Medical debt of doctors is symptom of debt as way of life
But while upgraded clinical facilities and spectacular research programs are obvious reasons, another key factor has gone largely unnoticed. It is our society's assumption that individual indebtedness is required to obtain big-ticket items, whether they are cars, houses or higher education.
"It's become normal now to take out loans to get anything of value," said Dr. S. Ryan Greysen, an assistant professor of medicine at the University of California, San Francisco, and lead author of a fascinating study published this month on the historical and social factors that have contributed to rising medical student indebtedness. "Getting a medical education has become similar to getting a mortgage on your house."
The acceptance of student indebtedness as the "norm" of medical school has provided a kind of carte blanche for robust tuition increases. Median yearly tuition at public medical schools is $29,000, and at private institutions it is $47,000 -- increases from two decades earlier of over 312 percent and 165 percent, respectively. While some may counter that future doctors can well afford such increases and loans, the rising debt load has had and will have repercussions on patients, particularly those in greatest need.
Paying so much up front has transformed an education that was once a path to public service into a significant financial investment that needs to yield returns. "Because of all the debt, people stop thinking of medicine as an incredible opportunity to do good," Dr. Greysen said. For some young people, looming debts mean eschewing a calling to serve a particularly needy, less lucrative patient population or practice, and instead pursuing a well-compensated subspecialty that caters to the comfortably insured.
For others, such large debts mean forgoing a medical career altogether. Cost remains a key deterrent for pre-medical students and is an important reason there aren't more African-American, Hispanic and Native American doctors. Despite the well-documented benefits of a diverse physician work force, these economic pressures are transforming the socioeconomic makeup of medical school classes; medical students are increasingly from affluent backgrounds. In 1971, almost 30 percent of medical students came from households with incomes in the lowest 40th percentile, but only 10 percent of all medical students now do, and more than half come from families in the top quintile.