March 22, 2019
The Cost of Becoming a Doctor
Be Well

The Cost of Becoming a Doctor

by Keng Lam, MD

Now that I am fortunate enough to have been accepted to at least one medical school, I have had more time to research the financial aid situation. I have to say it is not looking pretty. Without any scholarships—which are very limited—I may graduate with more than $300,000 in debt. Right now I have zero debt from college or credit cards.

According to figures from 2013, the median debt of the most recent medical school graduates is $175,000, a three percent increase from the prior year. Even scarier, more than a quarter of medical students from the class of 2013 graduated with debt topping $250,000.

You can’t talk about student loans without talking about the interest. On federal loans, the interest rates are typically 5.41 or 6.41 percent. State governments, individual schools and private banks may offer additional student loans, but their interest rates are usually the same or even higher than the federal government's rates. And that interest usually continues to accumulate even when students are attending school full-time.

When doing residency programs (which usually last three years or more), medical school graduates do receive a salary for living expenses and to cover interest. But the amount is far below their median earning potential, because they are still in training. This means we will see many young doctors with nearly half a million dollars in student loans by the time they finish their training.

So why should you care how much debt new doctors have? I am offering two reasons.

First, these debts limit socioeconomic diversity in our physician workforce. In 1987, about 15 percent of medical students came from households with income in the bottom two quintiles. That number stayed roughly the same through 2005, even after medical schools began focusing on recruiting more applicants from socioeconomically diverse backgrounds. On the other end of the economic spectrum, in the year 2000, nearly 51 percent of medical school students came from upper income families (those in the top quintile). In 2005, this grew to 55.2 percent.

So what? This means that many patients may be unable to see a doctor who comes from—and understands—their background. In addition, doctors from less wealthy families are more likely to provide care in underserved areas. Thus, discouraging students from economically disadvantaged backgrounds from attending medical schools may lead to insufficient medical care options in poorer communities.

Second, because of debt, a majority of medical students are choosing a specialty other than primary care—even though we need more primary care physicians. In 1960, more than half of medical school students chose primary care. In 2007, less than one-third of med school students made the same choice. As a result, the United States will be facing a shortfall of about 35,000 to 44,000 adult care generalists by the year 2025.

Most primary care doctors earn less than $200,000. While this is a large salary, doctors in some of the higher paying specialties can earn more than $400,000 per year. And with up to half of million dollars in debt, seven or more years of training post-college and, potentially, a family to support, it is hard to blame medical students for opting out of primary care careers.

A career in primary care appeals to me in many ways. I like the idea of providing long-term care, seeing and treating a diverse number of health conditions and helping underserved communities. But I will need to do some very careful financial planning before I buy my textbooks and begin taking my anatomy courses, so that I don't drown in loans.