For many students, getting through medical school is a grueling process.
So is paying for it.
The average balance on medical school loans for physicians graduating in 2015 was $183,000, according to the Association of American Medical Colleges. Add that to the average amount students borrowed to obtain their undergraduate degrees and the tab rises to $207,000.
“I really hated the fact that people were in debt,” says Florence Haseltine, PhD, MD, a physician, biophysicist, reproductive endocrinologist, journal editor, inventor, advocate for women's health, and founding member of the Women in Medicine Legacy Foundation.
In 1993, she instituted a loan repayment program at the National Institutes of Health (NIH) in which researchers in reproductive biology would get their loans repaid, the springboard for an expansive repayment program at the NIH.
Today’s med school grads have access to a number of programs that reduce their debt. It’s a financial incentive for doctors to work in areas where patients lack access to the care because they are poor, live in remote areas, or both.
The National Health Service Corps Loan Repayment Program offers doctors who serve for two years at an approved Health Profession Shortage Area (HPSA) up to $50,000 in loan repayments. Participants in the Students to Service Loan Repayment Program can earn up to $120,000 in their last year at med school by promising to serve three years at an HPSA.
Other federal programs include: Federal Public Service Loan Forgiveness; Indian Health Service Loan Repayment Program; Army/Air Force Active Duty Health Professions Loan Repayment Program; and the Army/Navy Healthcare Professions Loan Repayment Program. A number of states offer loan forgiveness programs, too.
After she graduated from the Medical College of Wisconsin, Ellen Piernot, MD, worked at Presbyterian Medical Services in isolated Grant, New Mexico, caring for a diverse population of Native Americans, Hispanics and whites.
“Two years is a small price to pay for having your loans removed,” she said in an HPSA testimonial.
Dr. Piernot wound up staying for seven years. She now leads Golden Valley Health Centers in central California, a Federally Qualified Health Center (FQHC) that operates more than 20 safety-net clinics in a largely agricultural region.
Firoza Faruqui, MD, got an HPSA scholarship that paid for all four years of med school in exchange for a commitment to work 32 hours a week for four years at Hampton Roads Community Health Center in Virginia, where she practices pediatrics.
“Health is important for children because it really sets up their future for being healthy adults,” she says in her testimonial. Dr. Faruqui notes that her service allows her to maintain a satisfying work-life balance, with time to devote to her husband and children.
Westside Family Health, an FQHC in Delaware, serves poor patients at sites in Wilmington and Dover, as well as itinerant farm workers through a mobile clinic. Westside harnesses a government program to forgive debt as a recruiting tool for physicians.
“Loan forgiveness absolutely helps Westside attract doctors,” says spokeswoman Maggie Norris-Bent.
Debt programs are also influencing residencies. One young physician, who recently completed a residency in family medicine, took several elective blocks in obstetrics in anticipation of serving on a Native American reservation where her work might likely include prenatal care and delivering babies.
Still, the problem of medical school debt has not gone away. In 2016, the average cost for a year at a public medical school was $32,495. The least expensive was Texas A&M Health Science Center, which charges in-state students $16,432 a year. Private med schools averaged $52,515 a year for tuition and fees, with Columbia University Medical School topping the list at $61,485. Those figures don’t include books, transportation and living costs.
In addition to the crushing financial burden, debt can have other influences on a doctor’s career path. Ascendant physicians may pursue higher-paying specialties such as neurological surgery, with an average annual paycheck of $680,000, and orthopedic surgery, an average of $450,000, creating shortages of pediatricians and internists, who can expect to earn less than $200,000 a year.
Already, there is a shortage in geriatricians, a field in which demand is on the rise, Dr. Haseltine says.
“I have to wonder about the impact debt and finances is having on the choices physicians make in their careers.”
The demands of debt also pressure some doctors to change jobs, following paychecks rather than their personal passions. Dr. Haseltine says the repayment program at NIH reduced turnover.
“Biomedical researchers get their loans paid, so they do stay in the lab. Because as long as you’re in the lab, it’s paid.”
It’s a legacy she is proud to leave.
“That can go on my tombstone,” she says.