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Monday, May 1st 2006

A Dowry In Reverse

How student loans affect career choices.

In fact, she won’t consider much except how to meet the $300 a month she owes on her $34,000 student loan balance.

“The school debt makes you decide [about your career] based on the money factor. Not based on what you want to do,” said Wegmann.

It plays out on a much bigger field for medical school graduates. There is some evidence high debt balances are influencing medical students away from primary care fields. For instance, imagining a medical student has the grades and CV to go into whatever field he wants, a physician who goes through a 3 year Family Practice residency makes considerably less, on average, than a radiologist who went through a 4 year radiology residency.

I go to a state school which according to the AAMC is one of the five cheapest schools (in terms of tuition) in the country. I live in an area of the country with one of the lowest costs of living. Still, I will borrow more than $35,000 each of my four years here. Along with my undergraduate loans (which were kept down through the fortunate help of my parents) I will owe well over $150,000 when I enter my residency.

Imagine someone without scholarship attending a private medical school. Debts of more than $200,000 are not uncommon. Specialties with still relatively short training (so you start earning sooner) but which compensate well, start looking like smart options.

No wonder so many incoming residents in primary care specialties (family practice, internal medicine) are international medical school graduates.

There’s nothing really wrong with this model. I’m already subsidized, mildly by funds provided by my state, and in a larger sense through the federal student loan program. However, it does put physician income in perspective. Physicians are exceedingly well compensated no doubt, but physician income varies wildly amongst specialties. I sometimes get the sense that whining over reimbursement is kind’ve offsetting to patients and those on the outside. However, especially coming from your family physician (who is probably comparatively poorly compensated to other types of physicians) this is a very real problem and a legitimate complaint, especially for new MDs with huge school debt.