Most medical students can enter primary care and still repay their loans, an economic model study found, although debts above $200,000 might more often require extended repayment terms, federal loan forgiveness/repayment programs, or not living in the highest-cost cities.
The study examined the economics of loan repayment and household income and expenses to determine whether debt could affect specialty choice, an assumption that's never actually been studied, the authors wrote. Their results appeared online at Academic Medicine.
The economists analyzed household finances of a fictional couple over their lifetime using financial planning software to study the impact of three career tracks (primary care, psychiatry and obstetrics-gynecology) and living in a high-cost or low-cost locale on the monthly discretionary income of the physician. The model considered that the physician was married to an employed, college-graduate spouse with two children and that the person remained married until the couple's deaths at 85 years old.
Researchers concluded that medical school graduates with the median amount of education debt ($160,000) can enter primary care, raise a family, live in an expensive urban area, and repay their debt in 10 years without going further into debt.
But if the new graduate had $200,000 of debt, a primary care physician would need to consider an extended repayment plan and/or a federal loan repayment program, such as the National Health Service Corps. Once student debt reached $250,000 or more, a primary care physician would need to consider living in a moderately priced area or opting for an extended 25-year repayment plan or a multiyear commitment to loan forgiveness/repayment program, the authors noted.
"Although education debt levels for indebted medical school graduates in the classes of 2009-2011 remained stable, if they were to increase in the coming years at a rate comparable to those that we have seen historically, an increased number of indebted graduates, particularly those pursuing primary care, might need to consider repayment options beyond the standard 10-year repayment plan, which could make primary care less attractive to some graduates," the researchers wrote.