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Physicians with High Debt More Likely to Work in Medically Underserved Areas

Federal and state loan-repayment programs draw more physicians as med school debt mounts.

By AOA Media Team


CHICAGO—May 29, 2018—Graduating physicians with the highest levels of student loan debt are increasingly planning to practice in underserved areas, a trend associated with debt repayment programs, according to a new study in The Journal of the American Osteopathic Association.

Despite the common belief that physicians with high debt avoid practicing in underserved communities where the pay is lower, researchers found state and federal loan repayment programs designed to address physician shortages are driving indebted doctors to areas that most need them.

“The largest take away is that loan repayment programs are working as intended and helping bring much needed medical expertise to medically underserved communities,” says Jesse Richards, DO, an osteopathic internal medicine physician at University of Kansas Health Systems and co-author on this study.

Debt swells for docs

Between 2007 and 2016, medical schools’ tuition increased at a rate more than double that of national inflation. To understand if the added debt impacted normal trends in new physician practice, study authors analyzed responses to annual surveys of graduating medical students’ plans for residency.

In that nine-year period, physicians who were interested in underserved communities went from representing 27 percent of their graduating class in 2007 to 35 percent in 2016.

However, the increase was far more pronounced among those in the top quartile for indebtedness, compared to the bottom quartile. Whereas the number of graduates in the lowest debt quartile, who intended to practice in underserved areas, increased by 20 percent, graduates in the highest debt quartile rose by 37 percent.

“We found a strong association among factors of increased debt load, intention to use a loan-repayment program, and intention to practice in underserved areas,” Dr. Richards says.

Graduating physicians were also asked whether they intended to take advantage of state and federal loan repayment programs. Researchers found 68 percent of those who intended to practice in underserved areas planned on participating in loan-repayment programs, compared to 35 percent of those planning on practicing in non-underserved areas.

Community benefits

“This is good news, because we know the lack of access to health care is having a profoundly negative impact in certain parts of our country,” says Caleb J. Scheckel, DO, an osteopathic internal medicine specialist at Mayo Clinic and co-author on this study. He points to a 2017 Centers for Disease Control and Prevention report on physician shortages in rural areas. The report noted higher rates of death due to heart disease, respiratory disease, and stroke compared with people in urban areas.

A ZIP code analysis of major metropolitan areas in Oklahoma also found that people in the same city can have life expectancies that differ by as much as 14 years. Although many factors contribute to these troubling statistics, a common theme is evident: lack of access to medical care in certain geographic areas.

Room for improvement

While existing loan repayment programs are helpful, Dr. Scheckel hopes they become more robust as his study and others validate the programs’ efficacy.

“The average monthly student loan payment for a new physician is around $2,500,” says Dr. Scheckel. “Unfortunately, the average monthly income is only about $3,000, so residents end up choosing between deferring loan repayment and allowing their loan interest to balloon or living very, very poorly.”

Drs. Richards and Scheckel believe additional study is needed to determine how to optimize loan-repayment programs, but continued expansion of these programs and incentives is critical to placing newly graduated physicians in areas of greatest need.

About The Journal of the American Osteopathic Association

The Journal of the American Osteopathic Association (JAOA) is the official scientific publication of the American Osteopathic Association. Edited by Robert Orenstein, DO, it is the premier scholarly peer-reviewed publication of the osteopathic medical profession. The JAOA’s mission is to advance medicine through the publication of peer-reviewed osteopathic research.

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