Between 2010 and 2016, the proportion of medical school students who graduated without educational loans increased from 16.1% to 26.9% despite steady tuition hikes, according to new research.
That may seem like good news, the authors write. However, because there was no substantial increase in scholarships in that time, the data suggest that more wealthy students are entering medical schools, which could exacerbate inequities.
Within the debt-free cohort, scholarship funds actually took a steep dive from
$135,186 in 2010 to $52,718 in 2016, the investigators report in an article published online September 5 in a research letter in JAMA Internal Medicine. (Figures were adjusted to 2016 dollars.)
“[A]s we consider increasing the diversity of the physician workforce, this would suggest that we’re not moving in the right direction in terms of income,” senior author David A. Asch, MD, from the Penn Medicine Center for Health Care Innovation, in Philadelphia, Pennsylvania, told Medscape Medical News.
Meanwhile, among medical school graduates who do report debt, the average increased to $190,000 by 2016, according to the Association of American Medical Colleges (AAMC).
However, that average masks the very different burdens students have, write Justin Grischkan, from the University of Rochester School of Medicine and Dentistry in Rochester, New York, and the Penn Medicine Center for Health Care Innovation, and colleagues.
When stratified according to amount of debt, the researchers found that the subset of students graduating with more than $300,000 in debt doubled from 2.1% (263 of 12,786) in 2010 to 4.2% (565 of 13,610) in 2016.
Dr Asch says that their findings, which are based on data from the 2010-2016 AAMC Graduation Questionnaire (response rates, 78%-83%), have implications for the future physician workforce.
“It’s important that the economic burden of becoming a doctor isn’t something that perpetuates the disparities that we have seen in the physician workforce where it continues to be a field that only the rich can enter,” he said. “I think we need to have a much finer-grained look at the cost of producing a physician and who bears that cost.”
The researchers also studied how the debt-free numbers played out across specialties.
They found wide differences among specialties and identified 6 that had the largest increases in the percentages of medical students who graduated without debt.
Six Specialties With the Largest Increase in Debt-Free Students
| Specialty | 2010 | 2016 |
|---|---|---|
| Ob/Gyn | 11.5% | 24.7% |
| Radiology | 17.1% | 30.4% |
| Neurology | 18.1 | 30.7% |
| Pathology | 20.8% | 34.8% |
| Dermatology | 23.1% | 36.1% |
| Ophthalmology | 26.3% | 39.9% |
Dr Asch says his team thinks there is some correlation between debt and choice of specialty, but they don’t know what it is and it doesn’t appear to be related to how much the specialties pay.
If specialty had no link to debt, you would expect to see more uniform increases in the proportion of debt-free graduates across the specialties, he notes. Instead, the increases are all over the map.
“The fact that we don’t see that suggests that there’s something else operating,” he said. “I don’t know what that is. This is the first work in this area.”
The authors have disclosed no relevant financial relationships.
JAMA Int. Med. Published online September 5, 2017. Full text
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