Current Trends in Debt and Specialty Choice - AAMC

Current Trends in Debt andSpecialty ChoiceGEA Small Group DiscussionMoscone 20221:30 – 3:00pmJulie Fresne, AAMCJohn Wiecha, MD, MPH, BU SOMJay Youngclaus, AAMCNov. 6, 2012

How we will pass your time~15min.• Quick overview of current debt & cost trends• 2012 data on debt and specialty choice• Brief summary of forthcoming research paper• A few insights from counseling indebtedmedical students60+min.• Discussion, Discussion, DiscussionThis will be most of our time ….2012 AAMC Annual Meeting

Class of 2012 IndebtednessAll SchoolsPublic PrivateSchools SchoolsMean $166,738 $156,018 $183,002Median $170,000 $160,000 $190,00086% of graduates report having educational debt36% of graduates report debt $200,000 or higherData includes medical and premedical/undergraduate debt2012 AAMC Annual Meeting

Median Education Debt of IndebtedMedical School Graduates, 1992-2012$175,000$170,000in 2012$150,000$125,000Constant2012$$100,000Actual $$75,000$50,000$25,0001992-2012:Debt CAGR = 6.3%CPI CAGR = 2.5%$01992 1994 1996 1998 2000 2002 2004 2006 2008 2010 20122012 AAMC Annual Meeting

Cost of Medical School, 2012-2013Median M1Tuition/FeesMedian M1 Cost ofAttendance (COA)Median 4-Yr. COAfor class of 2013Public(In-State)Private(In-State)$32,414 $50,309$53,685 $72,344$207,868 $278,4552012 AAMC Annual Meeting

Median 4-Year Cost of Attendance (COA) andEducation Debt of Indebted Medical School Graduates,2000-2012 (in Constant 2012$)$300,000$250,000$275,300$200,000$150,000$196,700$190,000$160,000$100,000Private 4Yr COA in 2012$Private Median Ed Debt in 2012$$50,000$-Public 4Yr COA in 2012$Public Median Ed Debt in 2012$2000 2002 2004 2006 2008 2010 20122012 AAMC Annual Meeting

Influence of Various Factors on the Specialty Choice of2012 Graduating Medical Students (GQ)0 Percent 20 indicating “strong” 40 or “moderate” 60 influence80 100273341.140.447.562.66078.077.398.398.12012 AAMC Annual Meeting

Influence of Various Factors on the Specialty Choice of2012 Graduating Medical Students (GQ)0 Percent 20 indicating “strong” 40 or “moderate” 60 influence80 100273341.140.447.562.66078.077.398.398.12012 AAMC Annual Meeting

Median Salary First Year Post-Residency 2011Dermatology $312K$K $50K $100K $150K $200K $250K $300K $350KSurgery: GeneralAnesthesiologyEmergency MedicineOB/GYNPsychiatryInternal MedicineHospitalist: IMFamily Practice (w/ OB)Pediatrics$260K$250K$245K$222.5K$197.5K$180K$180K$160K$145KSource: Selected Specialties, MGMA 2011 Data2012 AAMC Annual Meeting

2012 GQ Data on Debt and Specialty ChoiceInterest in Specialty with ….Starting Salary of $300K+Starting Salarybetween $220K and $260KStarting Salary around $200KFamily MedicineStarting Salary=$160KPeds. Starting Salary=$145KEd Debt=$220K24% 22% 22%40% 44% 46%12% 11% 11%8% 10% 9%16% 13% 11%Graduates planning to become certified in specific specialties and“moderately” or “very” confident in their choice. Excludes Internal Med.2012 AAMC Annual Meeting

2012 GQ Data on Debt and Specialty ChoiceInterest in Specialty with ….Starting Salary of $300K+Starting Salarybetween $220K and $260KStarting Salary around $200KFamily MedicineStarting Salary=$160KPeds. Starting Salary=$145KEd Debt=$220K22%$260K46%$260K11%$257K9%$256K11%$255KGraduates planning to become certified in specific specialties and“moderately” or “very” confident in their choice. Excludes Internal Med.2012 AAMC Annual Meeting

Rate of USMDs likely to becomePCPs may be stabilizing37%33%Percent USMD PGY-1 ResidentsLikely to Become PCPs30%28%26% 25% 26% 25% 24% 24%25%2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Source: GME Track analysis by Paul Jolly (AAMC)Notes: Percent equals 1) number USMDs entering IM, FM, or Peds minus number entering IMSubspecialties or Ped Subspecs. that same year 2) divided by number of PGY1 entrants2012 AAMC Annual Meeting

Jan. 2013 in Academic MedicineYoungclaus, Wiecha et al.available online next week“Can Medical Students Afford to Choose Primary Care?An Economic Analysis of Physician EducationDebt Repayment”Analyzed whether a physician earning a typical primary caresalary can repay current levels of education debt and meetstandard household expenses without incurring additional debtUsed data and financial-planning software to model the annualfinances for a fictional physician’s household (Dr. Median)2012 AAMC Annual Meeting

Jan. 2013 in Academic MedicineYoungclaus, Wiecha et al.available online next weekConclusionsA primary care career remains financially viable formedical school graduates with median levels ofeducation debt. Graduates pursuing primary care withhigher debt levels would need to consider additionalstrategies to support repayment such as extendedrepayment terms, use of a federal loanforgiveness/repayment program, or not living in thehighest cost areas.2012 AAMC Annual Meeting

One on One Student CounselingWhat happens when you share thesefindings with individual medicalstudents who have debt and areundecided about their career choice?Perspectives from BU SOM2012 AAMC Annual Meeting

Discussion Questions•Do national debt trends mirrorwhat audience members areseeing at their schools?2012 AAMC Annual Meeting

Discussion Questions•Current research suggests thatdebt and potential income haveless of an impact on specialtychoice compared to other factors.Does this ring true with theexperiences, anecdotes, andobservations of audiencemembers?2012 AAMC Annual Meeting

Discussion Questions•Is there a point at which debtlevels will make a primary carecareer seem untenable?If yes, are we close to thatpoint?2012 AAMC Annual Meeting

Discussion Questions•Will current cost of attendance anddebt trends impact the futurephysician supply and specialtydistribution?What do audience membersthink?2012 AAMC Annual Meeting

Further QuestionsFor more resources see aamc.org/firstjy@aamc.orgjohn383@bu.edujfresne@aamc.org2012 AAMC Annual Meeting

Medloans AAMC Medloans ® Organizer/Calculator® and Calculator2012 AAMC Annual Meeting

Organizes Loan Information2012 AAMC Annual Meeting

Set Parameters2012 AAMC Annual Meeting

Calculate Repayment Scenarios2012 AAMC Annual Meeting