Burdensome student loan debt is discouraging aspiring doctors from setting up their own practices, exacerbating the decline of primary care doctors in rural and impoverished communities.
Student debt hit a record high of $1.4 trillion in 2019, forcing many indebted young people to factor paying student loan bills into choosing a career path. Young doctors are no exception.
Residents in primary care programs across the U.S. are more drawn to practicing in parts of the country, both urban and rural, where employment opportunities are plentiful and compensation is higher. As a result, brain drain from rural America is creating a gap in the most necessary branch of medical care.
Primary care doctors are often patients’ only care providers in areas that lack specialists, particularly poor or rural communities, according to Dr. Tracey Henry of Grady Memorial Hospital in Atlanta. Few young people want to pursue careers in primary care or general medicine because of their relatively low salaries, and high student loan balances make the calculation even less favorable.
“There are some great places out there to practice, but the thing you can’t change is the student loan debt at this point. So that is the biggest determining factor,” Henry told the Washington Examiner.
The Association of American Medical Colleges expects to see a decline in the number of primary care physicians somewhere between 14,800 and 49,000 by 2030, a trend “undesirable” areas will feel most acutely.
Americans in rural areas are already five times more likely to face a shortage of primary care doctors in their counties, but even urban and suburban areas face a shortage almost as substantial.
Henry said Grady Memorial has too few providers to adequately care for all patients, who are often poor and uninsured.
Henry herself has $400,000 in student debt hanging over her head, she testified this month at a Small Business Committee hearing about the effects of student debt on the declining number of young doctors pursuing primary care, particularly in private practices and community centers.
Even though primary care physicians’ salaries have steadily increased over the past decade, medical school debt has climbed concurrently. By 2018, average salaries increased to about $219,000, but the median debt of the 2018 medical school graduating class reached about $195,000.
At the June 12 Small Business Committee hearing, Chairwoman Rep. Nydia Velázquez, D-N.Y., said that climbing student debt “is nothing short of a national crisis.”
As fewer young doctors start private practices due to financial constraints, Velázquez said, “this trend also leaves many communities at a disadvantage without the healthcare providers they need.” She noted in particular that more doctors, not fewer, are needed in rural areas because of those areas’ aging population.
However, medical professionals such as Dr. Sondra Zabar, co-director of New York University Langone Health Center’s internal medicine residency program, say they are optimistic that federal and state policies to mitigate the burdens of student debt are starting to work.
NYU’s medical school, for example, announced in 2018 that tuition would be free regardless of need thanks to generous donations from large companies and private philanthropists amounting to about $450 million.
Zabar said many faculty members at NYU come from affiliated clinics throughout New York City, which offer an option of applying for the National Health Service Corps loan repayment program, run by the Department of Health and Human Services. The program will repay up to $50,000 every two years for select doctors who work full time in community centers in areas that otherwise wouldn’t have access to health services.
Outside of New York City, many smaller community-based clinics are taking advantage of programs such as the National Health Service Corps loan repayment plan to stem the tide of brain drain from their areas.
For example, the Wyoming Primary Care Association offers young doctors the option of applying for National Health Service Corps repayment plans if they join one of their 13 general medicine clinics.
“For us in Wyoming, it’s a very important recruitment tool to entice these medical professionals that are in such high demand that they can essentially go anywhere,” said Hannah Wickey, director of operations for the Wyoming Primary Care Association.
To convince doctors to start practices or work for private practices, some states now provide assistance when federal programs aren’t enough.
John Mengenhausen, CEO of Horizon Health Care in South Dakota, told the Washington Examiner that physicians seeking jobs at one of their 32 rural community clinics not only have the option of applying for the repayment plans but can also apply for the state recruitment assistance program, which will reimburse doctors over $200,000 for a three-year commitment to the state’s clinics.
Mengenhausen said these loan repayment and forgiveness options have thus far been successful.
Velázquez said the purpose of the June Small Business Committee hearing was to “[shed] light on the burden of student debt in this sector“ and help “to reach serious solutions that can empower small businesses, medical professionals, and the communities they serve.”
The best way to do that, Henry said, is to create a curriculum that shows residents and students every kind of practice that’s out there and to put financial assistance in place to incentivize more doctors to consider primary care and private practice paths in the communities that need them most.
