Hernried J, Binder L, Hernried P
Office of Graduate Medical Education and Student Affairs, Texas Tech University, El Paso 79905.
JAMA. 1990 Feb 23;263(8):1102-5.
Cumulative figures of "average medical student indebtedness," although meaningful, do not convey the effect of loan repayments on residents' cash flow, effect on a resident's value system and residency performance, and effect on trends in health care manpower allocation. Using a computer-based cash flow model, a "typical" house officer with $20,000 in undergraduate indebtedness who is training in a less expensive city will realize a $2390 deficit during internship and negative cash flow throughout a 5-year residency. House officers with extreme indebtedness (greater than $80,000) who are training in an expensive metropolitan area would accumulate an overall deficit approaching $75,000 or more, in excess of their undergraduate indebtedness, during a 5-year residency program. Effects of these findings on residency education and health care manpower issues, along with potential solutions for alleviating residents' cash flow problems, are discussed.
“医学院学生平均债务”的累计数字虽然有意义，但并未体现贷款偿还对住院医师现金流的影响、对住院医师价值体系和住院医师培训表现的影响，以及对医疗人力分配趋势的影响。使用基于计算机的现金流模型，一名本科负债2万美元、在生活成本较低城市接受培训的“典型”住院医师，在实习期间将出现2390美元的赤字，并且在为期5年的住院医师培训期间现金流均为负。在昂贵大都市地区接受培训、负债极高（超过8万美元）的住院医师，在为期5年的住院医师培训项目中，累计赤字将接近7.5万美元或更多，超过其本科负债。本文讨论了这些研究结果对住院医师培训教育和医疗人力问题的影响，以及缓解住院医师现金流问题的潜在解决方案。
