In the Journals

Most graduating family medicine residents $150K or more in debt

More than half of graduating family medicine residents in the United States reported having more than $150,000 in student loan debt, and approximately a quarter said their education debt topped $250,000, according to a policy brief published in the Journal of the American Board of Family Medicine.

“High educational debt has been shown to deter students from choosing primary care careers, but the levels of debt carried by those who do is less well known,” Andrew Bazemore, MD, MPH, of the Robert Graham Center, in Washington, D.C., and colleagues wrote.

The researchers drew their data from the American Board of Family Medicine certification examination questionnaire from all applying third-year family medicine residents, a total of 3,038 graduates. One question asked residents, “What was your level of educational debt (undergraduate and graduate) at the end of medical school?”

According to the researchers, 32% of graduating family medicine residents reported educations debts ranging from $150,000 to $249,999, while 26% reported debts of $250,000 or more. Eighteen percent reported having no educational debt.

The researchers also noted findings from an American Association of Medical Colleges study indicating that graduating with more than $200,000 student debt required extended loan repayment, and perhaps the selection of a service-related loan forgiveness program. Meanwhile, debts of more than $250,000 required even longer repayment periods, and service in a shortage area.

“Published student reactions to the American Association of Medical Colleges’ findings affirmed suspicions that high debt levels help to explain why students are less likely to choose family medicine and raise concerns for those who still do,” Bazemore and colleagues wrote. “… Policymakers hoping to increase output in primary care specialties such as family medicine should be aware of this growing debt burden and consider strategies such as loan repayment, small-business loans, practice transformation support and payment reform targeting the physician payment gap.”

In a related commentary, Julie Phillips, MD, MPH, of the Sparrow-MSU Family Medicine residency program, at the Michigan State University College of Human Medicine, said the effects of high student loan debts could lead to depression, delaying marriage, childbearing and major purchases, and to regrets over choosing family medicine.

“More graduates may choose to work in hospitals, rather than in outpatient primary care,” Phillips wrote. “It may become increasingly difficult to recruit family physicians to academic positions or geriatric fellowships, worsening shortages of family physician educators, researchers and geriatricians.”

Phillips added that “fixing the income gap” between primary care and high-income specialties is essential to addressing the educational debt issue.

“The gap in payment between primary care and specialty physicians is not primarily the result of a difference in market value,” Phillips wrote. “It is caused and sustained by Medicare reimbursement policy, which must be reformed to value primary care in a real way.” – by Jason Laday

Disclosure: Bazemore reported no relevant financial disclosures. Researchers Lars Peterson, MD, PhD, and Robert Phillips, MD, MSPH, report affiliations with the American Board of Family Medicine. Julie Phillips reports no relevant financial disclosures.

More than half of graduating family medicine residents in the United States reported having more than $150,000 in student loan debt, and approximately a quarter said their education debt topped $250,000, according to a policy brief published in the Journal of the American Board of Family Medicine.

“High educational debt has been shown to deter students from choosing primary care careers, but the levels of debt carried by those who do is less well known,” Andrew Bazemore, MD, MPH, of the Robert Graham Center, in Washington, D.C., and colleagues wrote.

The researchers drew their data from the American Board of Family Medicine certification examination questionnaire from all applying third-year family medicine residents, a total of 3,038 graduates. One question asked residents, “What was your level of educational debt (undergraduate and graduate) at the end of medical school?”

According to the researchers, 32% of graduating family medicine residents reported educations debts ranging from $150,000 to $249,999, while 26% reported debts of $250,000 or more. Eighteen percent reported having no educational debt.

The researchers also noted findings from an American Association of Medical Colleges study indicating that graduating with more than $200,000 student debt required extended loan repayment, and perhaps the selection of a service-related loan forgiveness program. Meanwhile, debts of more than $250,000 required even longer repayment periods, and service in a shortage area.

“Published student reactions to the American Association of Medical Colleges’ findings affirmed suspicions that high debt levels help to explain why students are less likely to choose family medicine and raise concerns for those who still do,” Bazemore and colleagues wrote. “… Policymakers hoping to increase output in primary care specialties such as family medicine should be aware of this growing debt burden and consider strategies such as loan repayment, small-business loans, practice transformation support and payment reform targeting the physician payment gap.”

In a related commentary, Julie Phillips, MD, MPH, of the Sparrow-MSU Family Medicine residency program, at the Michigan State University College of Human Medicine, said the effects of high student loan debts could lead to depression, delaying marriage, childbearing and major purchases, and to regrets over choosing family medicine.

“More graduates may choose to work in hospitals, rather than in outpatient primary care,” Phillips wrote. “It may become increasingly difficult to recruit family physicians to academic positions or geriatric fellowships, worsening shortages of family physician educators, researchers and geriatricians.”

Phillips added that “fixing the income gap” between primary care and high-income specialties is essential to addressing the educational debt issue.

“The gap in payment between primary care and specialty physicians is not primarily the result of a difference in market value,” Phillips wrote. “It is caused and sustained by Medicare reimbursement policy, which must be reformed to value primary care in a real way.” – by Jason Laday

Disclosure: Bazemore reported no relevant financial disclosures. Researchers Lars Peterson, MD, PhD, and Robert Phillips, MD, MSPH, report affiliations with the American Board of Family Medicine. Julie Phillips reports no relevant financial disclosures.