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Letters to the Editor

In Reply

Youngclaus, James “Jay, MS; Fresne, Julie, MS

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doi: 10.1097/ACM.0b013e3182a5d0ac
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In reply to Phillips: We appreciate the kind words from Dr. Phillips about our recent report of current data on the cost of medical school and the resulting education debt of medical school graduates. We focused on current data in order to inform the discussion on these topics, which is often lively and opinionated. Her perspective on how debt can influence a medical school’s “culture” is both interesting and invaluable, because while we work on behalf of U.S. medical schools, we do not work at one.

Regarding the perception that some students may conclude “a primary care career is not financially feasible,” this concern was the motivation for our recent article in this journal1 which addressed this topic directly. The article concluded “a primary care career remains financially viable for medical school graduates with median levels of education debt” and describes the trade-offs necessary for graduates with higher debt totals to pursue primary care. Furthermore, as the article and our recent report both document, there are two new federal repayment plans (Income Based Repayment and Pay As You Earn) that not only base borrowers’ monthly payments mainly on their income, regardless of their debt level, but also offer the potential for loan forgiveness after a number of years, which make them particularly attractive for graduates considering primary care.

Regarding the “relationship between specialties’ potential income and U.S. graduates’ preferences,” in Table 9 of our report, we compared the specialty intentions of graduates with different debt levels and found the percent interested in family medicine and pediatrics was remarkably consistent across all debt levels.2 In fact, the specialty choice of medical school graduates makes a fascinating subject. As shown in Figure 3 of our report, the Association of American Medical Colleges annual survey of graduating students consistently shows that, while financial factors play a role in specialty choice, the key factors include “a student’s personal interest in a specialty’s content and/or level of patient care, desire for the ‘controllable lifestyle’ offered by some specialties, and the influence of a role model in a specialty.”2

We admire Dr. Phillips’s commitment to primary care and wish her well as she continues to work directly with medical students facing this important career choice.

James “Jay” Youngclaus, MS

Senior education analyst, Association of American Medical Colleges, Washington, D.C.; [email protected]

Julie Fresne, MS

Director, student financial services, Association of American Medical Colleges, Washington, D.C.


1. Youngclaus JA, Koehler PA, Kotlikoff LJ, Wiecha JM. Can medical students afford to choose primary care? An economic analysis of physician education debt repayment. Acad Med. 2013;88:16–25
2. Youngclaus J, Fresne JA Physician Education Debt and the Cost to Attend Medical School: 2012 Update. 2013 Washington, DC Association of American Medical Colleges Accessed July 11, 2013
© 2013 by the Association of American Medical Colleges