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The Burden of Debt: Impacting GME

mbMaya A. Babu, MD, MBA (left)
Neurosurgical Resident, Mayo Clinic
Vice-Chair, CSNS Communications and Education Committee
Rochester, MN

William Metcalf-Doetsch, MD (right)
Neurosurgical Resident,
Chicago, IL

Like all higher education, completion of medical school comes with a hefty price tag and likely significant post-graduation debt. This issue has been the focus of the (AMA) for more than a decade as the amounts owed climb to crisis levels. National media outlets, including the New York Times, The Hill and the Wall Street Journal, have increasingly shined a spotlight on this problem as well. Consider the facts.

Medical student debt continues to be a significant burden for residents in their postgraduate medical training across specialties and even extending beyond graduation from residency trainings. To get up-to-date data on this important topic, Medscape recently surveyed more than 1,700 residents in 24 specialties as part of a 2015 online survey. All participants were currently enrolled in a US residency program. Notable findings include:


Critical care residents ranked highest in salary ($62,000) in 2015, earning more than internal medicine and family medicine, who earned the least ($53,000). The average resident received $52,000 in the first year, with salaries increasing to a high of $66,000 by the seventh year. The largest increase was between year six and year seven.

Several strategies to address the issue of mounting medical student debt have been proposed. The Association of American Medical Colleges (AAMC) maintains a list of 68 state and regional programs for loan repayment and forgiveness for students and residents. For example, the New Jersey chapter of the American College of Surgeons has developed a novel method of offering scholarship support up to $10,000. Another innovative program creates a pathway for medical student loan forgiveness through a partnership between industry (local banks, businesses) and hospitals in underserved parts of the state. In several other regions, hospitals commit to loan forgiveness up to a certain amount assuming that a newly employed surgeon remains on staff for a period of time of time. The diversity of models in existence helps meet specific regional needs.

deIn addition to these programs, current students and residents can benefit from several different methods to manage existing debt. Residents can qualify for a number of different repayment options, including standard repayment, graduated repayment plans, or more flexible income-based repayment, which can help a young physician when making budgetary decisions on a limited salary. For surgeons, the newer Income-Based Repayment Plan (IBR) can offer some an attractive option, by capping repayment at 10-15 percent of monthly income. Furthermore, if for 10 years of that repayment a physician works for an approved government or non-for-profit sector program, the entire rest of the loan may qualify for forgiveness. For a surgical resident who spends five to nine years or more in training, this allows a reasonable option for eliminating debt by the time one enters practice. Working residents can also qualify for forbearance and continue to defer making payments until such time as they complete GME training and enter practice. Refinancing student loans can also help alleviate sometimes lofty graduate student loan interest rates, although this may limit other perhaps more flexible repayment options.

Another opportunity to curtail the impact of medical school debt may also exist. When young surgeons negotiate with a hospital or practice for employment, they should be encouraged to discuss student debt relief, perhaps contingent upon staying with the group for several years. Teaching young surgeons how to better navigate contract negotiations, could offer another sustainable strategy to reduce the burdens of medical student debt.

Neurosurgery, along with all of medicine, wants to attract the best and the brightest to the profession. Only this will ensure the highest quality of patient care as well as ongoing innovation, research and progress forward for our health care system. The rapidly growing level of medical school debt has the real potential to interfere with this. Strong consideration of sound policy to address this should be one of the priorities now and for the foreseeable future.

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