Journal Club: January 2013

Can Medical Students Afford to Choose Primary Care? An Economic Analysis of Physician Education Debt Repayment
James A. Youngclaus, MS, Paul A. Koehler, PhD, Laurence J. Kotlikoff, PhD, and John M. Wiecha, MD, MPH
Academic Medicine. 88(1):16-25, January 2013.

About Medical Student Debt and Specialty Choice

Most U.S. medical school graduates have education debt—79% with $100,000 or more in 2012. In addition, the median level of education debt is increasing—up 5% from 2011-2012 to $170,000. Controlling for inflation, the average education debt for an indebted medical school graduate in 2011 was nearly 3.5 times what it was in 1978. Some discussions of physician specialty choice suggest that indebted medical students don’t choose primary care because repaying their debt seems economically unfeasible.

Article Summary 

The authors analyzed whether a physician earning a typical primary care salary can repay the current median level of education debt and meet standard household expenses without incurring additional debt. The authors used comprehensive financial planning software to model the annual finances for a fictional physician’s household to compare the impact of various debt levels, repayment plans, and living expenses across three specialties. In total, they analyzed 384 different scenarios: 16 repayment plans at 4 different debt levels for 3 different career tracks in 2 different locations.


  1. Based on the authors’ data, can indebted medical students afford to choose primary care?
  2. What future research is needed to confirm or disprove theories that debt level affects specialty choice decisions?
  3. Does a suitable model for a successful loan repayment or forgiveness program exist for trainees in another field? If so, identify the program and what academic medicine could learn from it.

Further Reading

  1. Colquitt WL, Zeh MC, Killian CD, Cultice JM. Effect of debt on US medical school graduates’ preferences for family medicine, general internal medicine, and general pediatrics. Acad Med. 1996;71:399-411.
  2. Weeks WB, Wallace AE. The more things change: revisiting a comparison of educational costs and incomes of physicians and other professionals. Acad Med. 2002;77:312-319.
  3. Rosenblatt RA, Andrilla CH. The impact of U.S. medical students’ debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire. Acad Med. 2005;80:815-819.
  4. Greysen SR, Chen C, Mullan F. A history of medical student debt: observations and implications for the future of medical education. Acad Med. 2011;86:840-845.
Stay tuned for additional posts this week and next on medical student debt and specialty choice!

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