Would eliminating medical school debt produce more primary care doctors?

There’s little question that medical school debt is rising rapidly, affecting the career choice of medical students.

It’s one of the main reasons why the disparity between the number of specialists and primary care doctors is widening. There have been a variety of proposed solutions — most recent of which are medical schools completely subsidizing their tuition. I think that’s a good step forward, but so far, has only been limited to a few schools nationwide.

The WSJ Health Blog recently discussed a more innovative solution, where tuition would be dispensed of entirely. Instead, doctors will contribute a fixed percentage of their income to medical education:

[The proposal suggests] that med schools cut out tuition and fees during medical education, then collect a fixed percentage of income for 10 years after a physician has finished training. Because specialties vary in their training time, a neurosurgeon might not start paying until 13 years after entering med school, while for a family practitioner payment could start as soon as seven years after beginning school …

… Public med school attendees would pay 5% of their gross income per year for a decade, and those who went to private schools would pay 10%. Docs would be paying out of their post-tax income unless tax policy changed.

Using a fixed percentage would help doctors choose a specialty or an employer without worrying as much about how it would affect their ability to repay educational debt, says Weinstein. “Those students who are financially successful in lucrative specialties will return more financial support to their medical school, whereas those in primary care specialties, public health professions or charity work will pay less,” the authors write.

There would be adjustments for doctors working part-time, or those who take extended breaks for clinical care.

Interesting idea, but it’s unlikely to be adopted anytime soon, making this an interesting thought experiment.

Without the burden of medical school debt, would medical students be more inclined to become primary care doctors? Some might. But the salary disparity is so huge, doctors who become specialists will still financially come out ahead.

Until that changes, like one commenter from the WSJ wrote, “it’s like re-arranging deck chairs on the Titanic.”


 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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