Is Medical Student Choice of a Primary Care Residency Influenced by Debt?

Marc J. Kahn, MD; Ronald J. Markert, PhD; Fred A. Lopez, MD; Steven Specter, PhD; Howard Randall, PhD (deceased); N. Kevin Krane, MD


October 24, 2006

In This Article


Context: The average medical student accumulates more than $120,000 in debt upon graduation.
Objective: The purpose of this study was to investigate whether medical student debt affects residency choice.
Design: This was a cross-sectional research study.
Setting: This study was a 5-year analysis of student debt and residency choice for 2001-2005 graduates from 3 US medical schools (n = 2022): Tulane University School of Medicine, New Orleans, Louisiana; University of South Florida College of Medicine, Tampa, Florida; and Louisiana State University School of Medicine in New Orleans.
Main outcome measures: Individual student data were collected from offices of financial aid for debt prior to and during medical school to determine total debt at graduation. Total debt (adjusted for inflation) was compared with residency match results coded according to specialties listed in the Graduate Medical Education Directory 2005-2006. Graduates were coded into either primary care (PC) or nonprimary care (NPC) specialty categories. Logistic regression for the choice of a PC residency was used with 4 predictors: (1) total debt, (2) medical school, (3) year of graduation, and (4) number of years of training required for a residency program.
Results: Mean total debt for the study population was $89,807 (SD = 54,925). Graduates entering PC did not have significantly less total debt than those entering NPC ($87,206 vs $91,430; P = .09). Further, total debt was not a predictor of a PC residency after adjusting for medical school, year of graduation, and years of training in residency (P = .64).
Conclusion: There is no association between PC residency choice and debt. We conclude that medical students make residency decisions on the basis of a complex set of factors.




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