Mounting medical student debt and increased difficulty in repaying this debt is a problem that threatens American health care. According to the American Association of Medical Colleges (AAMC), over 80 percent of medical school graduates carry educational debt. Median debt for graduates is $115,000 and one-quarter of students with debt have a principal of over $150,000. Some report a principal of over $350,000. These amounts do not include credit card debt, which often is in the thousands of dollars.
A massive increase in medical school tuition and fees is driving the growing medical school debt. Government cutbacks in education and health care spending are behind the tuition increases.
Physician incomes have not kept up with the dramatic increases in tuition and debt burden for medical students. According to the AAMC, “in recent years, physician incomes have increased only slowly, and in constant dollars, the amounts have trended slightly downward.” Medical residents earn on average between $31,000 and $34,000 per year (about $10 per hour) so they ultimately wait to pay their debt after completion of residency (allowing interest to accumulate).
Since residency programs range from three to seven years, thousands of dollars in additional debt is accumulated. The counterargument is that doctors will eventually make enough to pay off this debt. Sometimes this is true, but many primary care doctors, particularly those providing care for low-income patients, find their loan repayments to be a daunting portion of their monthly expenses. Many internists and pediatricians face 30 years of repayment and end up paying about three times as much as they borrowed.
As a result, 2002 was the sixth year in a row that the number of students entering family medicine has fallen. A continued decrease in numbers of primary care physicians threatens population health because, although these physicians are the lowest paid, they are the most important in protecting the health of individuals and communities. Primary care physicians can provide the most comprehensive, most culturally sensitive, and most cost-effective care for complex communities.
Access to care, diversity and cultural competency among physicians, and health disparities are all affected by the current trends of increased debt among medical school graduates. African Americans, Latinos, and Native Americans make up about 25 percent of the U.S. population, but only 12 percent of medical students. An AAMC survey showed that costs of attending medical school was the primary reason why qualified students of color chose not to apply to medical school. The rising cost of medical education is result in fewer and fewer people of color being included in the nation’s pool of physicians. It also concentrates medical education among the wealthiest: over 60 percent of medical students come from families with incomes in the top 20 percent, while only 3 percent of medical students come from families in the lowest 20 percent income category.
There is sound evidence demonstrating that minority and working-class medical students are more likely to enter primary care fields and practice in underserved communities where disparities are most severe. According to Healthy People 2010, a report published by the Department of Health and Human Services, minority physicians are more likely to serve in physician-shortage areas and to research diseases that affect mostly minorities when compared to their white colleagues.
Poor financing for medical education is a clear example of how the current administration is attacking both health care and education in our country. The presence of fewer African American, Latino and Native American physicians is resulting in decreased quality and access to care for people of color — a policy that is perfectly in line with attacking Medicare, Medicaid, and Social Security.
It is only through much improved public financing of primary, secondary, university, and professional education that we can achieve enough physicians who are equipped to deal with the realities of our complex society. The fight for affordable medical education is a crucial component in our fights for democratic access to quality education and for a health care system that guarantees universal access and excellent quality.