The issue of high student loan debt influencing specialty choice and how this ties into the US doctor shortage is being looked at very closely by physician organizations. The AAMC issued an updated
report last April which estimated that there will be a shortage of approximately 122,000 physicians by 2032, encompassing around 55,000 primary care physicians, 12,000 medical specialists, 13,000 surgical specialists, and 40,000 other specialists (such as pathologists, neurologists, radiologists, and psychiatrists.)
This data highlights the need to understand what factors contribute to specialty choice, something that several studies have reported on.
One study examining data from the AAMC's Medical School Graduation Questionnaire found an inverse relationship between debt levels and intention to enter primary care. This trend was strongest for students who owed more that $150,000. This study also pointed out that factors such as gender and race strongly influenced specialty, indicating that several factors are contributing to graduating medical students choices.
Another study published in 2014,
A Retrospective Analysis of the Relationship Between Medical Student Debt and Primary Care Practice in the United States, supports this idea that the reasoning behind students choice of medical specialty is multi factorial. Researchers found that debt levels as well as public vs private schooling and socioeconomic status influenced specialty choice. For graduates of public med schools, researchers found an inverse relationship between debt levels and intention to practice primary care. For all graduates overall, they found that students with little to no debt, as well as students with very high debt, were less likely to chose primary care. They propose a few possible explanations for these findings:
" We believe that 2 important relationships contribute to this curve (
Figure 3). First, graduates with little or no debt may be less likely to choose primary care because they often come from wealthier families (ie, a socioeconomic status effect). The socioeconomic status of a students’ family of origin strongly predicts their educational debt.
8,
12,
18,
19 High socioeconomic status also predicts specialization.
8,
17,
19 The reasons for this association remain relatively unexplored but may be related to higher income expectations among students from wealthier families. Second, public school graduates with very high debt may be less likely to choose primary care because they perceive a need for the higher financial return of specialization to finance their debt (ie, a deterrent effect).
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One
study that analyzed responses from an AACOM survey of pending Osteopathic medical school graduates found that for graduates with high debt burden, students who used loan forgiveness/repayment programs had higher rates of entering primary care fields, while high debt students who did not utilize these programs were were more likely to enter non–primary care specialty fields, with this trend increasing as mean medical school debt increased.
The connection between student loan debt burden and the need for more primary care physicians appears to be one of the main motivations behind some medical schools moving towards tuition free med school. In their
press release from August 2018, NYU spoke to this topic:
"Overwhelming student debt is fundamentally reshaping the medical profession in ways that are adversely affecting healthcare. Saddled with staggering student loans, many medical school graduates choose higher-paying specialties, drawing talent away from less lucrative fields like primary care, pediatrics, and obstetrics and gynecology...“Tuition-free medical education goes beyond the merit and financial scholarships, and debt cancellations that other academic centers have traditionally favored,” says
Rafael Rivera, MD, MBA, associate dean for admissions and financial aid. “More importantly, it addresses both physician shortages and diversity.”
Quite recently, physician organizations have been bringing this issue to the attention of Congress, in asking for more financial support for medical school graduates entering primary care fields. On June 12th, the U.S. House Committee on Small Business held a hearing entitled "The Doctor Is Out. Rising Student Loan Debt and the Decline of the Small Medical Practice."
Here, a representative from the American College of Physicians spoke about how the ACP acknowledges that the burden of student debt can deter students from entering primary care, and they advocated for increased funding for scholarships and loan repayment programs for primary care physicians. In a
written testimony submitted to this hearing, the American Academy of Family Physicians also voiced their support for such legislation that would support the education of primary care physicians.
While it's clear that student loan debt is not the only factor contributing to a shortage of primary care physicians, it does appear to be playing a tangible role that has raised concerns from medical schools and physician organizations alike. Promising research on the benefits of student loan forgiveness/repayment programs will hopefully continue to address the increasing demand for more physicians in general.
