A second response to this website’s recent post, Drowning in Student Debt: Young Professionals at the End of Graduate School, has been received from Doctor Michael D. Prislin, Associate Dean of Students of the University of California, Irvine Medical School.
The economic circumstances that young professionals often find themselves in following completion of their studies are distressingly familiar to the medical education community. But the sheer size of the accumulated debt is only the proverbial tip of the iceberg. The reality is that 75% of those who attend medical school come from families whose income is in the upper two quintiles in our society.
This circumstance influences students well before they get to medical school. Students who have access to high schools which have strong college preparatory curricula such as magnet sciences programs and AP courses, and whose families can afford SAT preparation courses and other enrichment activities are much more likely to attend the relatively small number of highly selective colleges and universities whose graduates, in turn, account for the majority of students entering medical school.
And student economic factors are strongly affecting the nature of the physician workforce in terms of both geographic distribution and specialty mix. Community of origin is an important factor influencing where physicians ultimately practice. If small numbers of individuals from less affluent rural and urban communities are entering medical school, fewer medical school graduates will ultimately be available to practice in these communities. Further, income discrepancies between specialist and generalist physicians may, in aggregate, be greater than $30 million over the course of a practice career.
For those students “drowning in debt” this reality is difficult to ignore. While developing solutions to physician workforce imbalances will be complex, assuring the entry of a more diverse group of students in to medical school will be a key piece of the puzzle. This will require that both the process of selecting students and the method of paying for medical education be altered. Public funding of medical education in exchange for post graduation public service is a strategy that has proven successful in other countries. At the very least, a substantially expanded targeted loan forgiveness program is needed if we are going to adequately address the health workforce needs of our nation
See also the comments of Dr Gary LeRoy of Wright State University, at: An Associate Dean’s Response to “Drowning in Student Debt”.