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Despite growing medical education debt, more students graduating without debt

Although medical education debt has continued to increase, the proportion of students graduating with no debt increased from 16.1% in 2010 to 26.9% in 2016, according to research published in JAMA Internal Medicine.

The researchers also found that the distribution of debt varies considerably by specialty.

“Among medical students graduating with educational loans, the mean debt was $32,000 in 1986, which is approximately $70,000 in 2017 dollars,” Justin Grischkan, BA, from the University of Rochester School of Medicine and Dentistry, and colleagues wrote. “Rising tuitions and a growing reliance on loans increased mean medical education debt to $190,000 by 2016. Alongside these well-known trends is a quieter increase in the proportion of graduates without debt. The combination of these observations suggests a concentration of debt among fewer individuals — a finding that is obscured by population means.”

Grischkan and colleagues used deidentified data from the 2010-2016 Association of American Medical Colleges Graduation Questionnaire to evaluate the trends in the distribution of medical education debt. They included 12,786 of 13,904 (92%) graduates who self-reported medical school debt in 2010 and 13,610 of 15,232 (89.4%) who self-reported medical school debt in 2016. Figures were adjusted to 2016 dollars.

Medical education debt was stratified into one of four categories: no debt; $1 to $100,000; $100,001 to $200,000; and greater than $200,000. The researchers used total educational debt to perform a sensitivity analysis on debt distribution.

Data indicated that among those with debt, the mean amount of debt increased from $161,739 in 2010 to $179,068 in 2016. Overall, 16.1% of graduates reported no debt in 2010 compared with 26.9% in 2016.

The researchers noted that while the rise in graduates with no debt seems positive, it suggests that more students from wealthy backgrounds are entering medical school.

The proportion of graduates in the other debt categories either remained generally consistent or decreased from 2010 to 2016. However, graduates reporting more than $300,000 in debt doubled from 2.1% in 2010 to 4.2% in 2016.

The largest absolute increase in no debt was experienced by individuals in the following fields: radiology (2010, 17.1% vs. 2016, 30.4%); dermatology (2010, 23.1% vs. 2016, 36.1%); neurology (2010, 18.1% vs. 2016, 30.7%); obstetrics and gynecology (2010, 11.5% vs. 2016, 24.7%); ophthalmology (2010, 26.3% vs. 2016, 39.9%); and pathology (2010, 20.8% vs. 2016, 34.8%).

The mean amount of total educational debt increased between 2010 and 2016 from $177,362 to $197,426, and there was no change in distribution by specialty. The mean scholarship funding increased from $53,065 to $58,136 between 2010 and 2016, but not substantially enough to justify the growth in medical graduates without debt. The mean amount of scholarship funding decreased from $135,186 in 2010 to $52,718 in 2016 among graduates without debt. “The causal associations among debt, specialty choice and income are challenging to disentangle,” Grischkan and colleagues concluded. “Conceptually, debt is likely to be less of a determinant of specialty choice than is future income. There is also no consensus on the balance across the medical specialties to best meet the United States’ workforce needs. But to the extent that specialty choice is important and that indebtedness may be associated with it, we need to begin to examine second-order debt effects and, in particular, its distribution across specialties.” – by Alaina Tedesco

Disclosures: The researchers report no relevant financial disclosures.