Influence of debt on medical roles studied

Medical students saddled with high tuition debt are not all chasing high-paying roles after graduation, and many are prepared to take jobs in rural areas or in general practice, a new study suggests.

Historically, medical students have shied away from careers in general practice due to perceived lower pay rates, and rural areas have struggled to recruit and retain medical professionals. A range of previous studies have made similar findings, and in response programmes such as the voluntary bonding scheme were put in place, offering financial incentives for doctors and nurses to either move to the country or work in primary care.

New research just published by University of Auckland researchers in the Journal of Primary Health Care suggests such schemes may be proving successful.

"We were surprised to see for both medical and pharmacy students an association between higher levels of [student loan] debt and a preference for rural practice," the article said.

"This is an encouraging signal that, on average, high debt levels do not deter students from a rural career."

The survey did not provide enough information to suggest why that might be, but the study’s authors had several theories.

"Among these are that students see living in a rural area or purchasing a business there as less expensive than in the city, or, in contrast to commonly held views, there may be greater financial returns associated with rural practice."

Medical Students’ Association president Jibi Kunnethedam said it was important to note the study did not indicate cause and effect, something stipulated by the authors.

"We know students from rural communities are more likely to be students for a longer period, hence having larger student loans," he said.

"These students are also the students more likely to return to rural communities to serve as doctors.

"To marry the idea of increasing student debt as a solution to shortages in the rural health workforce is rather dangerous and not the right approach to solving what is a much more complex issue that we face as a nation."

At the University of Otago annual fees range from  about  $7000 for physical education to $15,000 for dentistry or medicine.

The study’s survey of University of Auckland medical graduates found 31% had student debt of more than $90,000. The median was $67,500.

The authors warned their estimates of student debt were conservative and that their top category of $90,000-plus was open-ended.

International studies have found a connection between high student debt and graduates choosing to work in rural areas. Financial incentives were a key driver for students making that decision.

New Zealand may be following a similar trend. Of 1068 medical students surveyed, those with debt of at least $90,000 were  much more  likely to be looking for work in a rural than an urban area.

The survey defined a rural area as one with a population  under 100,000.

Similarly, pharmacy, optometry  and nursing students with the highest debt levels were favouring rural over urban job prospects.

Students were also surveyed about their degree of interest in primary health care roles, and 72% of medical students with $90,000 or greater owing on student loans had either some or strong interest in a primary health care career. Pharmacy, optometry and nursing students showed similar results.

"While the effect of student debt continues to be debated, the high debt levels in this study did not seem to have a negative effect on the preference for either a rural or primary care career for health professional students," the article said.

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