As a new academic year for medical students begins, I’m excited for the next generation of physicians to start their careers in medicine. However, like many of these students, I’m also nervous: The increase in student debt has created significant roadblocks to physicians who want to enter the primary care profession and practice in underserved communities.
While the administration’s recent actions to cancel some debt for eligible borrowers and extend the student loan pause through the end of the year are welcomed as positive steps forward, Congress must enact permanent solutions to address medical student debt and our shrinking primary care workforce.
According to a 2021 report from the National Academies of Sciences, Engineering and Medicine, “primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes.” Yet, the U.S. will need as many as 48,000 more primary care physicians in the next decade, and according to the Association of American Medical Colleges, the average medical school debt among the class of 2021 was $200,000. Physicians will incur the same cost for their medical education whether they enter primary care or sub-specialist fields, but once they complete their training, primary care physicians may face more challenges managing their debt compared to higher-paid surgical and procedure-focused specialty physicians.
With the above in mind, the health care community faces a workforce and an equity problem: We need more doctors to practice in underserved communities, yet that is where salaries may be lower. While the administration has made efforts to alleviate the burden of student debt and address our health care workforce shortage, we need to focus on programs that will encourage more medical students to choose primary care, as well as break down real and perceived barriers to practicing medicine in underserved communities.
Student debt is a major source of stress for medical students, residents and new physicians. Loan forgiveness programs, such as the Public Service Loan Forgiveness program, have become a potential lifeline for those struggling with student debt. These programs, and others like it, must be expanded at the federal level to improve access to health care in underserved communities, diversify the health care workforce, advance health equity and address the physician shortage. Legislation like the REDI Act allows medical students to qualify for interest-free deferment on their student loans while in a residency training program, creating more financial viability for physicians to specialize in family medicine and primary care.
There’s also an urgent need for increased investment in federal programs that incentivize physicians to practice in rural and medically underserved areas. One example is the National Health Service Corps (NHSC) program, which offers scholarships, loan repayments or coverage of the full cost of medical school tuition as incentives for physicians to enter primary care and deliver care for Americans in rural and underserved areas. By addressing student debt burdens, the NHSC program helps to expand health care access to our most vulnerable communities and ensures medical education opportunities for people who may not have thought it was within reach.
As a practicing family physician in a rural community, I know that if the government doesn’t incentivize students to pursue family medicine and primary care, we are going to continue to see a severe shortage of physicians in rural and underserved areas — something we as a society cannot afford. Recent data from the Health Resources and Services Administration shows that the number of people who live in a health professional shortage area has increased to over 95 million people — reaffirming the need for increased and targeted federal investment in primary care. More is at stake: For individuals living in many underserved areas, care by a family physician or primary care doctor is often the only option for meeting their health care needs.
As our future doctors start medical school, we hope our nation’s leaders will enact policy solutions that address the crippling burden of student debt and invest in high-quality primary care, which will improve health outcomes and equity. We need solutions that encourage medical students and early career physicians to follow their hearts and career goals versus only following the money. We need solutions that promote the health of each of our communities by making it easier for doctors to practice in underserved areas, and solutions that ensure our health care system is equitable for all.
Sterling N. Ransone Jr. is a family physician and president of the American Academy of Family Physicians. The AAFP represents 127,600 physicians and medical students nationwide.