These are unsettling times for would-be physicians. By the time most doctors hang out their shingles, they have incurred an average of $55,859 in debts (box). Unlike previous generations, who could at least look forward to professional autonomy and handsome incomes, medical students today worry about downward mobility. “If I had to do it over again, I don’t think I’d choose medicine,” says Feoktist Orloff, a third-year student at UCLA’s medical school. “You go through a lot, you put up with a lot, then you get out and the future is totally unpredictable.” Some school administrators worry that qualified people will be scared away. “There has to be security and a reasonable wage compared to other professionals,” says Dr. Steven Abramson, an associate dean at New York University School of Medicine.
Faced with the inevitable, some students and school officials are saying that health-care reform is actually a boon to medical education. Applications had dropped off in the mid-1980s-a reflection of the values of those highflying times. This year some 43,000 people applied to medical school-a record. “We’re in a rebound now, in part because this is a more idealistic group of students,” says Dr. Fredric D. Burg, vice dean for education at Penn’s medical school. “I’d love to see [reform] done in a manner that facilitates the idealism of the people who will be part of that system in the year 2000.” Plenty of medical students say that they welcome reform-whatever the cost. “Everyone was telling me, ‘Don’t go into medicine if you want to make any money’,” says Chap Attwell, a first-year student at Baylor College of Medicine in Houston. “But that’s not why I wanted to go into medicine. I can’t see myself doing anything else.”
Clinton’s plan will call for a greater emphasis on primary care. Yet at the moment, programs provide scant opportunity for students to study family practice; most professors are themselves subspecialists. Schools are thinking about ways to introduce a greater primary-care orientation into the curriculum. But this year, about 85 percent of all medical students chose lucrative specialties-partly so they could pay off their loans more quickly. Medical educators warn that unless the Clinton plan factors in student debt, promising young doctors will be less likely to go into primary care. Though it seems unlikely, students say that they wish the president would expand existing national-service programs that allow medical graduates to pay off some debt by working in underserved parts of the country. That is one prescription that might promote the well-being of indebted doctors and patients alike.
The median cost of four years at a private medical school is expected to be $79,160 for the graduating class of ‘95. At public institutions, local students will pay $27,500; out-of-staters can expect $62,572 in tuition and fees.
Median debt owed by medical-school seniors with student loans: $50,000.
Average stipend for three years of residency: $28,618 for the first year, rising to $31,795 by the third.
Average stipend for additional years of training: $33,409 for the fourth year; about 4 percent more per year thereafter.
