Doctor shortage worsens as student debt rises

Christina Rogers

Michigan medical students getting slammed by mounting post-graduate debt are shying away from areas of medicine that are in high need and demand, but rank low on the doctor pay scale, a state association asserts.

To address what it calls a crisis and its impact on a looming doctor shortage, the Michigan State Medical Society, which represents about 15,000 doctors statewide, is proposing long-term solutions for curbing medical school costs that average $155,000 for Michigan graduates and in some cases total more than $200,000.

The rising debt already influences how students choose their practice areas, with many forgoing the lower-paying practices such as pediatrics and family medicine for more lucrative specialties, such as surgery and radiology. One study by the Association of American Medical Colleges estimated that primary care physicians earned about 30 percent less than the base-year salary for all physicians in 2006, which was about $216,600.

“A lot of students may come in and say, ‘I’d really like to be a pediatrician or a family physician,’ and then they realize what’s going to be required to pay back their debts,” said Dr. James Woolliscroft, dean of the medical school at the University of Michigan. “And so they are faced with, ‘I need to go into a much more highly paid discipline to make my debt payment if I want to buy a house or start a family.'”

For Michigan, fewer primary care physicians could ultimately mean less access for patients seeking the most basic types of care, such as people looking for help managing diabetes, said Dr. Chris Bush, president of the Wayne County Medical Society. A work force study completed in 2006 already projects a shortfall of approximately 4,400 physicians in Michigan by 2020, as a large group of doctors retires and baby boomers demand more medical services. The shortage is anticipated to be most pronounced in family medicine.

“Unfortunately, in family medicine, they have had difficulty recruiting medical students for a long time,” Bush said. “It’s not always glamourous, but it is certainly the bedrock of medical care.”

On Tuesday at the American Medical Association’s annual meeting, a resolution presented by the Michigan organization addressing the issue was discussed by delegates. It offers several solutions, such as paid internships for fourth-year medical students who have passed initial licensing exams and freezing medical school tuition in a students’ first year so they know how much they’ll need to borrow during the four-year course of study.

“We’re now at a crisis point,” said Dr. Laura Chromy, a 2008 graduate of the University of Michigan’s medical school and immediate past chairwoman for the state association’s medical student section. “Graduating medical students are really in a bind and reports say it is only going to get worse.”

Double-digit cost increases

The medical colleges at the University of Michigan, Michigan State University and Wayne State University all have experienced double-digit percentage increases in tuition and fees over the past four years, according to the state medical society’s resolution. Higher education costs — such as having to buy expensive teaching equipment and adding instructors — coupled with cutbacks in state funding to medical schools have contributed greatly to these increases, school administrators said.

Wayne State had the highest jump, with tuition and fees rising 65 percent for in-state students since the 2003-04 academic year. Dr. Kertia Black, assistant dean for student affairs at Wayne State, said those increases are now beginning to narrow, with tuition expected to only grow 3.9 percent this coming academic year.

Still, the debt burden on graduates is daunting, especially given that they must spend at least three more years on post-graduate residency training that pays about $44,000 to $45,000 for the first year, according to the Association of American Medical Colleges.

While in their residencies, many future doctors choose to defer their school loan payments, so their arrears grow even larger as they accrue interest, Black said.

That option will be gone, however, beginning in July 2009, when the U.S. Department of Education ends medical school payment deferment — a move that could further put aspiring doctors in a financial bind, said Chromy, who helped author the resolution.

“We’re required to do this residency, but we can’t defer,” she said. “If we’re trying to increase the supply of physicians, the answer is not to make it harder to make physicians.”

The resolution estimates that the average monthly payment on debt of about $160,000 starts at $1,400 a month on a 25-year repayment plan — or about 50 percent of the post-tax income of a resident’s salary.

In his two years of medical school at Wayne State, Joseph Khouri has racked up about $140,000 in debt, a figure that includes out-of-state tuition and loans to pay for living expenses.

“I mean, this is ridiculous,” said Khouri, who is from Cleveland. “Medicine isn’t about money and it never was about it for me. But graduating $280,000 in debt is intimidating.”

It could be worse for future medical students at Wayne State Medical School. One report by the medical college association projects debt for graduates could rise to about $750,000 by 2033.

To stem these sharp increases, the resolution proposes several fixes, such as using Medicare funding for undergraduate medical education and shortening the length of study for undergraduates and medical students who have mastered aspects of the curriculum ahead of schedule. It also asks the AMA for a feasibility study to analyze whether some of these solutions will be effective in slowing the rise in graduate debt.

No shortage of applicants

The growing financial strain still hasn’t slowed the demand for spots in Michigan medical schools. The University of Michigan, for example, saw a 10 percent increase in medical applications this year to 5,807 for about 107 first-year slots. Similarly, Wayne State saw about a 7 percent increase.

It’s possible the aspiring doctors don’t fully appreciate the debt they’ll have to take on.

“People are still clamoring to go to medical school,” Black said. “The thing is that what they don’t anticipate is the loan payments can be very hefty, as well.”

For Erica Huddleston, who expects to graduate from Wayne State medical school in 2010, growing loan debt is making her think twice about choosing family medicine, an area where she says she has a “strong interest.”

“I’m extremely worried about how that salary will ever pay off the mounds of debt I have accumulated,” said Huddleston, who is from Indianapolis. “Is it worth sacrificing a field you love for the peace of mind and knowledge that you won’t be in debt forever?

“That’s something I ask myself every day as tuition and costs continue to rise.” 

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