Maybe medical school debt isn’t the problem

The high cost of medical school often gets tossed around as a key reason why doctors don’t go into primary care jobs, instead choosing specialties such as radiology and surgery that prove more lucrative. When physicians graduate with an average of $161,290 in debt, it’s hard
(Melissa Cannarozzi/The Washington Post) to see money not factoring into career decisions.

While this narrative makes sense, there’s one major flaw: It doesn’t seem to be true. Aaron Carroll flags a story in the San Francisco-area Bay Citizen, where a local health-care authority established a loan forgiveness program. If doctors committed to practicing primary care in the area, for at least four years, all of their loans would be forgiven.

The program has been around for a decade now — and no one has signed up. Not a single doctor has volunteered for the opportunity to have all of their educational debt relieved. In San Mateo County, at least, debt didn’t seem to be the big obstacle for doctors pursuing primary care careers.

This doesn’t seem to be specific to one area of California. National data on medical student debt find that those with a high debt burden are actually more likely to go into the less lucrative primary care fields than doctors who hold no loans at all.

“For private schools, odds of choosing primary care increases as debt increases, with those having no debt (and no scholarships) less likely to choose primary care,” researchers at the Robert Graham Center concluded in a 2009 report.

Why do those with a higher-debt burden go into lower paying medical fields? Debt-free doctors, the thinking goes, come from higher socioeconomic backgrounds and tend to have higher expectations for their eventual salary.

For those who come from a less advantaged background, and do take out loans, the calculus might be a bit different. “You have people who are willing to tolerate up to $200,000 in debt to become a doctor,” Robert Phillips, director of the Robert Graham Center, said in a recent interview. To him, it suggests that doctors who have already made a huge financial commitment to becoming a physician aren’t as concerned with their eventual salary.