Carrying a heavy debt load is not only a rite of passage for medical students but also a factor that may influence their choice of specialty, according to a recent study.
In the study,(www.jabfm.org) published in the March/April issue of the Journal of the American Board of Family Medicine, researchers found that 58 percent of family medicine residents have education debt of $150,000 or more and 26 percent carry debt of $250,000 or more. Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, was one of the lead authors.
"High debt levels help to explain why students are less likely to choose family medicine and raise concerns for those who still do," the researchers wrote. "Students from disadvantaged backgrounds may be dissuaded from this choice at even lower debt levels."
The researchers said policymakers should consider addressing the situation with loan repayments, small business loans and payment reform measures aimed at correcting the gap in physician payment.
- In a recent study, researchers found that 58 percent of family medicine residents have education debt of $150,000 or more and 26 percent carry debt of $250,000 or more.
- A companion commentary said student debt weighs on residents as they plan their careers
- The author of the commentary said many students and residents do not realize that family medicine is the most highly recruited specialty.
Another move that may help would be to restore graduate and professional students' eligibility for Stafford loans, which are federally subsidized and carry lower interest rates. AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., sent a letter to Rep. Judy Chu(1 page PDF) on April 1 thanking her for introducing a bill that would do just that. Wergin cited the recent study and wrote that debt relief for students who want to enter primary care is wise public policy.
And one item on the agenda of the Family Medicine Congressional Conference, which will be held April 18-19 in Washington, will address requests from Congress to continue funding programs devoted to training primary care physicians. The AAFP will seek an additional $70 million for the National Health Service Corps (NHSC) and an additional $59 million for the Primary Care Training and Enhancement grant program. The annual award for NHSC loan repayments was increased from a maximum of $35,000 to $50,000 per year as part of the Medicare Access and CHIP Reauthorization Act.
In a companion commentary(jabfm.org) to the debt study, Julie Phillips, M.D., M.P.H., director of research for the Sparrow-Michigan State University Family Medicine Residency Program, explained how debt carried by residents influences the difficult decision they have to make about their careers.
"We are now facing a paradox in the United States: family medicine -- the specialty that creates the greatest health value for the nation -- is viewed by medical students as the specialty that offers the least personal financial security," Phillips wrote.
Although tuition and debt are increasing, talk about medical school debt has been going on for as long as students have paid tuition, said Ashley Bentley, M.B.A., a student interest strategist for AAFP.
"The data on whether the debt makes residents less likely to choose primary care is mixed," she said. "Students with low and high debt are choosing family medicine and primary care."
And salaries for family physicians are steadily increasing at a rate faster than those for most other specialists. The average salary is now $195,000 and starting salaries in a primary care practice can be $200,000 thanks to generous signing bonuses.
"You can afford to be anything you want to be," Bentley said. "Don't make a decision based on debt. That income expectation should not be the deciding factor for students to choose a medical specialty. They should choose what they love doing, not pick something because of what they expect in terms of income."
In fact, surveys indicate that students who choose family medicine value income and lifestyle less than their peers.
"When we chose to become family physicians, we viewed this as a career that offered economic security, even if it would not support extravagant luxury," Phillips wrote.
But many medical students tell Phillips that they want a salary of at least $300,000.
"I hear them talk about their debt and the salary package they are looking for," she told AAFP News. "They have fears about being able to pay off those loans so they believe they need a salary that will support that."
Phillips said students and residents often mistakenly believe that higher subspecialist salaries mean more job security and greater demand, when family medicine actually is the most highly recruited specialty.
The salary gap, exacerbated by Medicare reimbursement rates, affects the number of candidates in several areas of need, Phillips said.
"I worry about the effect it has on academic institutions," she said. "Academic family physicians earn lower salaries and there are major shortages. They are also less likely to do a fellowship in geriatrics, where there is also a big shortage."
Phillips acknowledged that as she proceeded through medical school and residency, the thought of repaying her loans caused some concern initially.
"I worried about it somewhat," she said. "Now I have some perspective. Physicians in any specialty are paid very well. It's not like we are suffering. The debt is part of my life, but it has not had a huge impact on my life. It has a much bigger impact on students and residents than it does on practicing physicians."
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