BU Researchers: Primary Care Careers ‘Very Possible’ Despite Med School Debt

BOSTON — The health care system has been concerned for a long time that many medical school graduates are choosing not to go into primary care because they worry they won’t make enough money to pay back their student loans. And that’s bad news since there’s already a shortage of primary care doctors.

But a group of Boston researchers has published a study in the Journal of the Association of American Medical Colleges finding that medical school debt and primary care may not be incompatible after all.

WBUR’s All Things Considered host Sacha Pfeiffer spoke with the study’s senior author, John Wiecha, assistant dean for academic affairs and an associate professor of family medicine at the Boston University School of Medicine.

Sacha Pfeiffer: I think we should start with two baseline numbers: the average student loan debt for people just graduating from med school, and the average starting salary for primary care physicians. Would you tell us what those dollar amounts are?

John Wiecha: The average debt of medical student graduates as of the class of 2012 is about $166,000. Among private medical school graduates, it’s actually $183,000. And that’s increased just in the past year by about 4 percent.

Starting salaries for physicians vary pretty dramatically. And among primary care physicians, starting salaries are about $145,000, as of the most recent data we have.

That’s a national average. As you said, it can vary. But whether you’re in Idaho or New York City, that’s a fair average to go by, you believe?

It’s a fair average. Again, it can vary pretty dramatically between the type of practice that a physician finds himself or herself in.

So you wanted to try to figure out if various levels of med school debt actually are manageable on a primary care salary. What did you find?

By and large, except for the highest levels of debt, with careful financial planning, they actually should be able to pay off their debt, purchase a house at a median house price, and even save some money for eventual retirement.

So even making about $145,000, but owing about $160,000 to $170,000, you can pay for your kids to go to college, have money in retirement, and still pay off your loans?

It looks that way. I will say, though, that about 27 percent of students in private medical schools had debts of $250,000 or more. At that level or above that, we’re really seeing that students need to be very careful about financial planning, and they may have to make some compromises in terms of the practice environment that they’re in.

Meaning what city they might live in, what suburb they may own a house in?

Exactly. So, for example, we find that at those really high debt levels, which unfortunately are becoming more common, it may be more difficult to live in a very high-priced area. Or the student may have to participate in [an extended] loan repayment situation.

But in many ways, this seems like basic financial planning. Should it be a revelation that if you come out with very large debt, you’re either going to have to have a salary that can pay it back, or you’re going to have to live more cheaply?

It shouldn’t be a surprise. But I think there are real concerns here, as well. And one of the concerns really relates to the fact that these debt levels are rising dramatically. So although our findings at this point are relatively reassuring, I think given the rapidity of the increase in debt, I’m not sure that the picture will be as rosy in the near-future, even.

But can we conclude from your study that if a med school grad is avoiding primary care because he or she is afraid they’ll struggle too much to pay back their student loans, that could be a false alarm, depending on the debt level?

Yeah, I think that’s a fair characterization. But I think we also need to realize that students’ choice of career direction really is responsive to many other factors — not so much education debt or even income expectation. Those are really fairly low down on the list of influences that students report regarding their career choice.

What would you say is the overall message of your study?

I would say to a student that’s graduating from medical school, who’s interested in primary care, I would say it’s very possible. They should look carefully at loan repayment options. There are a number of federal programs that can help them. And I think they should follow their heart.

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  • CircusMcGurkus

    Anyone making $145k/year should not have any problem with finances. The salaries of doctors are so outrageously high that this seems like a pittance only to medical professionals. But compared to, umm, the rest of America – $145k is an excellent income and believe it or not, people, actual people, “manage” to live on that amount (and far less), pay off debt, raise families, go on the occasional vacation and also worry that they may lose their jobs…a worry doctors do not have.

  • elewisg39

    Two comments

  • elewisg39

    How does BU Medical School justify charging $70,000 a year to their incoming students

    Responding to previous writer:
    It becomes a choice for graduating students
    They have this large debt
    All other things being relatively equal, If one can get a position for $145k or one for $195k, which one would you choose.

    To support their study, ask the deans what percentage of their graduates are in primary care 10 years after graduation.

    • CircusMcGurkus

      Agreed on the cost of medical school – all higher ed is outrageously expensive with no end in sight – urged on by the federal school loans which were instituted to cover the cost for everyone to get educated…but it has run amok. The stipends the schools give a lot of students in multi-degree programs (i.e. MD/PhD) can be enormous. Perhaps better to use the endowment more efficiently and lower the cost of the education process for all qualified to get in.

      But, the other argument is poppycock. Primary care doctors have a much shorter residency than other specialties that pay better and there are programs that offer tuition reimbursement. But, I do not think people should choose careers in SERVICE (i.e. law, education, medicine, even banking) based on salary – it should be much more noble than that. We have lost the idea that service professionals are anything but that. While necessary for the functioning of the society, service professionals do not contribute to the overall economy: they create absolutely ZERO wealth yet they take a huge chunk.

      My point is now and always that the money equation has to become rational before anyone can see care improve on any level. Single payer (and enormous regulation) with reforms to the cost of medical school is fair: make this holisitic – professionals need to learn from day one in school that this should be collaborative and not competitive. It is NOT a business, it is a service. And it starts from the beginning – if we want better doctors at a more reasonable cost, we need to improve the entire system.

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