Monday, September 21, 2009

Primary care: no next generation?

My wife and I are both family physicians, 9 and 8 years out from medical school graduation, respectively. Principal and interest payments on our remaining combined six-figure student loan debt consume about 5% of our pre-tax income each year, and at our current rate of repayment, we could still be paying off this debt when our oldest child starts college. But after attending my alma mater's annual Alumni brunch in Washington, DC recently, I realized that today's future family physicians are much worse off than we are.

Consider these figures from a follow-up solicitation letter for scholarship donations: "Among the 155 members of the Class of 2008, 78 percent graduated with an average debt load of nearly $143,000. 18 percent graduated with a debt load that exceeded $200,000." These figures are hardly atypical for most private (and some public) medical schools. Given these grim numbers, it's a wonder that any medical students choose careers in primary care - the lowest-paid specialties being general pediatrics, family medicine, and general internal medicine.

In a 2008 letter published in the Journal of the American Medical Association, family physician-educator Mark Ebell, MD, MS demonstrated a near-linear association between median income and the percentage of U.S. senior medical students who entered a medical speciality - put simply, students go where the money is. And given their increasingly staggering debt loads, who can really blame them?

That's why I was excited to hear that the recently established University of Central Florida College of Medicine awarded full scholarships to its entire inaugural class of 41 students. Other schools may soon follow suit. Not surprisingly, UCF was the most selective medical school in the country this year. But will the absence of student loan debt result in this school ultimately training more primary care physicians? Only time will tell.

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