Response to 2010 Question of the Year
I am reluctant to open student loan statements because on the second page there is a section that states, “Under the standard repayment plan your monthly payments will be….” Twice a year this number jumps by several hundred dollars and I get a sick feeling in my stomach when I think I am still a year and a half from graduation. This feeling of helplessness in the face of mounting student debt is familiar to most people who have attended medical school. They know firsthand the heavy price tag attached to attending medical school.
However, I do not think the cost of a medical education is always a problem. The business community would likely see the investment in a medical education as very attractive, considering the potential, that is, the salary of the superspecialized medical practitioner, for a return on the investment. Fortunately, an incoming medical school class consists mostly of idealists and few, if any, entrepreneurs. Regrettably, the burden of student debt falls hardest on those interested in primary and rural care. Inevitably, primary care enthusiasts sit down with their calculators, their student loan statements, some rough number on the cost of, say, having a family, a medical practice, et cetera, and then after looking up the average salary of a family practice doctor they will conclude perhaps that their idealism has its disadvantages.
I am such a medical student with rural primary care ambitions and a well-worn calculator and scratch pad. But my personal mountain of debt looms much less ominously than many of my fellow classmates. Prior to starting medical school, I anticipated that if I were accepted I would like to return to my rural hometown to practice. About the time I was thinking over the cost of medical school, I was approached by a member of my local medical community who offered to help with some of the educational costs if I would promise to return there to practice. I readily accepted this offer and signed a formal agreement to make the arrangement official.
Because of this unconventional partnership with my community, I have been able to finance my education and will assume only a modest about of debt. As far as I know, entering into a partnership with a specific community is an uncommon method of finance. This is regrettable because signing an agreement with my hometown and shaking some hands felt good, while e-signing my master promissory note to the Department of Education was nothing special. Really, the only reason I, too, am not up to my eyeballs in debt is because news travels fast in a small town, and the medical community recognized and seized the opportunity to secure a future colleague. Therefore, my small contribution to this discussion is that for every medical student who has his or her heart set on being a pediatrician, general surgeon, or family physician, there is a community awaiting that student—a community that he or she would like to live in and that really needs him or her, and if they could meet each other and talk they could probably help each other out.
All that is needed, I think, to make community partnership a more common means of medical school financing is to provide a way for those initial conversations to occur. The real merit of this idea is that it does not require massive grant money or an act of Congress to be successful. Success may be as simple as a medical school inviting communities to a community fair to talk with their students or providing the technical support for a bulletin board for posting information. Any means that allow future doctors to get together with the communities they wish someday to serve would be appropriate.
The author wishes to thank W. Patrick Roche III, MD for his help with this article.