Trends along the debt-income axis: implications for medical students' selections of family practice careers.

Abstract

To examine whether medical students' levels of debt have an influence on selection of family practice careers, independent of other factors. Data from the Jefferson Longitudinal Study were analyzed for 1,350 graduates from the classes of 1987-1993 at Jefferson Medical College of Thomas Jefferson University; a focused analysis for 326 graduates from the classes of 1992 and 1993 was specifically performed to identify recent trends. A binary logistic regression equation was used to predict the probability of a graduate's entrance into a family practice residency based on first-year preference for family practice, income expectation, debt level, age, and gender. A high level of indebtedness (at least $75,000) was a significant independent predictor of specialty choice (away from family practice); first-year preference for family practice and income expectation were also significant independent predictors. Combining these three factors (debt, specialty preference, and income expectation) led to a greater than 12-fold difference in specialty selection of family practice. Notably, 36% of the students graduating in 1992-1993 had debts of at least $75,000, more than three times the percentage in the classes graduating in 1987-1989. High levels of debt had a significant negative effect on family practice specialty, choice among recent Jefferson graduates. An increase in the number of students with such debt carries strong implications for the selection of careers in family practice.