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Medical training debt and service commitments: the rural consequences.

Publication ,  Journal Article
Pathman, DE; Konrad, TR; King, TS; Spaulding, C; Taylor, DH
Published in: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
January 2000

This study assesses how student loan debt and scholarships, loan repayment and related programs with service requirements influence the incomes young physicians seek and attain, influence whether they choose to work in rural practice settings and affect the number of Medicaid-covered and uninsured patients they see. Data are from a 1999 mail survey of a national probability sample of 468 practicing family physicians, general internists and pediatricians who graduated from U.S. medical schools in 1988 and 1992. A majority of these generalist physicians recalled "moderate" or "great" concern for their financial situations before, during and after their training. Eighty percent financed all or part of their training with loans, and one-quarter received support from federal, state or community-sponsored scholarship, loan repayment and similar programs with service obligations. In their first job after residency, family physicians and pediatricians with greater debt reported caring for more patients insured under Medicaid and uninsured than did those with less debt. For no specialty was debt associated with physicians' income or likelihood of working in a rural area. Physicians serving commitments in exchange for training cost support, compared to those without obligations, were more likely to work in rural areas (33 vs. 7 percent, respectively, p < 0.001) and provided care to more Medicaid-covered and uninsured patients (53 vs. 29 percent, p < 0.001), but did not differ in their incomes ($99,600 vs. $93,800, p = 0.11). Thus, among physicians who train as generalists, the high costs of medical education appear to promote, not harm, national physician work force goals by prompting participation in service-requiring financial support programs and perhaps through increasing student borrowing. These positive outcomes for generalists should be weighed against other known and suspected negative consequences of the high costs of training, such as discouraging some poor students from medical careers altogether and perhaps influencing some medical students with high debt not to pursue primary care careers.

Duke Scholars

Published In

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

DOI

EISSN

1748-0361

ISSN

0890-765X

Publication Date

January 2000

Volume

16

Issue

3

Start / End Page

264 / 272

Related Subject Headings

  • Workforce
  • United States
  • Training Support
  • Surveys and Questionnaires
  • Rural Health Services
  • Public Health
  • Professional Practice Location
  • Physicians, Family
  • Pediatrics
  • Medically Uninsured
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pathman, D. E., Konrad, T. R., King, T. S., Spaulding, C., & Taylor, D. H. (2000). Medical training debt and service commitments: the rural consequences. The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association, 16(3), 264–272. https://doi.org/10.1111/j.1748-0361.2000.tb00471.x
Pathman, D. E., T. R. Konrad, T. S. King, C. Spaulding, and D. H. Taylor. “Medical training debt and service commitments: the rural consequences.The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association 16, no. 3 (January 2000): 264–72. https://doi.org/10.1111/j.1748-0361.2000.tb00471.x.
Pathman DE, Konrad TR, King TS, Spaulding C, Taylor DH. Medical training debt and service commitments: the rural consequences. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2000 Jan;16(3):264–72.
Pathman, D. E., et al. “Medical training debt and service commitments: the rural consequences.The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association, vol. 16, no. 3, Jan. 2000, pp. 264–72. Epmc, doi:10.1111/j.1748-0361.2000.tb00471.x.
Pathman DE, Konrad TR, King TS, Spaulding C, Taylor DH. Medical training debt and service commitments: the rural consequences. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2000 Jan;16(3):264–272.
Journal cover image

Published In

The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association

DOI

EISSN

1748-0361

ISSN

0890-765X

Publication Date

January 2000

Volume

16

Issue

3

Start / End Page

264 / 272

Related Subject Headings

  • Workforce
  • United States
  • Training Support
  • Surveys and Questionnaires
  • Rural Health Services
  • Public Health
  • Professional Practice Location
  • Physicians, Family
  • Pediatrics
  • Medically Uninsured