Debt and anticipated income impact med students' career choice

How to get more medical students interested in primary care careers has been much discussed due to the primary care physician shortage and the spotlight the Affordable Care Act has placed on primary care. A new study provides insight into understanding what drives medical students away from careers in primary care.

A longitudinal study of medical students published in Medical Education finds that debt and anticipated income have the most impact on the career choices of medical students.

Researchers at Albert Einstein College of Medicine of Yeshiva University, the Brody School of Medicine at East Carolina University and North Carolina State University surveyed more than 2,500 medical students between 1992 and 2010. They asked first- and fourth-year medical students about which area of medicine they planned to enter, their anticipated debt on graduation, the annual income they expected to achieve five years after completing residency and, in general, the importance they placed on income.

The researchers compared medical students who decided to enter a primary care area, such as general internal medicine and family practice, with students entering specialty fields (designated in the study as high-paying non-primary care [HPNPC]), such as radiology and general surgery.

In their analysis, the researchers found that 30 percent of medical students for entered medical school planning to pursue primary care careers switched to the HPNPC fields by graduation.

“These students that switched rated income as being more important at the end of medical school than at the beginning,” said Martha Grayson, MD, and Dale Newton, MD, in an email to Healthcare Finance News. Grayson, of Yeshiva University, and Newton, of East Carolina University, are two of the three authors of the study.

The students who switched from primary care to HPNPC fields also anticipated significantly higher debt than students who didn’t switch out of primary care, they noted.

The authors posited that an internal tension may develop within medical students as the years pass in school and they become more aware of the income disparities between primary care fields and HPNPC fields.

“While we found that debt was important, it was not nearly as important as anticipated income,” Grayson and Newton said. “This supports our belief that legislation should be put in place to decrease differences in physician reimbursement between specialties.”

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Grayson and Newton also suggested programs addressing student debt should be explored, with options including additional scholarship money, increases in public and private funding for medical education that results in primary care careers and legislation addressing debt forgiveness for students entering primary care fields.