Factors Influencing Specialty Choice

Student loan debt is an ever-increasing burden for graduates, particularly those who attend medical school. In 2012, 86% of medical school graduates reported having debt and the media debt was $170,000, according to a new report by the Association of American Medical Colleges (AAMC).

The class of 2012 reported a total of $1.7 billion in education debt after completing their medical education, according to the AAMC report, Physician Education Debt and the Cost to Attend Medical School.

Since primary care is one of the lower-paying specialties, there were concerns that increasing student loan debt would dissuade graduates from entering primary care. However, the AAMC report revealed that medical graduates say that “personality fit” is the most important consideration when they choose a specialty. Education debt ranked last out of 11 factors.

“Education debt and/or potential income may play a role when some physicians choose their specialties, but they do not appear to play a determining role for most,” according to the report.

When graduates’ specialty choices were broken down by how much debt they owed, there was no discernible pattern to show that those with more debt were more likely to pick specialties with higher starting salaries.

Graduates with a median education debt of less than $81,000 were slightly less likely than those with median debt greater than $220,000 to choose a specialty with a starting salary between $200,000 and $260,000 (40% of students vs. 46%, respectively). However, those with less than a median of $81,000 in debt were more likely to have a starting salary of $300,000 than those with more than $220,000 in debt (24% vs. 22%, respectively). And yet, graduates with less debt were also more likely to become pediatricians with a starting salary of $145,000 than graduates with large amounts of debt (16% vs. 11%, respectively).

Although, there is no discernible bias against primary care, the increasing costs of tuition and increasing debt burden are worrying, according to Darrell G. Kirch, MD, AAMC president and chief executive officer.

“Cuts to state and federal support for higher education will continue to put upward pressure on student tuition and debt levels,” Kirch said in a statement. “If these trends continue, we are very concerned about the impact rising student debt levels will have on our ability to recruit a diverse physician workforce and ensure that we have enough physicians to care for our growing and aging population, as well as the poorest and most vulnerable among us.”