AMA Responds to Medical Students' Search for School Debt Relief

It's no secret that medical students typically carry such a heavy debt load coming out of medical school that it can influence their medical specialty and practice locale choices. Faced with that financial reality, many enter subspecialty areas of medicine, rather than family medicine and other primary care specialties. They also may choose to practice in more lucrative settings, such as larger cities and suburbs, rather than in rural communities.

In addition, the prospect of high debt can discourage minorities and persons from modest or disadvantaged backgrounds from choosing medicine as a career.

Delegates at the 2008 annual meeting of the AMA House of Delegates heard those messages and others like them while considering numerous resolutions dealing with medical student indebtedness.

Members of the Michigan delegation were some of the most vocal advocates of tackling the medical student debt crisis head-on. In a resolution they submitted on the topic, they pointed out that one medical school in their state, Wayne State University in Detroit, had increased medical school tuition for Michigan residents by as much as 52 percent in the past four years. At the same time, they noted, loan repayment options had become more restricted.

One Michigan delegation member who testified June 15 before the AMA Reference Committee on Medical Education said some students in his state come out of medical school owing as much as $160,000.

A medical student at the University of Utah School of Medicine in Salt Lake City testified that half of his classmates had said they were considering a career in primary care at the beginning of medical school; now that they're in their third year, however, he said that proportion has dwindled to about 10 percent.

And judging from other testimony at the reference committee hearing, physicians who teach at those medical schools agree that debt makes an impact on specialty choice. "Medical students are definitely making (specialty) decisions based on what their debt load is," said John Williams, M.D., an alternate delegate from Pennsylvania who teaches at the University of Pittsburgh School of Medicine.

In response to these and similar concerns, the delegates adopted one resolution that calls for the AMA to support requiring medical schools "to inform students of all government loan opportunities along with private loans, and require disclosure of reasons that preferred lenders were chosen."

The House of Delegates also gave a thumbs-up to a second measure that directs the AMA to encourage accredited medical schools to develop policies "that ensure information on the use of funds from tuition and fee increases is disclosed in a standardized format and in a timely manner to prospective and current medical students."

Finally, AMA delegates voted to refer three other resolutions designed to ease medical student debt and ensure that the nation's "best and brightest candidates" are not "financially discouraged from pursuing a career in medicine." The delegates suggested that these measures form the basis of an in-depth analysis "that will result on a comprehensive set of innovative and broad-based strategies to address the issue of medical student debt."

Among courses of action suggested in those resolutions: