A Looming Crisis:
Will Sky-High Medical School Costs
Deter Tomorrow’s Doctors?

by Erin McDonnell

As the daughter of two physicians, I am constantly asked if I too want to become a physician. While this profession has always been an option I’ve considered, I hold major reservations due to my parents’ observations of the current medical climate. My mom has been working for over twenty years in the specialty that’s been impacted the most: primary care. My parents have told and re-told and re-told stories about becoming and practicing as physicians, but they also have enlightened me as to how times have changed. Becoming a medical doctor is no longer the same game it once was. Although their responses are largely positive, they do convey a tinge of cautionary skepticism towards the field, questioning whether the increasing cost of becoming a physician is sufficiently compensated by the benefits of actually being a physician. The cost of medical school is continuing to rise. If this cost has practicing physicians like my parents questioning the financial value of their career path, how is it affecting prospective students who are considering the long educational process of becoming a physician? Because of the rising cost of medical school education, the delivery of medical care in the United States is changing, and not necessarily for the better.

Scholars speculate that fewer bright, intellectual candidates are applying to medical school because they don’t want to be financially crippled by debt early in their careers. In the article “Physician Pay and Student Debt,” William B. Weeks, MD, a professor at The Geisel School of Medicine, Hanover, N.H., evaluates the percent value of educational returns on a basis of opportunity, cost, work effort, and changing income over an individual’s working lifetime. His evaluation reveals that a much higher percent value of educational return is found in becoming an investment banker, Wall Street broker, or software designer (Weeks). With increasing awareness that these career paths are faster and more stable paths to financial success, medical education is seeming a less and less viable option for many students. Rapidly rising student debt continues to be an issue in the United States. An article on education financing featured in The Business Times reported that over the past five years, the average student loan debt has seen an increase of 30% (White). An article from the Association of American Medical Colleges has shown a 6.3 percent annual increase since 1992 (Youngclaus and Fresne). The issue of student loan debt is evolving into something that influences not only how students pay for school, but also where they attend, what they study, and what job they accept after graduation.

The Association of American Medical Colleges (AAMC), founded in 1876, is a non-profit association dedicated to bettering the health of all starting at medical school, taking educational initiatives to promote awareness on multiple aspects of medical school, cost being a major one of these aspects. The AAMC’s most recent 2012 report “Physician Education Debt and the Cost to Attend Medical School,” by James Youngclaus and Julie Fresne, builds on the outdated 2007 report by Paul Jolly. With tuition “rising at a rate greater than inflation,” higher education is no longer driven by passion but financial stability (Youngclaus and Fresne). A large percentage of students do decide to go to graduate school and take on a new layer of debt to add onto their debts from their undergraduate education. According to the national student loan survey, if students are either brave enough to take on the financial burden or financially secure enough to consider graduate school, they add on– at minimum–an additional $24,500 of debt (Yoon). This sobering financial shadow is pressuring some students to jump into career paths prematurely, abandoning or postponing their desire to continue their education.

The pressures of debt are showing a specific impact in the medical field and the specialties that physicians choose for careers. The New England Journal of Medicine presents the contemplative position of authors David A. Asch, M.D., M.B.A., Sean Nicholson, Ph.D., and Marko Vujicic, Ph.D. regarding medical education in their article “Are We in a Medical Education Bubble Market?”(21 November 2013). As defined in the 2013 journal, a Bubble Market is created “when an asset trades for increasingly higher prices as it is bought by people who are hopeful about its future value and then sold to others with even more optimistic views of that value.” (Asch, Nicholson, and Vujicic). The AAMC recently evaluated the cost of medical school, including tuition, fees, and living expenses. In 2013, the average cost of attendance came to $228,200, or, the cost of a house (Youngclaus and Fresne). With the rising cost of obtaining a medical education, students who successfully complete the extensive process are graduating with an average debt of $176,348 (Youngclaus and Fresne). With these numbers rising, there is a complementary rise in the potential of our nation’s “Medical Education Bubble” to burst. Because an increasing amount of students recognize that their medical school costs aren’t matched by financial returns, the value of medical education is experiencing a deflation (Acsh).

The AAMC informs students of multiple payment plans to repay their debt. Physicians are presented with the option to either pay back their loans during residency with an average monthly payment of $290-$340 on a $50,000 salary or to postpone payments until their residency is over. Postponing these payments, which means accumulating interest, typically results in an average monthly payment of $1,400-$2,200 (Youngclaus and Fresne). While the postponing of payments may seem unwise, it allows financial flexibility during physicians’ residency, in which they earn a lower income salary. The second repayment plan is especially favored by those who seek a high paying specialty in medicine (Youngclaus and Fresne).

It is predicted that the medical field will continue to suffer a shortage of doctors over the years with a predicted shortage of more than 90,000 doctors by 2020 (Youngclaus and Fresne). As cited in Jan Zhu and Ian Metzler’s article “Primary Care Physicians, an Endangered Species?: How Rising Medical School Debt is Threatening Our Health Care System,” primary care is currently experiencing a shortage of nearly 30,000 doctors. Traditionally known as the “heart and soul” of medicine, it is taking the brunt of our nations predicted shortage (Zhu and Metzler). According to Bio Medical Central Medical Education, the primary care physician specialty has seen a 41% drop within the past decade (Indyk et al). Why is Primary care suffering so much if medical school debt is high among all fields? With a primary care salary that is less than half the salary of a radiologist (Zhu and Metzler) and the lowest projected percent value of educational return (Weeks), the obvious financial gap is affecting the numbers in this specialty. Primary Care is an essential part of our health care system because it enables patients to develop a deeper relationship with their doctor. It is something that is unavailable to nearly one in five Americans today (Zhu and Metzler). “I never thought about the money,” my mom, a doctor of 33 years, said. “It was always about taking care of people.” Years ago, people became doctors purely for the desire to help people– a seemingly reasonable and altruistic purpose. Today, while those intentions may still be present, rising costs have dampened the enthusiasm for choosing medicine, and primary care in particular, as a career.

Many primary care physicians take on not only the stress of managing their own practice, but also a more restrictive budget when it comes to repayment plans with regard to their medical education debt. The equated debt is 85% of their income (Weeks). Comparing the salaries of a primary care physician to those in higher paid specialties, it is no wonder doctors are choosing to go into more lucrative sub-specialty careers. The salary difference between primary care and other specialties, when evaluated in the eyes of a monthly $2,000 repayment plan, reveals the financial pitfall primary care physicians are experiencing with their low income. Their monthly payments make the possibility of buying a house or car seemingly unattainable. The salaries earned by primary care physicians no longer present a meaningful financial offset to service doctors’ educational debt. By choosing a more specialized field of medicine, doctors, whether persuaded by passion or not, are also choosing a career path that allows for a more prosperous, financially stable life to develop earlier in their lives.

The result of medical school debt driving individuals’ career paths is an issue that is negatively changing our health care system– not only from a standpoint of educational costs, but from the standpoint of medical care as a whole. While efforts, such as repayment plans and service jobs offered by the National Health Service Corps, are being made to change the current medical education statistics, they are not enough (Youngclaus and Fresne). These issues are leading political leaders to develop options, propose solutions like the Affordable Care Act, and evaluate the approach of other countries, such as France, whose annual medical school tuition is $258, and Canada, whose tuition ranges from $6,000-$16,000 (Zhu and Metzler). The widespread debate over medical education costs speaks to its importance. This issue influences a wide range of societal fields, including health, politics, and education. If the price of medical school does not become manageable, or the salary of primary care physicians does not increase to cover this expense, our society will begin to feel the effects of the shortage of bright, young, motivated individuals in the medical field (Asch, Nicholson, and Vujicic). And society won’t like it.

Works Cited

Asch, David A., Sean Nicholson, and Marko Vujicic. “Are we in a Medical Education Bubble Market?” N Engl J Med 369.21 (2013): 1973-5. Print.

Indyk, Diane, Darwin Deen, Alice Fornari, Maria T Santos, Wei-Hsin Lu, and Lisa Rucker. The influence of longitudinal mentoring on medical student selection of primary care residencies. BMC Medical Education: 2011. Web 8 Nov. 2014.

Weeks, William B. “Physician Pay and Student Debt: A Recent New England Journal of Medicine Article Suggests that Professional Education–Particularly for Medical Specialties and Occupations–is Experiencing a Market Bubble.” 3 Nov. 2014: 128. Print.

White, Martha C. “Student Loan Debt Crisis: How’d We Get Here and What Happens Next?” The Business Times: Times Magazine, 4 Feb. 2013. Web. 8 Nov. 2014.

“WVU Official Warns Loan Debt Could Create Doctor Shortage.” The Charleston Gazette (Charleston, WV) 29 Jan. 2013. Questia. Web. 8 Nov. 2014.

Yoon, Intae. “Debt Burdens among MSW Graduates: A National Cross-Sectional Study.” Journal of Social Work Education 48.1 (2012): 105. Questia. Web. 8 Nov. 2014.

Youngclaus, James “Jay” and Julie A. Fresne. Physician Education Debt and the Cost to Attend Medical School 2012 Update. Association of American Medical Colleges: February 2013. Web. 8 Nov. 2014.

Zhu, Jane, and Ian Metzler. “Primary Care Physicians, an Endangered Species?: How Rising Medical School Debt Is Threatening Our Health Care System.” Kennedy School Review Annual 2012: 47. Questia. Web. 8 Nov. 2014.