I recently met an undergraduate who asked me what I was doing now that I had graduated from Rice. I replied that I had developed a portfolio of part-time positions — unpaid research jobs at Rice, and cashier, office temp and waitress positions to earn money. He promptly asked, “What was your major?” When I answered that my degree is in psychology, film and policy studies, he nodded knowingly. Had I just stumbled into casual conversation with a psychic? Nope, he was keeping a running tally of jobs associated with majors and wasn’t surprised by my answer. In his polling, social science and humanities degrees did not generally lead to job security and high earnings.
What I didn’t tell him was that I was also pre-med and was attending Baylor College of Medicine next year. Nevertheless, despite the near-assurance of job opportunities that come with an M.D., the “what’s your major?” question will become “what’s your specialty?” Will I decide to study what truly interests me — primary care or internal medicine — or specialize in order to gain financial security? Although there is a shortage of primary care physicians (PCP) in the United States, by venturing down the path urgently needed by society I will face more years of high debt repayments. According to the Association of American Medical Colleges, 23 percent of all medical students graduate with debts of $200,000 or more.
I’m not saying that PCPs and internal medicine are charity-care positions. They are well-paid professions, with family medicine physicians making an average salary of $185,740 — but they make considerably less than specialists such as orthopedic surgeons or radiologists who earn more than $400,000, according to a 2007 study in the Journal of the American Medical Association. Not surprisingly, this study found that PCPs had the lowest percentage of filled residency positions, while radiologists and orthopedic surgeons had the highest. Faced with monumental medical school debts that could exceed $200,000 and a median first-year medical resident salary of $46,717, many students forbear on their loan until they complete a four-year residency; they will then be saddled with loan repayments of $2,500 every month for 10 years, according to the Association of American Medical Colleges. This means, on average, doctors will repay student loans until they are 40. Furthermore, with the decrease in Medicare reimbursements and concomitant rise in patient population under health care reforms, PCPs are likely to be exposed to more turbulence than specialists.
More must be done to create financial incentives to correct for earnings distortions that favor specialties and subspecialties. Currently some incentives are in place, such as reduced-interest loans for medical students that commit to primary care. In addition, the federal government’s National Health Service Corps (NHSC) provides scholarships and loan repayment to medical graduates who serve in areas underserved by primary medical care, dental or mental health providers. With a two-year commitment to serve in an NHSC-approved area, doctors can earn $50,000 toward repayment of student loans. Alternatively, for students who know they wish to join the NHSC, future PCPs can also earn a tuition and fees scholarship for two to four years of service.
When I first heard about this program, my first thought was, where do I sign up? Then, in conversation with a third-year medical student, he posed the question “what if I meet someone in medical school?” With medical residents working all over the country, coordinating relationships and careers is hard enough, but having an obligation to practice in what is often a rural community becomes quite a trial.
As I embark on the notoriously intense journey of medical school, I am excited for the challenges that await me. But having to make a decision that pits my values against financial considerations is a situation I feel I, or any medical student, should not have to face.
Rachel Solnick, a May 2010 graduate of Rice University, is an intern for the Baker Institute Science and Technology Policy Program working under the supervision of Kirstin Matthews. She will begin classes at Baylor Medical School in the fall of 2011.