Primary Care Educational Debt

Like most doctors, I’m easily impressed by facts. Lately, I’ve been asking myself. Why don’t we have more primary care physicians? I know the usual suspects – little prestige, lack or respect in academic medical centers, low incomes, overwork, too much hassle a plot by the A.M.A’s Relative Value Update Committee (RUC) to keep code values down.

But sometimes I don’t think we pay enough attention to the facts of educational debts of family physicians.

In a spate of letters to the editor in the NYT on April 13, 2008, about why Massachusetts lacks primary care physicians (“Universal Health Care, but by Whom?”), one letter writer, Lee Shapley from Philadelphia, who has been accepted to medical school, writes he received an acceptance package from the Boston University School of Medicne containing this financial information about the current academic year, Tuition, he adds, is expected to go up by 4.5% next year.

Tuition: $42,734
Fees: $2,914
Room and Board: $11,923
Books and supplies: $2,845

This totals $60,416.

Now let’s do a little more math, assuming a 4.5% tuitions increase each year.

Cost of year #1 - $62, 735

Cost of year #2 - $65,558

Cost of year #3 - $68,307

Cost of year #4 - $71,381

Total $267,981

Paying off the principle of debt over the course of five years would require monthly payments of $4450, with more added for interest of course.

Assume no more debts are acquired during residency and the entry income of a family physician at $150,000, or $12,500 a month before taxes, and you get the picture.

Given these facts, it is hard to argue with Mr. Shapley’s concluding paragraph.

With a debt load that size, a family practice doctor would probably take home less money than a registered nurse/. Until the reimbursement system is fixed and the debt load addressed there will be shortage in primary care. The numbers don’t lie.