TRENDS ALONG THE DEBT-INCOME AXIS - IMPLICATIONS FOR MEDICAL-STUDENTSSELECTIONS OF FAMILY-PRACTICE CAREERS

Purpose. To examine whether medical students' levels of debt have an i nfluence on selection of family practice careers, independent of other factors. Method. Data from the Jefferson Longitudinal Study were anal yzed for 1,350 graduates from the classes of 1987-1993 at Jefferson Me dical College of Thomas Jefferson University; a focused analysis for 3 26 graduates from the classes of 1992 and 1993 was specifically perfor med to identify recent trends. A binary logistic regression equation w as used to predict the probability of a graduate's entrance into a fam ily practice residency based on first-year preference for family pract ice, income expectation, debt level, age, and gender. Results. A high level of indebtedness (at least $75,000) was a significant independent predictor of specialty choice (away from family practice); first-year preference for family practice and income expectation were also signi ficant independent predictors. Combining these three factors (debt, sp ecialty preference, and income expectation) led to a greater than 12-f old difference in specialty selection of family practice. Notably, 36% of the students graduating in 1992-1993 had debts of at least $75,000 , more than three times the percentage in the classes graduating in 19 87-1989. Conclusion. High levels of debt had a significant negative ef fect on family practice specialty choice among recent Jefferson gradua tes. An increase in the number of students with such debt carries stro ng implications for the selection of careers in family practice.