Doctors to lawmakers: Burden of medical school debt could have consequences for practices, primary care

Lauren Wiese is about to finish her residency in orthodontics, but even as she's getting ready to start her career, she feels the weight of a pretty hefty burden: $411,000 in debt from student loans.

Despite her efforts to save money by living with her parents and sharing an old car with her husband, Wiese said at a hearing Wednesday before the House Small Business Committee that she’s facing a hefty burden. She's got a $3,300 monthly payment, plus interest, to pay back the money she borrowed for her education.

That's put her dream of owning her own practice on hold, probably for the next 10 to 15 years, she said. Her husband is rethinking his own plans to attend medical or dental school because it could more than double the student debt they would owe.

“It’s paralyzing for us,” said Wiese, D.M.D., who was among a handful of witnesses who testified before House committee about the consequences of student debt.

The committee’s chairman, Rep. Nydia M. Velázquez (D-NY), said she fears student loan debt—now a $1.4 trillion issue for all students—has had a detrimental effect for medical professionals. High student debt has kept physicians from starting or joining private practices, keeps physicians from working in rural and underserved communities and has influenced the choice of specialties as doctors chose higher paying specialties rather than primary care, she said.

Tracey Henry, M.D., assistant health director at Grady Primary Care Center in Atlanta and an assistant professor of medicine at Emory University School of Medicine, said she works with many patients who are homeless or uninsured. “My dream has always been to practice in an underserved community,” she said.

“As much as I love working, giving back to my community through medicine, community service, and training our next generation of doctors, the burden of my student loan debt weighs on me heavily,” she said. Her debt amounts to well over $200,000.

Student loan debt can influence physician choices, she said. “Sometimes my medical residents who really enjoy primary care struggle with the decision to choose it as a career. I advise them to go with their heart and do what they enjoy, but I do so knowing that this is an issue I have not been able to solve for myself,” said Henry, who spoke on behalf of the American College of Physicians (ACP).

RELATED: Debt and financial stress contribute to physician burnout

Congress currently has numerous bills before it to address student loan debt. Henry said she supports the What You Can Do for Your Country Act, which would increase access to loan forgiveness for individuals, including doctors, who pursue careers in government service or in non-profit organizations.


It’s not easy recruiting and retaining medical professionals to work in rural settings where they receive less pay, said Sandra Norby, CEO, of HomeTown Physical Therapy in Des Moines, Iowa.

She’s hoping to bring on board a new physical therapist but worries she can’t pay her enough to cover her student loan debt, said Norby, who said she supports bipartisan legislation that would allow physical therapists to participate in a federal loan program.

But not everyone agrees on a solution. Jason Delisle, a resident fellow at the American Enterprise Institute, a conservative think tank, told committee members that federal student loan programs have become more and more costly to taxpayers. Physicians are some of the highest paid individuals, he said.

“I suggest reforms to these programs and explain how an accountability system for federal student loans would help ensure colleges align their prices with graduates’ expected earnings,” he said.

Committee member, Rep. Steve Chabot, a Republican from Ohio, questioned whether it is high student debt or other reasons why doctors chose not to join or state small medical practices. There are now fewer physician owners than employees, according to a survey by the American Medical Association. It's the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.

Some medical schools, however, agree that medical debt can be a factor in a doctor's choice of specialties.

Last year, NYU’s medical school decided to offer free tuition to all its students, saying it hoped that would encourage more students to pursue careers in less lucrative specialties such as primary care. Kaiser Permanente also decided to offer free tuition to all the medical students in its first five graduating classes at its new medical school, saying it hoped by reducing the financial burden on future doctors for their education, it would encourage students to go into primary care and other lower-paying specialties.