The burden of medical school debt: How to advocate for change

Efforts to tackle the current student debt burden – which is especially shouldered by medical students – must reflect a balance of principle and practicality. Currently, addressing student debt is a Herculean task, which is worsening as inflation creeps higher.

As an osteopathic medical student, I am acutely aware of the challenges my colleagues and I face as we prepare to enter the medical field. I am concerned about the impact student loans will have on those pursuing primary care and other critical specialties.

In the 2018-2019 academic year, osteopathic medical schools alone are educating nearly 31,000 U.S. medical students – one-quarter of all U.S. medical students. As medical student debt rises with no foreseeable solution in sight, the time has come to address the following:

1. A 2017 survey from the American Association Colleges of Osteopathic Medicine found that 86% of osteopathic medical students will be leaving medical school with debt, averaging over $240,000. The median average debt for a DO student graduating in 2020 rose to $265,000. If debt continues to grow at this rate, the average medical student debt will exceed $300,000 by 2026.
2. Interest rates on federal loans continue to accrue throughout a student’s medical education, during residency and as a practicing attending, causing considerable inflation in the overall cost of attending medical school. This has been temporarily addressed with the pause of accruing interest due to the ongoing pandemic; however, in May 2022, student loan payments and interest rates are scheduled to be reinstated.
3. Residency salaries are insufficient for making monthly loan payments on these large debts and the mounting interest, which increases the risk of defaulting on loan payments.
4. Lucrative programs that fund students pursuing primary care are lacking, which effectively discourages students from pursuing critical specialties such as family medicine, pediatrics and internal medicine.

Decreasing debt burden

A fundamental value of any educational program is access. Our current system of funding education does not meet the exponentially rising costs of attending medical school, and unnecessarily places the burden of debt at the feet of medical students. Many of these students are also entering medical school with high debt from their undergraduate programs, further exacerbating their loan debt upon graduation.

The process in deciding the cost of attendance at a university involves a complex governance arrangement set by state constitutions and local institutional boards. There should be stronger advocacy efforts to encourage the U.S. Department of Education to work at the state level to reduce the out-of-pocket cost of medical school attendance, which would in turn reduce the need to borrow and minimize the debt burden post-graduation.

In addition, students need to be protected as they navigate their existing debt. We need better programs to help borrowers understand their student loan terms and repayment options. Top priorities when funding education should include legal protection and avoidance of accumulating more debt than necessary.

Financing the costs of medical school

The nontraditional applicant has gained traction over the past five years, given the need to save prior to applying to medical school. At a state and federal level, increasing the grant aid for low- or moderate-income students and streamlining and expanding income-driven repayment plans and loan forgiveness programs could be another solution.

Lastly, colleges and universities could increase institutional grant aid and tuition waivers for low- and moderate-income students by establishing hardship funds to assist financially insecure students facing expenses they cannot pay without additional borrowing or leaving school. Along with this, there needs to be increased transparency for prospective and current medical students regarding post-graduation employment outcomes.

Regulation of government lending and spending

In the 1970s, financial aid was largely nonexistent, and most middle-income applicants did not receive money from the federal government to fund their education. It wasn’t until 1978 that Congress passed a bill known as the Middle-Income Student Assistance Act, which made all applicants regardless of their economic status eligible for subsidized loans and Pell grants.

As a result, universities raised fees, knowing that students receiving financial aid would be able to meet those increased costs.

Many state governments have reduced spending support for higher education, replacing this lost revenue with tuition hikes. Along with tuition hikes, the need for financial aid increases, and with these increased loans being delivered to medical students, so follows increasing interest rates.

The average student loan interest rate is 5.7% and 90% of all student debt is federal, leading to a vicious cycle of increased federal lending.

We need to advocate that Congress work with state governments to invest in funding education at a local level to reduce federal involvement. Establishing state programs that directly fund medical students who return to their place of training supports the community by retaining physicians, and also strengthens the local economy by reducing the debt burden of returning physicians.

Congress should also work with the Department of Education to explore solutions in regulating interest rates and instituting interest rate caps on loans. This would help reduce the length of time medical students spend paying off their loans as well as eliminate the year-to-year variability on financial aid interest rates.

Addressing the student debt crisis has been unsuccessful, in part because of the sheer magnitude of student debt the younger populations of the U.S. are currently shouldering. This is especially true for medical and graduate students.

There are a number of policy opportunities that have the potential to reduce the burden of student debt for osteopathic medical students and physicians. These include actions that could be taken both by the federal government as well as states, such as:

• Continue the current pause on payments and interest accrual, as student loan payments are scheduled to resume in May 2022. 
• Expand the Public Service Loan Forgiveness Program and GRAD Plus Program.
• Allow students to refinance loans at today’s interest rates.
• Drastically reducing interest rates on graduate student loans.
• Limiting tuition rates at public and private institutions.
• Increase grant aid and tuition waivers for low- and moderate-income students.
• Protect students as they pay down existing debt by regulating student loan services.
• Decreasing existing student debt burdens, including through state tax credits for borrowers, state-sponsored refinancing plans and loan forgiveness programs for those who enter certain professional sectors, such as health care and education.

DO Day is scheduled for April 23-27, with congressional meetings and related training taking place on the 26^th and 27^th. There are many reasons to participate in DO Day, but the opportunity to learn more about how to advocate for federal student loan forgiveness programs and discuss this issue with my members of Congress is at the top of my list.

One of the sessions in the student track on Saturday, April 23 is “Making the case for federal student loan forgiveness programs.” During this session, which is scheduled for 10:15-11:15 a.m. ET, we’ll learn about legislation that would expand opportunities for loan forgiveness and effective advocacy messaging.

For those of us participating in Congressional meetings on Wednesday, April 27, we’ll have an opportunity to talk about the impact of student debt on our health care system and ask our members of Congress to support legislation that would ease this burden.

 As students, residents and physicians of the osteopathic medical profession, it is our responsibility to make our voices heard and to advocate on legislation that affects our education and ability to choose our specialties and practice setting based on our interests, not our ability to repay our student loans.

If you need more information on the suggestions, please visit AACOM’s action center here.

Related reading:

What you need to know about student loan debt in 2021

How to finish medical school with less debt