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Managing Money for Medical School

(from the February 2019 ACP Internist)

Medical students can expect to pay a median four-year bill of $250,222 for public and $330,180 for private education.

By Charlotte Huff

The financing and affordability of a medical school education, never a cheap proposition, appear to be in a period of flux, depending on the outcome of several trends.

Recent discussions about the design of the federal Public Service Loan Forgiveness (PSLF) Program, along with related uncertainties, have caused some angst among medical students and recent graduates. Early reports show that, to date, only a limited number of loan forgiveness applications have been approved. Meanwhile, some medical schools have attempted to limit the overall price tag of a medical education, either by introducing three-year programs or, in a few cases, providing generous tuition coverage.

All of these changes occur in the context of other workforce challenges, including projected shortages in primary care and some subspecialties, as well as a need to attract a more diverse mix of future doctors, including along socioeconomic lines. And more physicians are graduating without any debt, for reasons that are still being unraveled.

One analysis, published in October 2017 by JAMA Internal Medicine, found that 26.9% of students graduated with no debt in 2016 versus 16.1% in 2010.More scholarship money does not explain the trend. The average scholarship award for that debt-free group of students actually declined during that same six-year stretch, from $135,186 in 2010 to $52,718 in 2016, the researchers found.

“Our analysis showed that there is an increasing proportion of young physicians completing medical school debt-free without a concurrent increase in scholarship support. This suggests that more medical students may come from wealthier backgrounds,” said Justin Grischkan, MD, one of the study researchers and an internal medicine resident at Boston's Massachusetts General Hospital. “This is all in the setting of increasing average debt among medical school graduates who must finance their education with loans.” Among those graduating with debt, the same analysis found, the average amount increased from $161,739 in 2010 to $179,068 in 2016.

The Association of American Medical Colleges (AAMC), which also has documented a debt-free trend, published an analysis in September 2018, finding that 33% of medical school graduates in 2017 had parents who earned more than $200,000, up from 24% in 2010.But the analysis also cited other potential factors, including an increase in graduates reporting scholarships, the AAMC authors wrote. In short, the debt-free trend “is notable but defies easy explanation,” they wrote.

Debt, workforce needs

Medical school students can expect to pay a median four-year bill of $250,222 for a public education and $330,180 if they attend a private medical school, according to AAMC data from October 2018. But given a physician's good long-term income prospects, as well as the various loan and scholarship options, going to medical school remains a good investment, according to Julie Fresne, AAMC's senior director of student financial and career advising services.

“We understand that it's a lot of money,” Ms. Fresne said. “But all of our data points to physicians being able to practice the specialties that they want to practice and managing to repay their loans, while still providing a comfortable lifestyle and saving for retirement.”

Still, medical students are looking at these hefty loan balances and making specialty choices at the same time that physician shortages loom, in large part due to a growing and aging U.S. population. One analysis for AAMC, published in March 2018, projected that as many as 49,300 more primary care physicians and as many as 72,700 more subspecialists will be needed by 2030.

ACP has long advocated for more programs that foster the primary care workforce, including Title VII, with a focus on Section 747, the Primary Care Training and Enhancement (PCTE) program, and the National Health Services Corps (NHSC). In the fall of 2018, ACP President Ana María López, MD, MPH, MACP, wrote to congressional leaders urging them to appropriate at least $415 million for NHSC. The program was funded at $415 million for fiscal year 2019, the same as the prior year.

Read the full article in ACP Internist.

ACP Internist provides news and information for internists about the practice of medicine and reports on the policies, products, and activities of ACP.

Back to the March 2019 issue of ACP IMpact