than I made," said McDermott, the senior Democrat on the Health Subcommittee of the House Ways and Means Committee, who entered medical school in 1957.
McDermott is the sponsor of legislation that would establish a state-based scholarship program for primary care medical students who would agree to practice in medically underserved areas for five years after residency. The legislation, known as the Restoring the Doctors of Our Country Through Scholarships Act, also would prioritize scholarships for students enrolled in six-year accelerated family medicine programs, as well as programs that include clinical training in underserved communities.
"I am basically trying to make it possible for medical students to go into primary care and not have to worry about the money," McDermott said in an interview with AAFP News Now.
Congressman Urges AAFP Members to Develop Rapport With Elected Officials
"I would encourage all of you to be knowledgeable about who your members of Congress are and to find a way to talk with them," said McDermott during a 90-minute discussion with family medicine leaders, medical students, residents and practicing physicians at the AAFP's Washington headquarters on Feb. 6. "It is harder for (representatives) to have an attitude when they know someone who has actually had the experience and can tell them, 'Congressman, that is not right -- that is not how it works.'"
McDermott said politics is about trust. "If I trust somebody, I will accept what they tell me. The way to have an impact on us is by getting to know us."
The same rules apply to state legislatures, and it is particularly important for AAFP members to get to know state lawmakers who serve on health committees and subcommittees, said McDermott. State legislatures will become increasingly important as states implement various provisions of the health care reform law.
Weighing Career Decisions
Kisha Davis, M.D., a family physician in North Potomac, Md., and president-elect of the Maryland AFP, said she was "lucky enough to have a full scholarship to medical school," which changed the trajectory of her career. "I was able to work at a community health center part time because I was not saddled with debt," Davis said.
She also was able to take a year off from practice to work as a White House fellow. "Not being saddled with debt has totally changed the options that are open to me as I move through my career," Davis said. "I can be the doctor that I wrote about in my medical school essays."
Laura Hehn, a fourth-year family medicine student at Georgetown University, is able to attend medical school because of a health professions scholarship. To fulfill the terms of the scholarship, Hehn has agreed to spend four years in the military on active duty and another four years in the reserves.
"When I did the math, it was eight years of my life in the military serving a great population or possibly the next 30 years of my life paying off my loans," Hehn said.
Adam Fletcher, a fourth-year medical student at Virginia Commonwealth University (VCU) in Richmond, said he is the first member of his family to attend college. "It is a great privilege, but it has come at a great expense," he said. The yearly tuition at VCU's medical school is $30,000, and Fletcher now owes about $200,000 in undergraduate and medical school loans, which are compounding at a yearly rate of 6.8 percent.
James Welsh, M.D., chair of the Department of Family Medicine at Georgetown University in Washington, said he was able to attend medical school through the National Health Service Corps Scholarship program. Without that program, Welsh said he "probably would be doing colonoscopies as we speak."
AAFP members told the congressman that one of the ways to increase the number of family physicians is to identify potential FPs before they enter medical school.
"There is a need to recruit people before they get to medical school -- to preselect those candidates who are likely to go into primary care and then support them along the way," said Matt Burke, M.D., a member of the Department of Family Medicine at Franklin Square Hospital in Baltimore.
Joey Nichols, M.D., a second-year resident at Medstar Franklin Square Medical Center in Baltimore, talked about two programs in Texas that identify and seek to get high-school students interested in careers in primary care medicine. "My point is there are things you can do reaching way back to identify students, (to) get them excited about careers in health and medicine," he said.
"If I had a dollar for every person who told me I am too smart to be a family physician, I wouldn't have to worry about my loans," said Stephens, prompting nods of agreement from other AAFP members at the meeting.
Stephens said "these young people endure a bludgeoning" about their decisions to go into family medicine. "It takes a lot of guts to stand up and say you are going to be a family physician. I applaud these young folks (here today) for doing it."
If enacted, McDermott's bill would create more family physicians, thus helping to overcome some of the entrenched attitudes in medical school that discourage careers in family medicine, the congressman said. "If you have 100 students who are going in (to primary care) you have a lot of people to talk to who think it is a cool idea."
Members Offer Opinions on Medical School Debt