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Can Medical Students Afford to Choose Primary Care? An Economic Analysis of Physician Education Debt Repayment

Youngclaus, James A. MS; Koehler, Paul A. PhD; Kotlikoff, Laurence J. PhD; Wiecha, John M. MD, MPH

doi: 10.1097/ACM.0b013e318277a7df
Medical Student Debt
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Purpose: Some discussions of physician specialty choice imply that indebted medical students avoid choosing primary care because education debt repayment seems economically unfeasible. The authors analyzed whether a physician earning a typical primary care salary can repay the current median level of education debt and meet standard household expenses without incurring additional debt.

Method: In 2010–2011, the authors used comprehensive financial planning software to model the annual finances for a fictional physician’s household to compare the impact of various debt levels, repayment plans, and living expenses across three specialties. To accurately develop this spending model, they used published data from federal and local agencies, real estate sources, and national organizations.

Results: Despite growing debt levels, the authors found that physicians in all specialties can repay the current level of education debt without incurring more debt. However, some scenarios, typically those with higher borrowing levels, required trade-offs and compromises. For example, extended repayment plans require large increases in the total amount of interest repaid and the number of repayment years required, and the use of a federal loan forgiveness/repayment program requires a service obligation such as working at a nonprofit or practicing in a medically underserved area.

Conclusions: A primary care career remains financially viable for medical school graduates with median levels of education debt. Graduates pursuing primary care with higher debt levels need to consider additional strategies to support repayment such as extended repayment terms, use of a federal loan forgiveness/repayment program, or not living in the highest-cost areas.

Mr. Youngclaus is senior education analyst, Association of American Medical Colleges, Washington, DC.

Dr. Koehler is quantitative analyst, State Street Corporation, Boston, Massachusetts.

Dr. Kotlikoff is professor, Department of Economics, Boston University, Boston, Massachusetts.

Dr. Wiecha is director, Office of Medical Education, assistant dean for academic affairs, and associate professor, Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts.

Correspondence should be addressed to Mr. Youngclaus, Association of American Medical Colleges, 2450 N St. NW, Washington, DC 20037; telephone: (202) 862-6072; e-mail:

First published online November 16, 2012

© 2013 Association of American Medical Colleges