Educational Debt and Reported Career Plans among Internal Medicine Residents

16 September 2008 | Volume 149 Issue 6 | Pages 416-420

Background: Physicians often enter the workplace with substantial debt. The relationship between debt and reported career plans among internal medicine residents is unknown.

Objective: To determine distributions of educational debt among internal medicine residents and associations of debt with reported career plans.

Design: Cross-sectional survey using data from the annual Internal Medicine In-Training Examination Residents Questionnaire completed by U.S. categorical internal medicine residents.

Setting: Categorical internal medicine residencies in the United States.

Participants: 22 563 residents in their third (final) year of residency, representing 74.1% of all eligible U.S. categorical internal medicine residents from 2003 through 2007.

Measurements: Distributions of educational debt were tabulated. Proportions of residents choosing career plans were calculated for various levels of debt.

Results: International medical graduates represented 48.7% of the cross section and had considerably less debt than U.S. medical graduates: 53.8% of U.S. medical graduates had debt of $100 000 or greater and 60.2% of international medical graduates had none. U.S. medical graduates with debt of $100 000 to $150 000 were less likely than those with no debt to choose a subspecialty career (57.5% vs. 63.5%). U.S. medical graduates with debt of $50 000 to $99 999 were more likely than those with no debt to choose a hospitalist career (8.5% vs. 6.2%), and this preference increased with increasing debt level (10.0% for those with >$150 000 debt). These associations are more pronounced for U.S. medical graduates than for international medical graduates.

Limitation: The study addressed total educational debt, but not when it was incurred, and did not allow inferences related to causality.

Conclusion: Educational debt is associated with differences in reported career plans among internal medicine residents.

Author and Article Information

From the Mayo Clinic, Rochester, Minnesota, and the American College of Physicians, Philadelphia, Pennsylvania.

Note: Dr. Kolars is the chair of the Internal Medicine In-Training Examination Steering Committee that writes the Internal Medicine In-Training Examination Residents Questionnaire. Drs. McDonald and West had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgment: The authors thank Ms. Glenda C. Lattie, Director of Registration at the American Board of Internal Medicine, for her assistance in obtaining the data on the total number of U.S. categorical postgraduate third-year residents.

Potential Financial Conflicts of Interest: Employment: C. Popkave (American College of Physicians).

Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Available from Dr. West, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Requests for Single Reprints: Joseph C. Kolars, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail, kolars.joseph{at}mayo.edu.

Current Author Addresses: Drs. McDonald, West, and Kolars: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Ms. Popkave: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Read all Rapid Responses

Priceless: Remembering The Reason You Became an Internist

Daniel G. Arkfeld

Annals Online, 18 Sep 2008 [Full text]

Elephants in the room & self inflicted wounds

Michael E. Miller

Annals Online, 23 Sep 2008 [Full text]