What’s the Price of Committing to a Career in Primary Care?

Dawn Pruett, Medical Student, Oregon Health & Science University School of Medicine

I’ll be matching into a family medicine residency this spring and, true to what the literature says, the potential earnings of a family physician played little part in my specialty choice. I can honestly say (perhaps naively) that I didn’t choose primary care for the money.

When I entered medical school, I was aware of how much debt I’d be taking on, but I don’t think I had a true understanding of its impact. At that time, I couldn’t imagine what it’d be like to make anything close to $100,000 a year, nor could I grasp what it’d be like to owe three times that amount. I would often hear, “You’ll be a doctor, you’ll be able to pay it off,” and “Medical student loans are ‘good debt,’” implying negligible future financial impact.

Even now, as I’m about to start residency and begin repayment on my loans, it’s difficult for me to feel the true burden of my debt. However, the conversations are changing.

At the recent AAMC Annual Meeting, the topic of medical student debt came up not only in official meeting sessions but also in informal personal conversations. I’m encouraged that this issue has been brought to the forefront, but I wish the focus would broaden even more. While it’s important to identify the nebulous costs associated with medical student education, and efforts to decrease tuition are certainly necessary, these considerations are only part of the multifaceted issue. What about the debts that have already accumulated? How will residents and physicians currently entering the workforce be affected by high debt burdens?

In the January issue, Youngclaus and colleagues used a meaningful approach that considered loan payments in the context of a personal budget. When I identified the scenarios in their tables most similar to my own, I was astonished. I’d come to terms with some of the numbers, such as my total repayment (up to 250% of what I borrowed). However, what I hadn’t anticipated was that, according to their analysis, loan forgiveness programs like Public Service Loan Forgiveness (PSLF) may not just be beneficial for me, they may be necessary. PSLF is a program often discussed by financial aid officers to buffer the distress associated with medical student debt. Rarely is it mentioned, however, that the program, which began in 2007, hasn’t repaid a single loan yet. It won’t until 2017, when its first participants have completed the required 10 years of monthly loan repayments. I’m particularly worried about the longevity of such a federally-funded program. When the number of participants and the amount of their loans become overwhelming large, will loan forgiveness programs be sustainable?

Students accumulate debt in medical school but don’t really experience the burden until much later. Although the effect of debt may not have a huge influence on the choices I made during medical school, I am sure that my debt will impact future decisions in my life. Will my husband be able to stay at home with our children? Will we be approved for a mortgage? As Youngclaus and colleagues suggest, those who choose a specialty with traditionally lower compensation may be dependent on “additional strategies” for loan repayment. For me, will this include choosing private practice over my true passion of academic medicine? Will PSLF even still be available as an option for me in 10 years?

I hope that we can continue to investigate the long-term effects of medical student debt, especially looking beyond medical school, when the debt will feel much more real.

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  1. Justin
    January 29, 2013 at 7:51 PM

    Gold is the currency of kings:
    Silver is the currency of tradesmen;
    Barter is the currency of peasants;
    Debt is the currency of slaves.

    Do we consider physicians to be professionals, or are they servants of the public?

  2. Looking Back: One Year of AM Rounds | AM Rounds
    January 3, 2014 at 5:16 PM

    […] What’s the Price of Committing to a Career in Primary Care? by Dawn Pruett, a medical student at the Oregon Health & Science University School of Medicine, reflecting on her motivations for choosing primary care (hint: it wasn’t about the money). […]

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