Advanced search

Search results      

The Influence of Medical School Debt on Specialty Choice: An Analysis of Colleges of Osteopathic Medicine
Dyches, R. P. [2]
Speicher, M. R. [7]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e193-e194. doi: Subito , type of study: longitudinal study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

debt [6]
economics [30]
longitudinal study [28]
medical students [402]
osteopathic medicine [1540]
specialization [10]
USA [1086]

Abstract:

Research Question(s)/Hypotheses: This study seeks to determine the association between medical school debt and specialty choice among graduating osteopathic medical students. Additionally, the authors aim to determine if the relationship (if any) between level of debt and specialty choice among graduating osteopathic medical students is likely to change as the impact of the single accreditation system (SAS) is fully felt. Statement of Significance: Although there have been several decades’ worth of studies on medical students regarding the influence of medical graduate debt on specialty choice, the impact of debt levels on graduating medical students’ selection of a specialty is generally thought to be minimal. However, previous studies have primarily focused on allopathic medical students, while little literature exists on the impact of debt on osteopathic medical students. Studies on allopathic students may not be generalizable, as levels of debt for allopathic students are significantly lower than the average osteopathic student's debt at graduation; in 2016, the difference between osteopathic and allopathic student debt was greater than $50,000. Since osteopathic tuition rates are increasing at an average of 4.3% per year, it is expected that the debt burden of osteopathic medical students will continue to increase accordingly. With a predicted physician shortage in the United States, particularly in primary care, and current national legislative debate on the future of loan repayment programs, identifying the impact of medical student debt on the career choice of osteopathic medical students is particularly urgent. The decision to enter a primary care specialty is multifactorial, but osteopathic medical students have historically entered primary care specialties at rates meaningfully higher than allopathic medical students. Other characteristics such as marital status, intellectual content of the specialty, prestige in the medical field, and gross income play a role in specialty selection; however, the rising costs of medical graduate debt may play an increasingly large influence on specialty selection. Methods: Data from the American Association of Colleges of Osteopathic Medicine's annual survey of graduating seniors were collected from graduation years 2014 (before SAS) through 2018 (2018 data were not available at the time the abstract was prepared, but will be included in the final poster.) Specifically, data on individual student self-reported debt level and self-reported predicted specialty training were collected from the study in a variable set that also included college of osteopathic medicine (COM), COM location (rural vs urban), COM structure (private vs public), and student self-reported undergraduate debt level. Because the survey was given to most graduating students after the residency match occurred, there is high correlation between projected specialty choice and residency specialty. Data were sub-grouped at 3 levels: rural vs urban COM location; private vs public COM structure; and student debt level. Medical school debt level was stratified into quartiles both including and excluding students with no debt. Specialty choice was sub-grouped into primary care vs non-primary care. Primary care was defined as family medicine, internal medicine, and pediatrics. Data Analysis: A χ2 analysis was performed predicting primary care specialty choice from medical school debt for all students, as well as only for students with debt. Additionally, a logit regression analysis predicting primary care specialty choice was conducted for all graduating students using the following variables: COM location (rural vs urban), COM structure, and total student debt. Results: Of the 30,067 respondents for which any data were obtained by the survey during the period 2014 to 2017 (2018 data will be available for the poster but were not available for the abstract), 19,369 respondents (64.4%) quantified their total medical school debt. Of those respondents who quantified their debt, 12,511 (64.6%) reported no medical school debt. Of those with no debt, 7423 (32%) reported practicing in a primary care specialty (other choices were 15, 524 reporting a non-primary care career and 262 reporting an indefinite career). Of those with debt, 2240 of 6858 (32.7%) reported practicing in Primary Care (non-primary care = 4545; indefinite = 73). This difference was not statistically significant (χ22=1.257; P=.533). However, when grouped by debt quartile, the differences between the highest quartile of debt-holders, 30% of whom selected primary care, was statistically significantly different from the other groups (χ28=16.599; P=.035). Among those graduates with debt, those in the top quartile of debt-holders were again statistically significantly less likely to match primary care specialties at a rate of 30% vs 33.5% (χ26=16.561; P=.011). A logit regression analysis of all students predicting choice of primary care from total medical school loans, medical school structure (private vs public), desired practice location was statistically significant but explained only 10% of the variation in primary care specialty choice (F=217.49; r2=0.10; P<.001). Conclusion: While many factors contribute to specialty choice, for osteopathic medical graduates, having the highest level of debt is currently associated with lower rates of selection of primary care specialties. The relationship between debt level and reduced preference for primary care residencies (and likely practice) is likely to be strengthened if currently available programs to reduce debt (and in some cases incentivize primary care practice) are de-funded, as is currently being discussed. With the addition to our study of 2018 data, when it becomes available from AACOM in August 2018, the impact of debt levels as most non-primary care residency programs move to the NRMP match under the single accreditation system, students with higher levels of debt may have trouble matching if they try to match into a non-primary care residency due to their debt. This study contradicts several other studies that have found no relationship between debt and specialty choice, generally in allopathic students. A recent analysis of debt level and practice location in osteopathic medical students indicates that debt may have some impact on desire to practice in a rural area. Likewise, this study shows that osteopathic graduates with the highest levels of debt are statistically significantly less likely to choose primary care than their less-indebted colleagues. Given increases in osteopathic medical school tuition and national policy under consideration that would de-fund loan repayment programs, including those specifically for primary care, these results indicate that current trends may exacerbate the shortage of primary care physicians.

Search results      

 
 
 






  • Impressum • Legal notice • Datenschutz •


ostlib.de/data_tcygrmfnbdswzjuaevpq



Supported by

OSTLIB recommends