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Tuesday Oct 27, 2015

Digging Out of Medical School Debt

The number of students enrolling in U.S. medical schools(www.modernhealthcare.com) has reached a record high, despite the fact that the cost of becoming a physician also continues to climb. The number of first-year allopathic medical students increased to 20,630 this year, up 1.4 percent from last year's record-breaking enrollment.

Although these brilliant young students can look forward to a future of serving their communities, healing the sick and comforting the dying, many also will face a future burdened by significant debt.

It is estimated that between education costs and years of lost earning potential, it costs at least $1 million to become a physician. And medical debt burden is growing at an alarming rate. In 2006, the average medical student's educational debt(www.ncbi.nlm.nih.gov) was more than $120,000. Less than a decade later, that figure has grown to an average of $180,000(members.aamc.org).

But does it have to be this way? The Association of American Medical Colleges projects a shortage of as many as 90,000 physicians(www.aamc.org) by 2025, so we cannot let students who are interested in careers in medicine be deterred by the high cost of training. The Robert Graham Center for Policy Studies in Family Medicine and Primary Care estimates that the shortage of primary care physicians(www.annfammed.org) alone will be in excess of 33,000 by 2035.

Wayne State University(www.freep.com) in Detroit recently announced plans for an innovative way to provide medical education for students from disadvantaged backgrounds. Each year, 10 students who agree to study health disparities as part of their medical career will receive free undergraduate tuition, free housing, guaranteed acceptance into medical school and free medical school tuition. This program will be paid for through donations, and the goal is for the university to become a national hub for the study of health disparities.  

Other programs like this are slowly cropping up across the country, and there is a huge need -- not only to help physicians pay off their burdensome debts, but also to address health disparities.

But what about those of us who already made it through medical school without the benefit of a program like the one at Wayne State?

I graduated from a private medical school in 2009 with roughly $215,000 in education debt, making my load significantly higher than the national average. With my growing family, I was unable to start payments until after residency, using the forbearance option on my loans. I have been paying slightly more than the minimum payments during my three years of practice and I currently owe … $215,000. Because of high interest rates, I have not yet gained any ground.

There are, fortunately, some programs to assist physicians with their debt burden. I recently took advantage of the AAFP’s new partnership with SoFi to consolidate and refinance my remaining loans. This has provided a lower interest rate, lower monthly payments and the ability to pay off my loans faster.

There are numerous loan repayment and forgiveness programs, as well as other resources. I recently authored a resolution adopted during the AAFP’s 2015 Congress of Delegates (COD) that calls for the Academy to add to its website a page listing various national options for repayment because it is often difficult to find them all on your own. The Academy's website already features many resources about debt for medical students.

My resolution also asked for the AAFP to assist state chapters in lobbying for programs that have been effective in other states. According to the Association of American Medical Colleges, there are currently 70 state-based repayment, forgiveness or scholarship programs(services.aamc.org) open to physicians, the majority of which are aimed specifically at primary care.

In Utah, we have recently had some success in recreating a loan repayment program for physicians practicing in rural areas. That program was defunded during the recession, but now we are hoping to expand it. At least three other states also passed bills this year related to physician loan repayment.

Another resolution adopted by the COD calls for the Academy to advocate for greater loan reimbursement for those in the National Health Service Corps who are not working full time. Many employers also offer some loan payback options to entice family physicians to work in areas of high need.  

I am glad I chose family medicine; I wouldn’t change my mind if I had to do it over again. But medical debt burden is a common problem facing physicians in all specialties. The best thing we can do is to share our stories, continuing to lobby both lawmakers and individual institutions to make costs more reasonable, decrease loan interest rates, provide more scholarships, and increase opportunities for loan forgiveness and repayment.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program in Salt Lake City. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11(twitter.com).

Posted at 11:35AM Oct 27, 2015 by Kyle Jones, M.D.

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