Money Matters

Physicians with high debt more likely to work in underserved areas

An increase in tuition over the last decade is associated with more interest in loan-repayment programs.


According to a new study in The Journal of the American Osteopathic Association (JAOA), physicians graduating with the highest levels of student loan debt are increasingly planning to practice in underserved areas, a trend associated with debt repayment programs.

Debt swells for docs

Between 2007 and 2016, medical school tuition increased at a rate more than double that of national inflation. During that same nine-year period, the percentage of medical students interested in practicing in underserved communities increased from 27 percent in 2007 to 35 percent in 2016, based on responses to annual surveys of graduating medical students’ plans for residency.

“We found a strong association among factors of increased debt load, intention to use a loan-repayment program, and intention to practice in underserved areas,” says Jesse Richards, DO, an osteopathic internal medicine physician at University of Kansas Health Systems and co-author of the study.

In fact, for graduates in the top quartile for indebtedness, there was a 37 percent increased interest in practicing in underserved communities compared to an increase of 20 percent for those in the bottom quartile of indebtedness.

Researchers found 68 percent of those who intended to practice in underserved areas planned on participating in loan-repayment programs, compared to 35 percent of those planning on practicing in non-underserved areas.

Community benefits

The increase in physicians in underserved areas is a benefit to the communities who need it most, researchers say. “We know the lack of access to health care is having a profoundly negative impact in certain parts of our country,” says Caleb J. Scheckel, DO, an osteopathic internal medicine specialist at Mayo Clinic and co-author on the study. Dr. Scheckel cited a 2017 Centers for Disease Control and Prevention report on physician shortages in rural areas. The report notes higher rates of death due to heart disease, respiratory disease, and stroke compared with people in urban areas.

“The largest takeaway is that loan repayment programs are working as intended and helping bring much-needed medical expertise to medically underserved communities,” says Dr. Richards.

Room for improvement

Dr. Richards and Dr. Scheckel believe additional study is needed to determine how to optimize loan-repayment programs, but continued expansion of these programs and incentives is critical to placing newly graduated physicians in areas of greatest need.

For further reading

6 smart ways to manage your student loans during residency


  1. Kurtis

    That’s just what us medical students needed, an article that provides social incentive and justification for medical schools to continue to raise tuition. Higher profits for schools, while filling rural needs, and increasing the amount and years spent repaying loans.

  2. Dan

    I agree with the previous comment. The assumptions implied by the writer of this article are very displeasing to me as a current Osteopathic medical student. There is no good justification for medical schools taking advantage of medical students. Every medical student knows that the quality of education has not increased with increasing tuition. In fact, there are more inexpensive and free resources being made available online that teach concepts clearer and more concisely than they are taught at expensive medical schools.

    The article also fails to mention that many students with higher debt opt to subspecialize rather than practice primary care because of their increased debt burden.

    Furthermore, if student debt were lower there would still be opportunities to lure doctors to underserved areas by offering bonus incentives rather than debt repayment.

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