Abstract
OBJECTIVE: There has never been a conclusive test of whether there is a relation between ultimately choosing to be a primary care physician and one’s amount of student loan debt at medical school graduation.
DESIGN/SETTING/PARTICIPANTS: To test this question, we examined data from the Women Physicians’ Health Study, a large, nationally representative, questionnaire-based study of 4,501 U.S. women physicians.
MEASUREMENTS AND MAIN RESULTS: We found that the youngest physicians were more than five times as likely as the oldest to have had some student loan debt and far more likely to have had high debt levels (p<.0001). However, younger women physicians were also more likely to choose a primary care specialty (p<.002). There was no relation between being a primary care physician and amount of indebtedness (p=.77); this was true even when the results were adjusted for the physicians’ decade of graduation and ethnicity (p=.79).
CONCLUSIONS: Although there may be other reasons for reducing student loan debt, at least among U.S. women physicians, encouraging primary care as a specialty choice may not be a reason for doing so.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
AAMC Generalist Physician Task Force. Association of American Medical Colleges policy on the generalist physician. Acad Med. 1993;68:1–6.
Greer DS, Bhak KN, Zenker BM. Comments on the AAMC policy statement recommending strategies for increasing the production of generalist physicians. Acad Med. 1994;69:245–60.
Rosenthal M, Turner T, Diamond J, Rabinowitz H. Income expectations of first year students at Jefferson Medical College as a predictor of family practice specialty choice. Acad Med. 1992;67:328–31.
Spar IL, Pryor KC, Simon W. Effect of debt level on the residency preferences of graduating medical students. Acad Med. 1993;68:570–2.
Lieu TA, Schroeder SA, Altman DF. Specialty choices at one medical school: recent trends and analysis of predictive factors. Acad Med. 1989;64:622–9.
Petersdorf RG. It’s report card time again. Acad Med. 1994;69:171–9.
Kassebaum D, Szenas P. Factors influencing the specialty choices of 1993 medical school graduates. Acad Med. 1994;69:164–70.
Rosenthal MP, Marquette PA, Diamond JJ. Trends along the debt-income axis: implications for medical students’ selections of family practice careers. Acad Med. 1996;71:675–7.
Colquitt WL, Zeh MC, Killian CD, Cultice JM. Effect of debt on U.S. medical school graduates’ preferences for family medicine, general internal medicine, and general pediatrics. Acad Med. 1996;71:400–11.
Berg D, Cerletty J, Byrd JC. The impact of educational loan burden on housestaff career decisions. J Gen Intern Med. 1993;8:143–5.
Martini CJM, Veloski JJ, Barzansky B, et al. Medical school and student characteristics that influence choosing a generalist career. JAMA. 1994;272:661–8.
Bazzoli GJ. Medical education indebtedness: does it affect physician specialty choice? Health Aff (Millwood). 1985;4:98–104.
Dial TH, Elliott PR. Relationship of scholarships and indebtedness to medical students’ career plans. J Med Educ. 1987;62:316–24.
Fox M. Medical student indebtedness and choice of specialization. Inquiry. 1993;30:84–94.
Frank E. The Women Physicians’ Health Study: background, purposes, and design. J Am Med Womens Assoc. 1995;50:64–6.
Frank E. Basic personal and professional characteristics of women physicians in the United States. West J Med. 1997;166:179–84.
Schieberl JL, Covell RM, Berry C, Anderson J. Factors associated with choosing a primary care career. West J Med. 1996;164:492–6.
Brotherton SE. The relationship of indebtedness, race, and gender to the choice of general or subspecialty pediatrics. Acad Med. 1995;70:149–51.
Rosenthal MP, Diamond JJ, Rabinowitz HK, et al. Influence of income, hours worked, and loan repayment on medical students’ decision to pursue a primary care career. JAMA. 1994;271:914–7.
Bland CJ, Meurer LN, Maldanado G. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70:620–40.
Linzer M, Slavin T, Mutha S, et al. Admission, recruitment, and retention: finding and keeping the generalist-oriented student. J Gen Intern Med. 1994;9(4 suppl):S14–23.
Trends: U.S. Medical School Applicants, Matriculants, Graduates 1995. Washington, DC: AAMC; April 1996.
AAMC 1996 Medical School Graduation Questionnaire Survey Results. Washington, DC: AAMC; Sept 18, 1996. Memo 96-45.
Randolph L. Seidman B, Pasko T. Physician Characteristics and Distribution in the US: 1996/97. Chicago, Ill: AMA; 1996.
Rubeck RF, Donnelly MB, Jarecky RM, Murphy-Spencer AE, Harrell PL, Schwartz RW. Demographic, educational, and psychosocial factors influencing the choices of primary care and academic medical careers. Acad Med. 1995;70:318–20.
Kassebaum DG, Szenas PL. Specialty intentions of 1995 U.S. medical school graduates and patterns of generalist career choice and decision making. Acad Med. 1995;70:1152–7.
Kassebaum DG, Szenas PL, Schuchert MK. Determinants of the generalist career intentions of 1995 graduating medical students. Acad Med. 1996;71:197–209.
Women in Medicine: 1995 Data Source. Chicago; Ill: AMA; 1995.
Author information
Authors and Affiliations
Additional information
This study was funded by the American Medical Association’s Education and Research Foundation, Chicago, Ill; the American Heart Association, Dallas, Tex; an institutional National Research Service Award (5T32-HL-07034) from the National Institutes of Health (National Heart, Lung, and Blood Institute), Bethesda, Md; and the Emory Medical Care Foundation, Atlanta, Ga.
Rights and permissions
About this article
Cite this article
Frank, E., Feinglass, S. Student loan debt does not predict choosing a primary care specialty for U.S. women physicians. J GEN INTERN MED 14, 347–350 (1999). https://doi.org/10.1046/j.1525-1497.1999.00339.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1999.00339.x