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Debt may influence young doctors' career plans

By Genevra Pittman

NEW YORK (Reuters Health) - Pediatricians-in-training are more likely to plan to go into primary care - rather than a specialty field - if they have lots of debt from college and medical school, according to a new study.

Researchers also found the average pediatric resident's debt increased 34 percent between 2006 and 2010. That suggests financial considerations may keep young doctors out of medical specialties, they said, especially those fields that aren't known for paying big bucks but still require extra training.

The debt "keeps climbing, and it doesn't seem like there's an end," said Mary Pat Frintner, the study's lead author, from the American Academy of Pediatrics (AAP).

"There are multiple factors that (affect) a pediatrician's career decisions, and debt is just one part of that," she told Reuters Health. But, "since there's no end in sight to the rise in debt, that relationship may become more important in the future."

Most surprisingly, the findings also hint that rising debt - due to increases in medical school tuition - is not what's driving young doctors away from primary care, as many people have suggested, according to one health economist.

The new data, collected by the AAP, are based on five years of surveys of young doctors finishing their residencies - the training that follows medical school. The study included about 2,700 pediatric residents.

Close to three-quarters of the responders had debt from school. The average graduating resident's debt increased from $104,000 in 2006 to $139,000 in 2010.

Forty-three percent of residents had career plans requiring further subspecialty training, such as in pediatric cardiology or adolescent medicine. The rest planned to go straight into primary care or hospital medicine.

Frintner and her colleagues found residents with at least $51,000 of debt were about 50 percent more likely to be planning a primary care or hospitalist career than those who owed less or no money.

Women and residents with children were also less apt to be seeking further specialty training before entering the workforce, the research team reported Monday in the journal Pediatrics.

Dr. Peter Bach from Memorial Sloan-Kettering Cancer Center in New York pointed out that residents with more debt may come from more disadvantaged backgrounds - which might influence the type of medicine they want to practice. So the link between debt and career plans might not be cause-and-effect, he told Reuters Health.

So far there hasn't been a spike in the number of pediatric residents pursuing primary care careers rather than becoming specialists, Frintner said.

In fact, there's still concern there may be too few primary care doctors, at least in some parts of the United States.

But increasing debt may also create or exacerbate other shortages by discouraging young doctors from pursuing specialty training in fields that aren't particularly lucrative, such as "developmental behavioral pediatrics" and adolescent medicine, the researchers noted.

Amitabh Chandra, an economist and health policy researcher from Harvard University in Cambridge, Massachusetts, said the findings go against conventional wisdom that debt is one concern driving medical students to specialties and away from lower-paying primary care jobs.

Based on this study, "It's completely false to argue that more medical debt is an impediment to having more primary care doctors," said Chandra, who wasn't involved in the new research.

"People have been getting this completely wrong."

That means debt forgiveness policies for medical students probably won't result in more primary care doctors, he added - just as recent research showed that creating more internal medicine residency slots isn't an easy solution either (see Reuters Health story of December 4, 2012 here: http://reut.rs/YM4TNZ).

At the end of the day, Chandra told Reuters Health, increasing the salaries for fields that need more doctors - including primary care - may be a more effective strategy than focusing on debt.

SOURCE: http://bit.ly/cxXOG Pediatrics, online January 7, 2012.

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