Can Future Docs Afford to Go Into Primary Care?

Dec 4, 2012

Researchers writing in Academic Medicine, the journal of the Association of American Medical Colleges, think so. Or rather, after crunching the numbers – medical school debt load to potential income and expenses – they think medical students who decide to go into primary care as a specialty will be able to pay off their school debt on a primary care doctor’s salary.


That’s for graduates with “median levels” of debt, they say – which is about $160,000 after four years of medical school. The study’s authors write that, out of all the graduates in 2011, 23% of those who went to private medical school left with $250,000 or more in debt. With that kind of debt load, the researchers found it economically unrealistic that a primary care doctor could pay off her loan in 10 years and have enough to live on, especially if she lives in an expensive region of the country. Rather, she might have to enroll in a loan forgiveness program, or extend the repayment period.

Why does this matter? Because there are calls for more primary care doctors coming from, it seems, everywhere these days. Better primary care – meaning annual check ups, a doctor who knows you and follows your health for a while, preventative care, help navigating the world of specialists and more complex health care if you need it – is being billed as the best way to improve our collective health as well as reduce health care costs. That’s opposed to waiting until a chronic condition, for example, sends you to the emergency room because you didn’t see a doctor regularly who could have helped you manage that chronic condition in a way that was better for your health and your bottom line.

But primary care hasn’t been as attractive a specialty for doctors because it’s just not as well paid as other specialties. And with so much debt to pay off after medical school, the thinking has been that doctors will choose a high paying specialty to help pay it off. Still, the data doesn’t necessarily bear that assumption out.

What Future Docs I meet tell me is that they really want to find the specialty that interests them most, that makes them happiest. And many seem to be considering specialties they think are in need right now, regardless of the pay.
They might be interested to know, however, that someone has finally done the math – a pretty extensive economic analysis – to learn whether their idealism can really pay off. Their conclusion in a nutshell:

Our economic modeling of a physician’s household income and expenses across a range of medical school borrowing levels in high- and moderate-cost living areas shows that physicians in all specialties, including primary care, can repay the current median level of education debt. At the most extreme borrowing levels, even for physicians in comparatively lower income primary care specialties, options exist to mitigate the economic impact of education debt repayment.