The NEJM takes a look the skyrocketing medical school debt of American students, and the numbers are staggering.

When you include undergraduate debt, medical student graduates are saddled with a burden ranging from $145,000 to $180,000, depending on whether they enroll in public or private universities.

There is no other country that can boast that amount of debt for newly minted physicians, which has to be taken into account whenever salaries are compared between the United States and other countries.

It is no surprise that there is a “strong direct correlation between higher mean salary in a specialty, such as orthopedic surgery or radiology, and the percentage of residency positions filled by U.S. graduates.”

Some medical schools recognize this by fully subsidizing medical education. But only a minority of institutions are able to do this, which means that specialists will continue be in demand for the foreseeable future.