Medical students say debt is their number one issue | Opinion

By: Alyssa Tuan, Anis Adnani, Shyama Sathianathan, Maria Poluch and Arnab Ray

Medical student debt has been an issue for decades. For current Pennsylvania medical students, that continues to remain the case, according to a 2020 survey administered by the Pennsylvania Medical Society Medical Student Section (PAMED MSS). The survey asked students to identify from a list of topics the issues most important to them. Medical student debt ranked number one.

This should come as no surprise as nearly three-quarters of medical students in the United States graduate in debt. In 2019, the median debt was $200,000 for public school students, and it was $215,000 for private school students. This debt can take students up to 25 years to pay off.

To better understand medical student debt in the state of Pennsylvania, we examined tuition data available from the Association of American Medical Colleges (AAMC) and American Association of Colleges of Osteopathic Medicine (AACOM). We found that in-state student costs in 2020 for five out of seven allopathic schools fell in the top 25% out of 151 allopathic schools in the United States. In comparison, only two allopathic schools fell in the top 25% for out-of-state student costs.

While the level of tuition costs for all medical students is a concern, the costs for in-state students are especially alarming. This is because Pennsylvania has a low retention rate of medical students compared to the national average, and this could be tied to medical provider shortages in various parts of the state.

To provide more information about costs in Pennsylvania, the cost of tuition rose about 15 percent for out-of-state students in Pennsylvania from 2013 through 2021, while it rose about 19 percent for in-state medical students. For osteopathic schools, one out of two schools has a tuition cost above the national average for in-state students, while its tuition cost for out-of-state students is below the national average.

Notably, all nine allopathic and osteopathic medical schools in the state of Pennsylvania are private. The question remains — what impact does privatization have on medical student retention and medical provider shortage in the state?

Pennsylvania has a lower retention rate of physicians compared to the national average (46% in PA vs. 55% nationally). One state graduates a similar number of medical students but has a much higher retention rate. This state could serve as a model for improvement.

The state of Texas has a retention rate of 66 percent, likely due to its disparity in in-state and out-of-state medical student tuition rates. According to state law, in-state tuition is capped to $6,550 per year and out-of-state students pay three times the rate of in-state students. Additionally, the state of Texas allocates about $330 million a year for their schools, averaging about $45,000 per medical student per year, in order to reduce costs for in-state students.

Subsidizing the cost of medical school tuition for in-state students could be a solution for the physician shortage in Pennsylvania, which has been estimated to be approximately 55,000 physicians. Pennsylvania also ranks fifth in terms of having the most designated medically underserved areas and populations, which are defined as areas with too few primary care providers, high infant mortality, high poverty, and/or a high elderly population. The commonwealth attempted to address the physician shortage in 2012 by proposing to both increase the recruitment of international medical graduates to fill underserved areas and promote cultural competence. However, the number of residency and fellowship spots did not significantly change, contributing to lower physician retention from in-state graduates.

On top of all these issues, medical students pay higher interest rates than undergraduate students, and interest begins right away with no deferment during school, unlike that seen for many undergraduate student loans. This provides a possible area for policy change that could mitigate the challenges of medical student debt.

The American Medical Association (AMA) has several internal policies to combat medical student debt at the federal level, ranging from providing financial support to increase the number of primary care physicians to advocating for legislation regarding loan forgiveness. But more could be done at the state level to rein in costs and examine the role of privatization in medical education in the state of Pennsylvania. Medical student debt has far-reaching implications across the healthcare system, affecting access to care, diverse representation in the healthcare workforce, and health disparity mitigation, and it is the responsibility of the public sector to help address these challenges in our society.

Alyssa Tuan and Shyama Sathianathan are students at Penn State College of Medicine.

Anis Adnani is a student at Geisinger Commonwealth School of Medicine.

Maria Poluch, is a student at Sidney Kimmel Medical College of Thomas Jefferson University.

Arnab Ray is a student at the University of Pittsburgh School of Medicine.