Trundling along the winding and sometimes precarious trail of medical-school rotations, one hopes to come upon a place one can call home. For some, this is a simple route. They have known their ultimate destination from the trailhead and run headlong toward a specialty. Others have been less certain but, donning a quiet poise, contently saunter along with the faith that they will spot a place to rest. For many of us, however, the road itself is enough of a challenge. Its potholes twist our notions of medicine while its heaves trip up our tenuous confidence. If we thought we knew what direction to head in, we were mistaken. And the road to discovery takes a decided turn for the worse.
In fact, it appears that the longer we traverse the path to a specialty, the more sinister it becomes. The surroundings, which were once so fascinating, take on a decidedly more threatening guise. The open way that once seemed so liberating gets lonely, and the unburdened optimism that we would find a home morphs into a desperation for the comforts that lie within it. Without a specialty in clear focus and faced with the darkened path of financial burden, it is not surprising that students would doubt their navigation instincts and turn instead to their anxieties, namely their medical school debt.
As my fourth year of medical school has arrived and the deadline for selecting a residency descends, I have seen this fear manifest firsthand in my peers. Those once so dedicated to a place called Primary Care are now mulling timeshare in a spot called Radiology. The long road to Neurosurgery has been replaced by the quick jaunt through Ophthalmology. And I understand. Who wouldn’t be tempted by the landscaped entrance at the house of Dermatology or dream of floating in the indoor pool of Anesthesia? But, even in this buyer’s market, caveat emptor. While each of these options has much to offer in terms of intellectual challenge, one should not be swayed to select them based merely on the promise of financial security.
Yet the fear of long-term indebtedness is real. According to the Association of American Medical Colleges, the average educational debt of the graduates of the Class of 2007 was nearly $140,000 dollars, seven percent more than the previous year. Moreover, this debt is carried broadly since nearly 90 percent of medical-school graduates will have outstanding loans and more than three fourths of us will be left holding a debt of at least $100, 000 dollars. There are several reasons for this: the steep rise in medical school tuition over the past 20 years, the carriage of existing debt from undergraduate training, and the rise of non-traditional students in medicine who may have families and greater financial responsibilities.
Regardless of the cause, the financial burden we take on is difficult to ignore and unlikely to improve in the near future. In fact, recent estimates suggest that by 2033, physicians who select a standard 10-year loan repayment plan would allocate half of their after-tax earnings to paying off their loans.
So what of selecting a life’s work? Must the choice of a medical specialty be quite so pragmatic? Are we naive to select what we love knowing that it may not enable us to both pay off our loans and cover the future costs of a family? Or is it irresponsible as physicians and as humans to pick a specialty that we know will permit us to live debt-free even as it fails to fill a significant gap in patient care?
The truth is that it is difficult to predict whether the priorities of a medical student entombed in financial debt will bear any resemblance to that of the income-generating adult he or she will become. It is equally impossible to foresee how the nature of medicine and financial compensation will change in the future. Even the most computationally gifted among us would find this an intimidating model to handicap. But, lacking clear answers, it is logical that most of us will wrestle with the trade-offs and, looking both forward and back along the road, hope that we have chosen well.
Rachel Jimenez is a fourth-year medical student at HMS.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
