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Evolving Practice Settings for Osteopathic Graduates: How Debt Influences Anticipated Career Path
Kunz, M. [3]
Richards, J. [8]
Scheckel, C. [7]
Newman, J. [7]
Poole, K. [6]
Mi, L. [4]

Journal: Journal of Osteopathic Medicine Date: 2017/11, 117(11):Pages: e131-e132. doi: Subito , type of study: retrospective study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2017.141/html)

Keywords:

career choice [40]
debt [6]
economics [30]
medical students [402]
osteopathic medicine [1540]
retrospective study [213]
USA [1086]

Abstract:

Research Question/Hypothesis: How has anticipated practice type of osteopathic graduates changed over the past decade and does debt affect anticipated career choices? Introduction: Over the past decade, the health care landscape in the United States has evolved. Changes in patient population, reimbursement, and insurance coverage have triggered variations in practice types chosen by early-career physicians in the United States. Similarly, it has been shown that debt has a significant influence on career decisions of graduating medical students. Each year, the average medical student debt continues to rise, with an average debt of nearly $200,000. To understand the future of the osteopathic medical profession, it is important to recognize the current motives and preferences of graduating osteopathic physicians. In this study we sought to analyze trends in graduating osteopathic medical students’ anticipated practice types and how debt may affect their chosen career. Methods: The American Association of Colleges of Osteopathic Medicine (AACOM) annually invites all accredited COMs to administer a voluntary survey to graduating classes. The survey examines trends in medical graduates in terms of demographics, satisfaction, career choice, and other metrics. The total response rate has remained between 72% and 77% of all graduates in the years evaluated (2007, 2010, 2013, and 2016). Total responses increased from 2403 in 2007 to 4191 in 2016. With permission, we received deidentified responses from the AACOM for analysis. We evaluated global trends in anticipated practice type and differences in high vs low debt respondents stratified into quartiles (25th percentile=Q<25, 75th percentile=Q>75). For analysis, χ2 and analysis of variance tests were used with standard statistical methods with a P value of .05. Results: From 2007 to 2016, there was a significant decrease in students anticipating entering self-employment, from 20.99% in 2007 to 9.87% in 2016, and inversely there was a significant increase in students anticipating working for health maintenance organizations (HMOs), from 1.95% in 2007 to 13.83% in 2016 (P<.0001). In 2007, 2010, 2013, and 2016, the students with the least amount of debt were more likely to anticipate government service (average QP75 of 61.92%) or group/private practice (average Q>P75 of 8.55%). Conclusion: The anticipated practice types of students evolved significantly from 2007 to 2016, with a shift away from solo practice and toward employee positions. Graduating osteopathic physicians demonstrated a significant shift away from private practice and toward HMOs during this time span. Our findings also suggest that debt has a significant impact on the anticipated future practice type of graduating students. Students with less debt were much more likely to participate in government service, and students with the most debt were more likely to work for HMOs or in private groups. As average medical student debt continues to rise, understanding its implications for physician practice patterns is imperative as we consider possible physician shortages in areas of geography or by specialty. This analysis demonstrates a significant shift in medical school graduates’ expected practice settings and demonstrates that debt can change expected career trajectory.

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