Effect of debt on U.S. medical school graduatesʼ preferences for family medicine, general internal medicine, and general pediatrics

Abstract

The authors assess the importance of educational debt in graduates' primary care specialty choices, and the variety of mechanisms through which debt may influence career decisions. Logistic regression models were used to identify significant predictors of the primary care specialty choices made by the 1991 and 1992 graduates of U.S. medical schools. These predictors were debt itself; other financial indicators; certain medical school characteristics; certain practice location plans; certain demographic factors; aspects of academic performance; and students' predisposition to a primary care specialty. Data for this study were gathered from a variety of sources at the Association of American Medical Colleges and from the Health Education Assistance Loans program. Both direct and indirect effects of debt were identified under specific conditions. The study revealed complex relationships between debt and the other predictors identified. For example, debt operated in relation to the levels of the graduates' expected incomes; debt from subsidized loan sources was significant for women who chose general internal medicine; debt was important in choices of family practice; and debt by itself was significant for those planning to practice in the West and who chose general internal medicine. Also, seemingly opposing effects of debt occurred. For example, in the family practice model used in this study, the threshold effect of debt was positive, while the linear effect of debt above the threshold was negative. Such vriations help explain the conflicting findings of some past research. These and other findings prompt the authors to state that when investigating the effects of debt, it is not fruitful to ask what the effect of the debt is on all three primary care fields as a group. It is more appropriate to ask several questions, such as: under what conditions does debt influence specialty plans? Among which groups of students does debt have an impact on specialty plans? Are all of the primary care specialties similarly affected by the issues surrounding debt? Does the effect of debt change over time? The authors conclude by indicating possible policy implications of their findings.

Factors Related to the Choice of Family Medicine: A Reassessment and Literature Review

“…18 -20 Three studies reported multivariate analyses with at least one other control variable. Of these, 2 did not find that gender predicted choice of family medicine, 21,22 whereas the other found that being female …”

“…22,26 The data from these studies provide limited support for the belief that Hispanics are more likely to select family medicine.…”

“…25 Studies using multivariate analysis also had conflicting results; one did not find that age predicted plans for a family medicine career, 22 the other found a linear positive relationship between age and a plan for a family medicine career. 23 Although these results are mixed, it would seem that older age is at least weakly related to a choice of family medicine.…”

The Selling of Primary Care 2015

“…Student debt may have a modest effect on career choice, but the effect is complex 41,56,57 and other factors seem to be at least as important. 10,20,37,41,58-62 Women, older students, and students from rural areas are more likely to choose primary care careers, 10,36,57,63 but admission strategies selecting for these features have not been tested and there is some evidence to doubt they would succeed.…”

Academic General Internal Medicine: A Mission for the Future

“…[24][25][26][27] Information systems, electronic health records and patient internet portals are diffusing across medical practices and enabling the collection and linkage of data from a wide range of settings. 28,29 At the same time, medical education is in a time of transition with duty hour restrictions for residents, 30,31 a shift to ambulatory settings for both residency and medical student training, increasing concern about student debt burden, 32 and a focus on teaching practice competencies rather than medical knowledge. 33,34 This transition is occurring as the physician workforce also changes, with a growing proportion of women (30 % of practicing physicians and 52 % of medical students) 35 , slow shifts in racial and ethnic diversity (17 % of current medical students identify as a racial or ethnic minority), 35 and a growing focus on work life balance.…”