Is being a primary care doctor worth it? Financially, maybe not

Nov. 28, 2012, 2:25 p.m.

A new analysis has found that students who incur $250,000 or more in medical school loans won't find it easy to pay off that debt if they decide to go into primary care. (Mae Ryan/KPCC)

When medical students graduate, their average debt is more than $161,000.

That's the highest average debt to date. Among the 86 percent of medical students who do graduate in debt, more than one in five from private medical schools have outstanding loans of $250,000 or more.

That's a quarter-million dollars they need to repay.

And it's not easy for medical students to do that when they decide to go into primary care, says a new study in the journal Academic Medicine. Primary care doctors act as the principal point of consultation for patients within a health care system, and will take care of many health problems – a cold, a headache, pain, the flu, trouble sleeping at night. If they can't treat a patient with their knowledge or with the resources available to them, though, that's when a primary care doctor would refer a patient to a specialist – someone who has an expertise in a particular, specific area (i.e., cardiologists and the heart, neurologists and the brain).

Analysts found that medical students who have the average amount of debt – around $161,000 – can enter primary care, raise a family, live in an expensive area and repay their debt within 10 years without incurring any more debt.

But it starts getting difficult for medical students with debts of $200,000 or more: If they want to work in primary care, they'll need to a consider an extended repayment plan or a federal loan repayment program.

And for aspiring primary care doctors with debts of $250,000 or more? They'll need to move to a cheaper area or look into repaying their loans on a 25-year plan model.

It's yet another reason for young health providers to choose a field that's not primary care, said Dr. Felix Aguilar, the chief medical officer of South Central Family Health Center.

"The common knowledge among medical students is that primary care is the least paid of all medical professions," he said, adding that it's true – out of residency, a medical student going into primary care will make around $140,000 annually. While that's "of course, a lot more money than most people make," Aguilar says, he notes that "medical education is also very expensive."

"It really makes people think twice about what they are going to do with this debt," he said.

Meaning it might make them think twice about going into primary care at all. But that's not good for an area like South Los Angeles, where Aguilar says primary care is far and away the biggest need among residents. (That's not to say specialty care isn't also in short supply on the southside.) When the Affordable Care Act's Medicaid expansion kicks in, the southside will see the number of people with access to health care grow by between 100,000 and 200,000.

Because of that, Aguilar predicts that within the next 10 years, most primary care won't be provided by doctors.

"It will be provided by mid-level providers: nurse practitioners, physician assistants," he said. "That's currently the trend, but it'll be accelerated with health reform, mostly because there's just a greater need for access and that's really going to create difficulties."

And that, said Aguilar, probably means that primary care doctors will continue to get paid less – relatively speaking. It's also a field with what he calls "tremendous workload issues" – primary care physicians are expected to see a patient every 15 minutes, while specialists tend to "have a lot more time."

Right now, only about 10 percent of medical students go into primary care, and Aguilar believes that number will go down.

In the Academic Medicine study, researchers found that more than half of the medical graduate class of 2011 had debts that exceeded $200,000, with 5 percent having incurred debts of $300,000 or more.

For those students, that's all the more reason to choose a more lucrative medical field that'll help them break even from those years of training.

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