The impact of US medical students' debt on their choice of primary care careers: An analysis of data from the 2002 Medical School Graduation Questionnaire

Purpose To examine the hypothesis that medical students' rising total educational debt is one of the factors that explains the recent decline in students' interest in family medicine and primary care. Method The authors used results from questions on the Association of American Medical Colleges' 2002 Medical School Graduation Questionnaire that focused on students' debt and career choices. Logistic regression was used to determine the independent association of students' debt with career choices, while controlling for students' demographic characteristics. Results In 2002, 83.5% of graduating students were in debt, and the average student owed US $86,870. Minority students had higher levels of debt. Students reported that higher levels of debt influenced their future career choices, and there was an inverse relationship between the level of total educational debt and the intention to enter primary care, with the most marked effect noted for students owing more than $150,000 at graduation. Total debt was associated with a lower likelihood of choosing a primary care career, but factors such as gender and race appeared to have more explanatory power. Female students were much more interested in primary care-and especially pediatrics-than were male students; African American students were more interested in inner-city practice than was any other identified racial or ethnic group. Conclusion In 2002, students' debt levels were high and increasing. Although students with higher debt levels were less likely than were their counterparts to pursue a career in primary care, the effect was modest when demographic characteristics were taken into consideration.