Student Debt Is Crushing The Next Generation of Healthcare

By Zoe Parrott

The financial impact of debt, or even the possibility of debt, impacts students on every level of academia, and this is especially true for students entering medical school. In 2023, the average total student debt for an American medical school graduate was $250,995, and if trends continue, this number is only projected to increase in decades to follow. Furthermore, not only does debt dramatically shape a future doctor’s career choice and foreseeable career, but this impact is often furthered by other social factors, such as race and class. The rising projected student debt for American medical students not only dissuades students from choosing to enter certain medical fields, but also discourages certain demographics from ever even applying, which ultimately contributes to an educational culture solely financially reliant on generational wealth or loans.

A 2017 article published by the American Medical Association called “How med student loan burdens can deepen health disparities,” noted that for many graduates, “the high amount of loan burdens they accumulate can mean that they are much more likely to choose a higher-paying specialty field rather than primary care.” Such a choice reflects the need to quickly repay debts. In a more general sense, such a decision can lead to a nation-wide lack of primary care physicians, a trend that will likely disproportionately affect rural and lower-income areas. This discrepancy is enforced even more strongly when, for the purposes of paying off their debts, physicians choose to “practice in more affluent areas, further widening the gap between lower-income populations and access to available physicians.” The article also claims that “students in ethnic and racial minority groups that are underrepresented in medicine, and those from lower-income families, can be particularly daunted by the prospect of six-figure loan burdens;” as only 5.7% of physicians in America in 2023 identified as Black or African American, and only 6.9% identified as Hispanic, despite both of these race/ethnicities making up a much larger percentage of Americans, this claim does have standing, and proves that racial and class disparities certainly has an impact on which students are able to make the huge financial commitment attending medical school.

The rising cost of medical school has been shown to have dramatic influence on possible pre-medical student’s choices to enter the field. But why are the prices rising? There is surprisingly little academic literature to inform concerned students why they may or may not be taking more than a quarter of a million US dollars in debt; regardless, the main reasons seem to lie in the basic economic principle of supply vs demand. “Certainly, the demand for medical education is high,” a NIH research paper explains; as of 2014, “the ratio of applicants to medical school to accepted candidates is 16:1. It is unsurprising that with this level of competition prices will rise.” Furthermore, the traditional model of medical school education demands fairly small class sizes and engaged, research-driven professors. This, along with the modern demand for state-of-the-art equipment, hyper-realistic simulations and brand-new facilities also drives tuition prices up. Another, more general reason for rising tuition is the demand for more resources and financing by the medical school’s parent institution or university, which is expected to regularly produce research and appease shareholders and alumni. Most causes of these tuition increases are completely outside of student’s control, yet it can take decades for students to ever truly be free of the repercussions of pursuing higher education, never mind the opportunity cost of attending medical school. So what are students in control of? Apparently, the way they pay back their debts.

Working full-time in the public sector (generally for a government or a nonprofit) while making 120 payments of your loan can get the rest of your loan forgiven under Public Service Loan Forgiveness (PSLF). This will take physicians about 10 years, a significant mark on a career that already takes generally more than a decade of additional schooling to achieve. There is also the State Loan Repayment Programs (SLRPs), which incentivizes physicians to work in understaffed areas, and also certain military programs that require years of working in military medicine before returning to civilian life. There are also other options, including Employer-Based Loan Forgiveness Programs and the use of low interest student loans. But none of these options really solve the greater issue of how wealth disparity impacts a physician’s choice in specialty, nor the years and years of debt repayment, which can impact future retirement, home ownership, marriage, and other life choices. 

So what should be done? Clearly, the inability for the government and schools to reliably provide a reasonable avenue of debt repayment is negatively impacting medical school graduates, and this issue does need to be addressed in a manner that permanently fixes the problem. However, no real solution can be proposed until the allocation of students’ tuition is transparently and truthfully reported by medical schools. What resources, salaries, benefits, institutions, and research are schools spending money on that they were not spending money on ten, twenty, and thirty years ago? Have the prices of each of these needs gone up in the past few decades? If so, why, and what can be done to stem the rapidly increasing cost of maintaining and contributing to academia? These questions, and, in stride, these answers, cannot be answered without more visibility. The fate of millions of students every year relies on this.

How does the concept of a meritocracy impact debt repayment for doctors?

Works Cited

Admin. “How Student Loans Affect Healthcare Professionals.” Marvel Medical Staffing, 3 Aug. 2023, marvelmedstaff.com/how-student-loans-affect-healthcare-professionals/.

Hanson, Melanie. “Average Medical School Debt [2020-21]: Student Loan Statistics.” EducationData, 8 Sept. 2020, educationdata.org/average-medical-school-debt.

Walsh, Kieran. “Why Is Medical Education so Expensive?” Journal of Biomedical Research, U.S. National Library of Medicine, July 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4102847/. “