Debt Burden


A recent study in the Journal of the American Board of Family Medicine found that 58 percent of family medicine residents have education debt of $150,000 or more and 26 percent carry debt of $250,000 or more.  And these are the family medicine residents who chose to still go into this specialty.  I would expect other residents, in other specialties, to owe a lot more. What a massive debt burden.  Think about not being in the work force for a decade while you go through college, medical school and residency and then think about starting behind the eight ball by this much money.  It is a hole from which you may never climb out.  I knew a doc would started in family medicine with $200K in debt and was even receiving loan repayment every year and 15 years later was still $200K in debt.  It’s crushing for the soul.

The researchers concluded that “policymakers should consider addressing the situation with loan repayments, small business loans and payment reform measures aimed at correcting the gap in physician payment.”  Why doesn’t anyone ever blame the government?  They started this by increasing loans, which opened the gates to colleges and medical schools to just raise tuition rates at a rate that is unaffordable (see pic above).  The answer, according these researchers, is then to address repayment and give out more loans?   If the government caused the mess then why would you think they could fix it?

We are now in a pickle and to be honest, I don’t have any great answers.  I cannot see school tuition going down unless less kids apply to these schools and they feel some fiscal pain.  Then they would have to get rid of some bloat (administrators).  One would hope.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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4 Responses

  1. Kurt says:

    It’s simple. Bust one’s rear and stay out of primary care medicine entirely.
    DPC is great for those that find the right location to set it up. Get out of training in debt, choose the wrong location and bankruptcy here you come.
    The itinerant cardiologists who provide services at our location say that every fellow has 5 or 6 lucrative offers before they get out of fellowship and they don’t want to go to commute to rural areas. The guys and gals rotate and have a 45minute to 1 hour commute to our location.
    Get inundated with uncompensateable paperwork in a standard primary care practice and watch the production go down and the unpaid time go through the roof.
    I amazed that the lambs are convinced to go to slaughter in FP residencies.
    The ivory tower boys must have really flavored the Kool-Aid nicely.

  2. Thomas D Guastavino, MD says:

    Congradulations on discovering the conspiracy. Endless government backed student loans in return for colleges agreeing with everything the government wants, including student indoctrination, and the government looking the other way as tuitions get jacked up into the stratosphere. Someday some smart attorney will file the greatest class action lawsuit in history on behalf of middle class students and families naming the government and the colleges as co-conspirators in this scam.

  3. This is the first article I’ve seen where the quoted numbers start to seem accurate. I believe the true numbers for those entering medical school this year are far grimmer.

    It used to be you got a discount going in-state. That discount for Virginia, at least, is minimal.

    Plan on $50K per year tuition which climbs to $70 – $80K for total living expenses.

    Multiply by four years. Delay payback until after residency is done.

    Assume zero debt from undergrad.

    Already, you hit the $300K mark easily.

    Add in your undergraduate debt. Try not to collapse in shock.

    The job situation for cognitive specialists: Primary Care, Endocrine, Neurology, Infectious Disease and others is good, but the pay is not.

    Don’t believe what the recruiters tell you. Your actual salary will drop in a couple of years and you will be trapped by a restrictive covenant. For heaven’s sake: Don’t buy a house. You will be moving in a couple of years no matter what.

    The higher paying fields seem to have a different problem: Good jobs are not as available. I’m seeing a lot of interventional fields bouncing around, trying to find jobs with a good patient base. Orthopedics and Urology seem like safe bets. Others are finding long term spots tough.

    At my recent Medical School Reunion, a comment was made and we all nodded in agreement: Computer Science is the new Premed. Many of us discouraged our kids from entering medicine.

    I love my job, but it gets tougher every year.

    The bottom line: Medical School is not a good investment if you have to take loans.

    If you are already wealthy and love the field: Go for it!

    Or… You can do what my practice partner and I did: Do a military scholarship. It was actually a good deal and my time was a good experience.

  4. Steve O' says:

    The problem is all across the board, and starts in high school. What is the incremental financial benefit of achieving the next measure of educational competence? Do you get a better job with a high school degree, with a college degree, BS or BA?
    Often, no. Educational institutions have little incentive to assist students in achieving employment positions when they graduate, and often, the hard-earned degree is financially transparent.
    The position is reversed from 100 years ago, in reference to India. They had a great British-style educational system, but little capacity to put the knowledge to work at home. They exported skilled professionals, or under-employed them at home.
    Now India’s booming, and America’s going backwards. People take a net financial loss going into primary care – which means the position becomes interesting only to those rare trust-fund babies who are independently wealthy at birth; or those who will accept dwindling wages to follow their dream. Should doctors be more noble, and grit through poverty to do their job? It seems to be the ‘noble path’ to bettering the community, as though a new religious order.
    When a culture works hard at making a job lousy, people will not do it – no matter how loudly the call is to be noble. The USSR ran for 75 years by calling all to nobly serve the Peasants’ and Workers’ Paradise. Now you can’t find the USSR on a map.

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