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Letters to the Editor

The Mental Health Argument for Forgiving Medical Education Debt

Agapoff, James R. IV MD, MS1

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doi: 10.1097/ACM.0000000000004346
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To the Editor:

We should pay attention to medical trainee debt. According to the Association of American Medical Colleges, the median debt of graduating medical students rose from $180,000 1 in 2014 to $200,000 in 2020. 2 To put this loan burden into perspective, a graduating resident with $200,000 in loans, who put them into forbearance during a 4-year residency at a rate of 5%, would pay approximately $111,000 in interest over a standard 10-year repayment plan with a monthly payment of about $2,600. Extend that residency to 7 years, and the average interest cost rises to $161,000, the monthly payment is $3,000, and the total loan repayment amount is $361,000. The mental burden of this debt is real and life-changing. 3 There is political momentum in the United States to forgive or reduce student loan debt based on fairness and equity, 4 but what about the mental health argument for forgiving debt?

We should consider the mental health of medical trainees in debt. The prevalence of depression in U.S. medical students is as high as 25%, which is double the national average. 5 Medical school graduates carry more than 6 times the average college debt, and their debt rate outpaces both economic and academic inflation. At its current pace, the average medical student debt will exceed $300,000 by 2024. 6 Increased odds of suicidal ideation have been found in medical students with increased levels of debt, especially over $100,000. 5 It remains unclear whether the high prevalence of depression in U.S. medical students is related to debt, but there is a body of evidence showing debt impacts the stress levels and mental well-being of medical trainees. If we accept that student loan debt negatively impacts mental health, we should advocate for its present and future elimination through loan forgiveness.


1. Association of American Medical Colleges. Medical Student Education: Debt, Costs, and Loan Repayment Fact Card. Published October 2014. Accessed July 26, 2021
2. Association of American Medical Colleges. Medical School Graduation Questionnaire: 2020 All Schools Summary Report. Published July 2020. Accessed September 10, 2021
3. Pisaniello MS, Asahina AT, Bacchi S, et al. Effect of medical student debt on mental health, academic performance and specialty choice: A systematic review. BMJ Open. 2019; 9:e029980
4. Walsh KP, Lewiston J. Human capabilities and the ethics of debt. J Value Inq. 20201–21
5. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008; 149:334–341
6. Hanson M. Average Medical School Debt.,as%20the%20average%20college%20graduate. Updated July 10, 2021. Accessed July 26, 2021
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