Financing medical education.

The cost of a medical education may dissuade qualified young people from entering the medical profession or may so load them with debt that they cannot pursue relatively low-paid careers in primary care or clinical investigation. Three aspects of this problem are examined: (1) the cost of medical school, (2) the magnitude of student indebtedness, and (3) the effects of this indebtedness on career choices. High tuition and fees require many students to assume sizable educational debts, some of which are so large that the trainees will be unable to repay them unless they enter highly remunerative specialties. Also, high levels of indebtedness may increase default levels once graduates feel the full impact of scheduled repayments. Several steps would help to alleviate this problem, but are unlikely to solve it. First, medical schools should lower tuition or at least declare a moratorium on increases. Second, limits should be imposed on the amount of total education debt a student is allowed to assume. Third, hospitals with extensive residency programs should assume some responsibility for helping trainees manage their finances. Fourth, the government should institute a loan forgiveness program that addresses the need for physician-investigators, primary care physicians, those willing to practice in underserved areas, and those from underrepresented minorities. And fifth, all institutions involved in medical training and its finance should work together to advise students on managing their debts.