Editorial Commentary.

Abstract

You have accessUrology PracticeThe Specialty1 Mar 2021Editorial CommentaryThis article comments on the following:Impact of Urology Trainee Debt Levels on Future Practice Choices and Expectations Elizabeth N. Bearrick and Kevin Koo Elizabeth N. BearrickElizabeth N. Bearrick Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author and Kevin KooKevin Koo Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000205.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail We teach and encourage residents to practice urology in the way that sustains their interest in the specialty, but to presume that they make career choices independent of educational debt burden would be naïve. The findings of this AUA Census study underscore the financial costs incurred even before residency: 78% of residents have educational debt, with a majority reporting >$150,000. While debt level was not statistically related to future practice type, trainees with higher amounts of debt were more likely to accept practice opportunities that offer loan forgiveness and to anticipate higher compensation. These data have important implications. When residents consider job opportunities, those who most need to negotiate, including the residents with higher debt, may be at additional disadvantage. For instance, female urology residents report significantly lower salary expectations and greater discomfort with business aspects of medicine, including contract negotiation, compared to their male counterparts.1 Empowering trainees with a realistic understanding of their value, financial and otherwise, should be as much a part of their preparation for practice as arming them with sound technical skills. We should also recognize—and destigmatize—the need for trainees to consider compensation among other factors when selecting their future practices. Just as medical student debt has long been known to influence specialty choice,2,3 the present study bolsters our understanding of the effect of debt on post-residency career decisions and strengthens the case for loan forgiveness programs, including federal proposals to augment the rural specialty physician workforce.4 To increase the freedom with which trainees can consider practice choices, efforts to decrease the burden of educational debt must first acknowledge its impact on their ability to choose.