A retrospective analysis of the relationship between medical student debt and primary care practice in the United States.
OBJECTIVE
We undertook a study to reexamine the relationship between educational debt and primary care practice, accounting for the potentially confounding effect of medical student socioeconomic status.


METHODS
We performed retrospective multivariate analyses of data from 136,232 physicians who graduated from allopathic US medical schools between 1988 and 2000, obtained from the American Association of Medical Colleges Graduate Questionnaire, the American Medical Association Physician Masterfile, and other sources. Need-based loans were used as markers for socioeconomic status of physicians' families of origin. We examined 2 outcomes: primary care practice and family medicine practice in 2010.


RESULTS
Physicians who graduated from public schools were most likely to practice primary care and family medicine at graduating educational debt levels of $50,000 to $100,000 (2010 dollars; P <.01). This relationship between debt and primary care practice persisted when physicians from different socioeconomic status groups, as approximated by loan type, were examined separately. At higher debt, graduates' odds of practicing primary care or family medicine declined. In contrast, private school graduates were not less likely to practice primary care or family medicine as debt levels increased.


CONCLUSIONS
High educational debt deters graduates of public medical schools from choosing primary care, but does not appear to influence private school graduates in the same way. Students from relatively lower income families are more strongly influenced by debt. Reducing debt of selected medical students may be effective in promoting a larger primary care physician workforce.
Michigan State University College of Human Medicine, East Lansing, Michigan Julie.phillips@hc.msu.edu.
Julie P
JP
Phillips
Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC.
Stephen M
SM
Petterson
Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC University of Cincinnati Department of Family Medicine, Cincinnati, Ohio.
Andrew W
AW
Bazemore
American Board of Family Medicine, Lexington, Kentucky Georgetown University, Washington, DC.
Robert L
RL
Phillips
D000328:Adult; D002321:Career Choice; D004501:Education, Medical / Q000191:economics*; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012577:Schools, Medical / Q000145:classification; D012959:Socioeconomic Factors; D013038:Specialization / Q000191:economics; D013337:Students, Medical / Q000706:statistics & numerical data*; D014146:Training Support / Q000145:classification / Q000191:economics*; D014481:United States
health manpower; primary care issues; undergraduate medical education; workforce