Sarah Kliff says that maybe medical school debt isn’t the problem behind the absence of primary care docs. She cites a couple of reasons:
- A program for medical student loan reimbursement had absolutely no applications.
- Those with the largest student loans tend to actually go into primary care, rather than avoid it.
It might be overstated as a reason, but there are other factors going into what she’s taking about that should be addressed. Clancy took a pass on Arapaho’s student loan reimbursement program. It had nothing to do with being unworried about student loan debts. Rather, it was based on (a) the bureaucratic difficulty of signing up and (b) committing to the job for six years. She signed a three year contract, and there will be a financial penalty when she leaves early, so San Mateo’s more generous program might have been something we’d have signed on with when we didn’t sign on with Arapaho’s. But specific programs that offer reimbursement often do so precisely because they are among the most uncomfortable jobs. the jobs that someone is least likely to want to commit to. And the repayment is often backloaded. And you’re making payments in the meantime anyway and interest is accumulating. And the jobs will often pay less than you could make elsewhere, with the student loan reimbursement failing to account for the difference.
As far as the second thing goes, well, there it’s more complicated as well. My wife graduated in the top third of her class and didn’t have to go into primary care. But a lot of doctors who end up going into primary care do so with little choice. I suspect that these people are also those with the most amount of student debt. They couldn’t get into a state flagship (as my wife did) and end up going to an expensive (non-elite) private college. I don’t know this to be the case, but I think it’s a factor.
To me, the really pernicious effect that student loan debt actually doesn’t have all that much to do with the dearth of doctors willing to go into primary care, however. Rather, it has more to do with the medical culture itself. The desire to make as much money as early as possible in order to get out from under. This makes high-paying jobs that, on the face of it, are questionable. There were jobs that paid significantly more than the job Clancy took. She took a pass, but the ability to pay off student loans in a year is tempting nonetheless. And while you might tell yourself that it’s temporary, I think that once you’re making that sort of money, it’s hard to go back. It sets the pace for contributing to The McAllen Problem.
So what’s the solution? I’m not sure. Relieving student loan debt for doctors who want to go into primary care may help, but since such programs are often so back-loaded, I’m not sure how much of an effect they would really have. Since they’re not something you can really count on, I think a lot of docs would end up taking the enterprising course anyway.
Not that I wouldn’t mind someone stepping in and taking care of that for us.