Every summer, medical schools around the country give out clean, crisp, new white coats. On the shoulder is the school’s signature emblem, with the new medical student’s name neatly etched above the pocket. A White Coat Ceremony commences where established physicians gown the new generation of doctors. It is a treasured, picturesque, and proud time. The ceremony ends with taking the Hippocratic Oath including the well-known verse “do no harm.” But, little do they know, these medical students have just signed up to be doctors of debt, potentially harming themselves first and foremost.
Medical education debt is much discussed throughout our training; everyone from the overburdened and overworked physician resident to the meek medical student knows that they have accumulated more debt than they know how to pay off. In fact, the average U.S. medical student graduates with over $175,000 in debt!
It is no wonder that a majority of medical students turn to the Public Service Loan Forgiveness Program (PSLF), which allows people working full time in public service jobs to have their loans forgiven after 10 years of monthly payments. For physicians-in-training, this is especially pertinent as 75 percent of U.S. hospitals qualify for PSLF.
October 2017 marks the first time that loan forgiveness will be offered to those who started making payments in 2007. But this very well might not happen. Before President Obama left office, he proposed a cap on PSLF at $57,500 for all students. This would reportedly save 12 billion dollars over the next 10 years. But, this proposed cap threatens to disincentivize medical education and doesn’t take into account the delayed financial gratification of physicians.
Consider this: Your average resident physician and school custodian make the same hourly wage! And residency can last anywhere from 3 to 7 years. That’s because the average resident salary is $50,000 for 80 hours of work or less. That’s double the number of hours in a normal workweek for most! Residents are not only overworked and underpaid, but also undervalued. Their salaries have remained stagnant since the 1990s.
While resident salaries remain stagnant, medical school tuition has skyrocketed over the past 20 years. The average tuition and fees for public medical schools has increased by 312% to over $31,000 per year. So as medical schools hike up their tuition rates, hospitals reap the benefit of cheap resident labor. It’s an inequitable system that preys on the outdated Graduate Medical Education (GME) system, placing exorbitant debt on the shoulders of students.
In response to this, people say, “Well, residency and fellowship are short-term. You’ll be attending physicians soon enough!”
Consider this: Medical debt disproportionately impacts students who are low income and from minority backgrounds. Minority students including African Americans, Hispanic Americans, and Native Americans make up only 12 percent of medical students in the U.S.. These same minority students are more likely to enter into primary care specialties and serve underprivileged communities than their White counterparts. Although residency and fellowship training is short term, the high price of medical debt actually deters the most underrepresented people from entering medicine in the first place.
So, what’s the solution?
Instead of capping the PSLF, legislators should reform graduate medical education (GME) as a way to address rising tuition and stagnant resident salaries. Some ideas for refinancing include decreasing medical school training to 3 years instead of 4, or increasing resident salaries in proportion to the hours worked. Additionally, changing the scope of public service as defined by PSLF could help make more physicians eligible for the program as well.
Ultimately, a proposed cap on the PSLF threatens to disincentivize medical student education, which is inherently different than other graduate programs because of the additional residency training. Capping loan forgiveness ignores the current realities experienced by both medical students and resident physicians. Instead of capping PSLF, policy makers should consider stopping rising medical student tuition costs and reforming GME stagnant salaries.
So, the next time you see your doctor in their clean, crisp white coat, ask yourself: “What’s the price of their medical education? Are they a doctor of debt?”
Emman Dabaja is a medical student.
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