Educational debt and reported career plans among internal medicine residents

Background: Physicians often enter the workplace with substantial debt. The relationship between debt and reported career plans among internal medicine residents is unknown. Objective: To determine distributions of educational debt among internal medicine residents and associations of debt with reported career plans. Design: Cross-sectional survey using data from the annual Internal Medicine In-Training Examination Residents Questionnaire completed by U.S. categorical internal medicine residents. Setting: Categorical internal medicine residencies in the United States. Participants: 22 563 residents in their third (final) year of residency, representing 74.1% of all eligible U.S. categorical internal medicine residents from 2003 through 2007. Measurements: Distributions of educational debt were tabulated. Proportions of residents choosing career plans were calculated for various levels of debt. Results: International medical graduates represented 48.7% of the cross section and had considerably less debt than U.S. medical graduates: 53.8% of U.S. medical graduates had debt of $100 000 or greater and 60.2% of international medical graduates had none. U.S. medical graduates with debt of $100 000 to $150 000 were less likely than those with no debt to choose a subspecialty career (57.5% vs. 63.5%). U.S. medical graduates with debt of $50 000 to $99 999 were more likely than those with no debt to choose a hospitalist career (8.5% vs. 6.2%), and this preference increased with increasing debt level (10.0% for those with >$150 000 debt). These associations are more pronounced for U.S. medical graduates than for international medical graduates. Limitation: The study addressed total educational debt, but not when it was incurred, and did not allow inferences related to causality. Conclusion: Educational debt is associated with differences in reported career plans among internal medicine residents.