In a recent article posted on this site, the author (a radiologist) waxed rhapsodic about a young medical student that was convinced to pursue primary care. When the author asked the student about the economic downsides to primary care, he responded by saying, “I’m not in it for the money … What matters to me isn’t the money — it’s making a difference in my patients’ lives.”
Well, good for him. Time and time again I hear the same narrative: “Doctors never go hungry,” “money shouldn’t matter,” etc. We should acknowledge that it is a huge privilege to be able to be able to remove one’s self from the financial reality of medical education. The mean education debt of graduating medical students in 2014 was $176,348, with half of all medical students leaving school owing more than $180,000 — and it is rising fast.
According to a 2012 report by the AAMC, the compound annual growth rate of medical education debt on average between 1992 and 2012 was 6.3 percent versus 2.5 percent from the consumer price index (a common measure of inflation). In just two years, the median medical education debt has risen: 5.9 percent from $170,000 (2012) to 180,000 (2014).
What is even more striking is that about 4 of every 5 medical students come from families in the top two quintiles of family income and that medical education debt levels are pretty much the same across income levels. This means students that enter medical school are overwhelmingly more likely to come from high-income families and the few students that do enter from lower socioeconomic backgrounds are saddled with the same debt burden as their peers from higher socioeconomic backgrounds.
Most alarming are the disparities in medical education debt by race. In 2012, Blacks had the highest median debt ($184,025 vs. $170,000 overall), lowest median parental income ($69,000 vs. $100,000 overall) and lowest average percent of education to be financed by family (3 percent vs. 9 percent overall). Concern about finances arises when medical students discuss specialty pay because while the cost of medical school is pretty much the same regardless of specialty choice, there are specialties and sub-specialties that earn significantly more than others.
For example, the estimates of lifetime earnings for the broad categories of surgery, internal medicine, and pediatric subspecialties, and other specialties were $1,587,722, $1,099,655, and $761,402 more than for primary care. The calculus of deciding how much money matters in regards to specialty choice may be completely different for a first-generation college student from the lowest quintile of household income than a student from the highest quintile of income that entered medical school with no education debt.
If these trends continue, I think many will choose not to pursue primary care; not because they feel that it isn’t for them, but because it may be financially unrealistic. I believe that choosing a field solely on earning potential is not ideal. That being said, medical education debt is rising and hits some of us harder than others. The time where all medical students could not worry about finances when choosing a specialty has passed. It is a shame.
Michael McClurkin is a medical student.