Current Trends in Debt and
Specialty Choice
GEA Small Group Discussion
Moscone 2022
1:30 – 3:00pm
Julie Fresne, AAMC
John Wiecha, MD, MPH, BU SOM
Jay Youngclaus, AAMC
Nov. 6, 2012
How we will pass your time
•
~15 •
min. •
•
Quick overview of current debt & cost trends
2012 data on debt and specialty choice
Brief summary of forthcoming research paper
A few insights from counseling indebted
medical students
60+ • Discussion, Discussion, Discussion
min.
This will be most of our time ….
2012 AAMC Annual Meeting
Class of 2012 Indebtedness
All Schools
Mean
Median
$166,738
$170,000
Public
Schools
$156,018
$160,000
Private
Schools
$183,002
$190,000
86% of graduates report having educational debt
36% of graduates report debt $200,000 or higher
Data includes medical and premedical/undergraduate debt
2012 AAMC Annual Meeting
Median Education Debt of Indebted
Medical School Graduates, 1992-2012
$170,000
in 2012
$175,000
$150,000
Constant
2012$
$125,000
Actual $
$100,000
$75,000
$50,000
1992-2012:
Debt CAGR = 6.3%
CPI CAGR = 2.5%
$25,000
$0
1992
1994
1996
1998
2012 AAMC Annual Meeting
2000
2002
2004
2006
2008
2010
2012
Cost of Medical School, 2012-2013
Public
Private
(In-State)
(In-State)
Median M1
$32,414
Tuition/Fees
Median M1 Cost of
$53,685
Attendance (COA)
Median 4-Yr. COA
$207,868
for class of 2013
2012 AAMC Annual Meeting
$50,309
$72,344
$278,455
Median 4-Year Cost of Attendance (COA) and
Education Debt of Indebted Medical School Graduates,
2000-2012 (in Constant 2012$)
$300,000
$275,300
$250,000
$196,700
$200,000
$190,000
$150,000
$160,000
Private 4Yr COA in 2012$
$100,000
Private Median Ed Debt in 2012$
$50,000
Public 4Yr COA in 2012$
Public Median Ed Debt in 2012$
$2000
2002
2004
2012 AAMC Annual Meeting
2006
2008
2010
2012
Influence of Various Factors on the Specialty Choice of
2012 Graduating Medical Students (GQ)
0
40
60
80
Percent 20
indicating “strong”
or “moderate”
influence
98.3
98.1
78.0
77.3
62.6
60
47.5
41.1
40.4
33
27
2012 AAMC Annual Meeting
100
Influence of Various Factors on the Specialty Choice of
2012 Graduating Medical Students (GQ)
0
40
60
80
Percent 20
indicating “strong”
or “moderate”
influence
98.3
98.1
78.0
77.3
62.6
60
47.5
41.1
40.4
33
27
2012 AAMC Annual Meeting
100
Influence of Various Factors on the Specialty Choice of
2012 Graduating Medical Students (GQ)
0
40
60
80
Percent 20
indicating “strong”
or “moderate”
influence
Personality fit
98.3
Specialty content
98.1
Role model influence
78.0
Work/Life balance
77.3
My future family plans
62.6
Fellowship training options
60
Income expectations
47.5
Competitiveness of spec.
41.1
Length of residency
40.4
Expectations of family
Education debt
2012 AAMC Annual Meeting
33
27
100
Median Salary First Year Post-Residency 2011
$K
$50K
Dermatology
$312K
Surgery: General
$260K
Anesthesiology
$250K
Emergency Medicine
$245K
OB/GYN
$222.5K
Psychiatry
$197.5K
Internal Medicine
$180K
Hospitalist: IM
$180K
Family Practice (w/ OB)
$160K
Pediatrics
$145K
$100K
$150K
$200K
Source: Selected Specialties, MGMA 2011 Data
2012 AAMC Annual Meeting
$250K
$300K
$350K
2012 GQ Data on Debt and Specialty Choice
Interest in Specialty with ….
Starting Salary of $300K+
Starting Salary
between $220K and $260K
Starting Salary around $200K
Family Medicine
Starting Salary=$160K
Peds. Starting Salary=$145K
Ed Debt
<$130K
24%
Ed Debt
Between
$130K and Ed Debt
>=$220K
$219K
22%
22%
40%
44%
46%
12%
11%
11%
8%
10%
9%
16%
13%
11%
Graduates planning to become certified in specific specialties and
“moderately” or “very” confident in their choice. Excludes Internal Med.
2012 AAMC Annual Meeting
2012 GQ Data on Debt and Specialty Choice
Interest in Specialty with ….
Starting Salary of $300K+
Starting Salary
between $220K and $260K
Starting Salary around $200K
Family Medicine
Starting Salary=$160K
Peds. Starting Salary=$145K
Ed Debt
<$130K
24%
$61K
40%
$75K
12%
$75K
8%
$80.5K
16%
$70K
Ed Debt
Between
$130K and Ed Debt
>=$220K
$219K
22%
22%
$170K
$260K
44%
46%
$177K
$260K
11%
11%
$175K
$257K
10%
9%
$175K
$256K
13%
11%
$172K
$255K
Graduates planning to become certified in specific specialties and
“moderately” or “very” confident in their choice. Excludes Internal Med.
2012 AAMC Annual Meeting
Rate of USMDs likely to become
PCPs may be stabilizing
Percent USMD PGY-1 Residents
Likely to Become PCPs
37%
33%
30%
28%
26% 25% 26% 25%
25%
24% 24%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: GME Track analysis by Paul Jolly (AAMC)
Notes: Percent equals 1) number USMDs entering IM, FM, or Peds minus number entering IM
Subspecialties or Ped Subspecs. that same year 2) divided by number of PGY1 entrants
2012 AAMC Annual Meeting
Jan. 2013 in Academic Medicine
Youngclaus, Wiecha et al.
available online next week
“Can Medical Students Afford to Choose Primary Care?
An Economic Analysis of Physician Education
Debt Repayment”
Analyzed whether a physician earning a typical primary care
salary can repay current levels of education debt and meet
standard household expenses without incurring additional debt
Used data and financial-planning software to model the annual
finances for a fictional physician’s household (Dr. Median)
2012 AAMC Annual Meeting
Jan. 2013 in Academic Medicine
Youngclaus, Wiecha et al.
available online next week
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 would 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.
2012 AAMC Annual Meeting
One on One Student Counseling
What happens when you share these
findings with individual medical
students who have debt and are
undecided about their career choice?
Perspectives from BU SOM
2012 AAMC Annual Meeting
Discussion Questions
•Do national debt trends mirror
what audience members are
seeing at their schools?
2012 AAMC Annual Meeting
Discussion Questions
•Current research suggests that
debt and potential income have
less of an impact on specialty
choice compared to other factors.
Does this ring true with the
experiences, anecdotes, and
observations of audience
members?
2012 AAMC Annual Meeting
Discussion Questions
•Is there a point at which debt
levels will make a primary care
career seem untenable?
If yes, are we close to that
point?
2012 AAMC Annual Meeting
Discussion Questions
•Will current cost of attendance and
debt trends impact the future
physician supply and specialty
distribution?
What do audience members
think?
2012 AAMC Annual Meeting
Further Questions
For more resources see aamc.org/first
[email protected]
[email protected]
[email protected]
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