title: Anesthesiology residents' medical school debt influence on moonlighting activities, work environment choice, and debt repayment programs: a nationwide survey.
abstract: BACKGROUND
  The amount of education debt incurred by medical school graduates in the United States has grown considerably over the last 30 years; it has outpaced inflation to reach a mean of $158,000. With this dramatic increase in education debt, there has been limited information on how medical school debt loads of anesthesiology physicians impact their decisions concerning moonlighting and future career choices. Our aim was to survey current anesthesiology interns, residents, and fellows to assess the correlation between the amount of medical school debt they had collected and (1) their outlook toward moonlighting activities, (2) future career plans, and (3) choice of employer with a debt repayment program.
  
  
  METHODS
  We developed a web-based survey instrument and contacted residency training programs to obtain access to their anesthesiology interns, residents, and fellows (residents). We assessed each relationship of interest using a multivariable proportional odds model, adjusting for all available baseline potential confounding factors. Second, we compared participants with >$150,000 medical school debt versus participants with no debt on the same questions of interest, each using a multivariable proportional odds model with the same covariable adjustment.
  
  
  RESULTS
  We had access to 2386 residents through their training programs and 537 completed the survey. Those respondents with a 1-category-larger amount of medical school debt (i.e., $30,000) were associated with 7%(99.3% confidence interval: 0%, 13%) increased odds of having the desire to moonlight during residency/fellowship, and were associated with 7% (1%, 13%) decreased odds of saying they would choose a career as an academic faculty, respectively. Also, those with a larger amount of medical school debt were more likely to be swayed to be interested in an anesthesiology group with an education debt repayment program (odds ratio: 1.3 [1.22, 1.39] for 1-category increase in the debt amount); furthermore, the corresponding odds ratio was increased to 4.6 (2.8, 7.5) comparing those with >$150,000 debt with those without debt.
  
  
  CONCLUSIONS
  In an effort to compete with private practice anesthesiology groups and to reduce the impact of debt on future career choices of residents/fellows, academic anesthesiology groups would do well to (1) promote moonlighting activities that are within the Accreditation Council for Graduate Medical Education and institutional guidelines, (2) develop financial curriculum for residents/fellows, and (3) offer debt repayment programs as an incentive for new faculty to join academic medicine.
authors.affiliation: Department of Anesthesiology and Pain Management, UT Southwestern Medical Center and Children's Medical Center Dallas, 1935 Medical District Dr., Dallas, TX 75235, USA. Jeffrey.Steiner@UTSouthwestern.edu
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Steiner
authors.forename: Radu B
authors.initials: RB
authors.lastname: Pop
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.forename: Stephen Q
authors.initials: SQ
authors.lastname: Hoang
authors.forename: Charles W
authors.initials: CW
authors.lastname: Whitten
authors.forename: Catherine
authors.initials: C
authors.lastname: Barden
authors.forename: Peter
authors.initials: P
authors.lastname: Szmuk
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000293:Adolescent; D000328:Adult; D000776:Anesthesiology / Q000191:economics* / Q000193:education; D002321:Career Choice; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D004503:Education, Medical, Graduate / Q000191:economics*; D004649:Employee Incentive Plans / Q000191:economics; D005257:Fellowships and Scholarships / Q000191:economics*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000191:economics*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011331:Private Practice / Q000191:economics; D012456:Salaries and Fringe Benefits / Q000191:economics; D011795:Surveys and Questionnaires; D014146:Training Support / Q000191:economics*; D016526:Workload / Q000191:economics*; D017132:Workplace / Q000191:economics*; D055815:Young Adult