Debt Concerns Turn Medical Students Away From Primary Care

By Christina Olenchek

Wesley Flint hasn't decided which specialty he'll pursue when he graduates from Penn State College of Medicine in Derry Township, Dauphin County.

But playing no small role in his decision is that he expects to owe nearly $300,000 in student loans by the end of his studies.

"I think it has some bearing (on my decision)," said Flint, a 27-year-old from Salt Lake City. "It definitely makes those fancy specialties look a lot more attractive."

That is bad news for doctors and policymakers trying to make primary-care services accessible to more Pennsylvanians. Rising medical-student debt is another reason why students will shy from relatively low-paying primary-care fields, such as internal medicine and pediatrics, and instead focus on higher-paying specialties like cardiology and radiology, observers said. A lack of primary-care doctors could force consumers to seek expensive emergency-room and specialist care for general ailments, which could drive up the cost of health care.

"Students with huge debt are not going to choose to go into primary care," said Dr. Daniel Kimball, chairman of the health and public-policy committee of the Pennsylvania chapter of the American College of Physicians. "They're going to look to a field where they can pay off that debt more easily or rapidly."

In 2006, medical-student debt averaged $120,000 for students graduating from a public medical school and $160,000 for students graduating from a private institution, according to the Association of American Medical Colleges (see "A growing burden," page 1). The average debt for a student at Penn State College of Medicine is about $150,000, said Dr. Harold Paz, the college's dean.

The financial pinch for new doctors doesn't end there, Kimball said. There are costs related to establishing a solo practice or buying into a group practice. There are medical-malpractice premiums to pay. Reimbursements from government payers and insurers often are inadequate, forcing doctors to see more patients to make ends meet.

Kimball, former chief of the residency program at The Reading Hospital and Medical Center, said he knew of many residents who initially wanted to go into family medicine but later decided against it because they could make more money elsewhere.

"You add (the other costs) on top of the debt, and it's overwhelming," Kimball said.

Loan forgiveness might be the only way to convince medical students like Kelly Burba to go into primary care. Burba, a 25-year-old from Ann Arbor, Mich., said she is more interested in a career in cardiology or emergency medicine.

"Without loan forgiveness, there wouldn't be enough (money in primary care) to pay back the loans," she said.

Kimball said he believes drastic action might be needed to make medical school less financially taxing to students. The United States could follow the model of other countries that offer medical school tuition free.

"I don't know if we'll ever get to that point," Kimball said. "But there has to be a big relook at how we fund medical care."

Source: http://www.centralpennbusiness.com/weekly_article.asp?aID=84064264.928651.873028.7127463.4956535.178&aID2=67147