Columbia University Medical Center

High Debt Load by Medical Students: African-Americans Most Affected

Male African-American medical studentThe cost of a medical education in the United States has been on the rise over the past 10 years. However, given racial and ethnic inequalities in access to financial resources, increases in the student debt burden may not be assumed equally. To evaluate the issue, researchers at the Mailman School of Public Health analyzed data from a sample of over 2 percent of the U.S. medical students enrolled at 111 accredited American medical schools.

In the sample of 2,355 medical students in 2010–2011, 62.1 percent of the medical students overall and 65 percent of white students anticipated debt above the $150,000 threshold. A greater portion of black students—77.3 percent—anticipated owing more than $150,000. Asian students, at 50.2 percent, expected the lowest levels of debt, and a slightly higher rate of Hispanics/Latinos—57.2 percent—predicted having debt in excess of $150,000. Results were weighted by race and class year.

The study was published online in the journal PLOS ONE.

“The finding that black medical students had significantly higher anticipated debt than Asian students has implications for understanding differential enrollment among minority groups in U.S. medical schools,” according to senior author Sandro Galea, MD, DrPH, Gelman Professor and chair of the Department of Epidemiology at the Mailman School of Public Health.

Since 2004, the percentage of black enrollment in medical schools has fallen, particularly in osteopathic schools. Meanwhile, enrollment of Hispanic and Asian students continues to rise. For 2010–2011, 60 percent of medical school students were white, compared with 21 percent Asian, 7 percent Hispanic/Latin, and 6 percent black.  Compared with the overall U.S. population, Asian students are overrepresented in the medical student population by more than 75 percent, while black students are underrepresented by more than 100 percent.

Unique to this analysis, the researchers included data from both allopathic—or mainstream medical practice—and osteopathic institutions. “This is uncommon in studies about medical student debt but better reflects the total population of students entering the physician workforce,” said to Robert A. Dugger, MD, MPH, study author and a former research associate at the Mailman School of Public Health, who is currently a psychiatry resident at North Shore-Long Island Jewish Hospital. “As concern over the physician supply grows, more investigation into the influence of medical education cost on the physician supply is needed,” he said.

Less Debt Anticipated by Hispanic and Asian Students

Disparities in medical student debt burden generally correlated with racial and ethnic disparities in income, although there was a significant exception. Hispanic medical students experienced comparatively low anticipated educational debt, yet they have among the lowest median incomes in the U.S.  Asian medical students, like their Hispanic counterparts, also had low anticipated educational debt; both groups of students are likely to come from immigrant households.

“It is plausible that immigrant families may be less comfortable with the American norm of educational loan utilization than non-immigrant families,” said co-author Dr. Abdulrahman El-Sayed, a fellow in the Mailman School Department of Epidemiology and medical student at Columbia’s College Physicians and Surgeons. “At the same time, they may be more willing to offset the costs of their children’s graduate education.”

The paper underscores that experts have been tracking the high cost of medical education for some time and, in particular, its effect on qualified black and Hispanic applicants. The higher anticipated debt among black compared with Hispanic students that this research revealed may explain, in part, why matriculation among blacks is decreasing that matriculation among Hispanics is increasing.

High medical student debt is known to frustrate efforts to create a diverse and representative physician workforce. “Our work suggests that the burden of medical student debt is substantial, and that the distribution of debt across race and ethnicity is disproportionate. With black students reporting higher debt burdens than their counterparts from other racial and ethnic backgrounds, it is plausible that this disproportionate debt burden may play a role in the relative decline in medical school attendance among black students,” said Dr. Galea.

This article originally appeared on the Mailman School of Public Health website.

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