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Health & wellness

Study: Medical school debt may prompt hard choices for primary care physicians

Most young doctors who choose a career in primary care will be able to pay off medical school debt of about $160,000, the median among medical school graduates in 2011, within 10 years even as they raise a family in a high-cost urban area. But, a study by researchers at Boston University and the Association of American Medical Colleges found that those with more debt may have to make careful choices to manage their finances.

Primary care physicians with debt of $200,000 or more may have to sign up for an extended repayment program, secure a federal loan, or live in a lower-cost region, the researchers found. While some say that those aren’t bad options and that opportunities for primary care physicians are growing, the study provides “a sobering picture,” said Dr. John Wiecha, senior author and assistant dean for academic affairs at BU School of Medicine.

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Wiecha became interested in looking at the financial prospects of young primary care doctors as he noticed that the debt load was growing among medical students who came to him for advice about whether to pursue family medicine.

After leveling off some in recent years, median debt among medical school graduates increased about 5 percent for the class of 2012, to $170,000, according to an AAMC analysis. Seventeen percent of graduates carry debt of $250,000 or more.

The role of primary care physicians is expected to grow considerably under the Affordable Care Act. People who gain insurance coverage starting in 2014 will be looking for a doctor, and new models of paying for health care outlined under state and federal laws require primary care physicians to more closely manage patients’ overall care.

Family physicians make far less than certain specialists. The median compensation for dermatologists and anesthesiologists, for example, was about $425,000 last year, according to the latest physician compensation survey by MGMA, previously called the Medical Group Management Association. Median pay for family physicians was $200,114.

Doctors and medical educators often talk about debt from schooling as a factor that deters students from primary care, though research shows personal preferences and other factors may play a bigger role in how people choose a career path.

James Youngclaus, lead author and senior education analyst for the medical colleges group, said the study should be seen as a tool for medical students, not a warning. Students with high debt should consider some of the choices they may face if they choose primary care, but they may find reasonable options.

“There are going to be some trade-offs,” Youngclaus said. “You can’t have the most expensive house in the most expensive neighborhood. ... I’d say [the debt] is not insurmountable, as long as you’re aware going in.”

The researchers modelled a typical career for a primary care physician who is married to a college-educated person, also employed, and who goes on to have two children. They factored in household spending, including mortgage payments, and compared the scenario to estimates for higher-paid specialists, who were able to pay off comparable debt load while maintaining higher discretionary income for their household.

The study did not account for how payment for primary doctors is changing, said Dr. Russ Phillips, a physician at Beth Israel Deaconess Medical Center and director of the Harvard Medical School Center for Primary Care.

Health centers and hospitals are recruiting, and they know that changing the way health care works “is going to start with primary care,” he said. “We’re attaching more value to the work of primary care” physicians.

Phillips said the average starting salary in primary care is rising and more providers may begin to offer hiring packages that include debt repayment to attract the best in the field.

Wiecha, the senior author, said more support from the federal government, in the form of scholarships for people pursuing primary care and better payment once they’re on the job, could help.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.

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