AMA House of Delegates

AMA meeting: AMA looks for ways to trim rising student debt

■ The Association will work to increase medical school funding, reduce tuition costs and ease students' loan repayment obligations.

By Amy Lynn Sorrel — Posted June 29, 2009

Chicago -- The American Medical Association House of Delegates took steps to help address the pressures of rising medical student debt -- an issue doctors said is critical to access to care.

The house directed the AMA to work with medical schools and other stakeholders to increase funding through state and federal scholarship and loan programs, and oppose state efforts to reduce school funding. The AMA also will promote other innovative ways to help students reduce debt -- for example, by shortening the length of training for combined residency or dual-degree programs, easing loan repayment obligations and ensuring equitable tuition increases.

"As a dean [at the State University of New York at Buffalo] I can tell you, students are coming out of medical school with $140,000 to $200,000 in debt. It is a very serious issue," said AMA Immediate Past President Nancy H. Nielsen, MD, PhD.

In addition to tuition hikes, the reauthorization of the federal Higher Education Opportunity Act and related legislation eliminated opportunities for medical graduates to defer loan repayments based on economic hardship. The AMA will study the impact of the changes, set to take effect July 1, and advocate for reversal.

Joseph Nezgoda, MD

Joseph Nezgoda, MD, chair of Pennsylvania's Resident and Fellow Section and a resident in ophthalmology, said med school debt was a big factor in his specialty choice. He sees many colleagues opting out of primary care or other specialties for the same reason. "I have about $200,000 in debt ... and I went to a public medical school," he said. He pursued his MBA degree at the same time, which added an extra year of training and costs.

Moderating students' debt obligations is key to recruiting young doctors to practice in underserved areas, said Jonathan Klein, MD, an alternate delegate for the American Academy of Pediatrics. "We need a variety of mechanisms to address disparities in the work force."

Along those lines, delegates directed the AMA to advocate for equal tax benefits in public loan repayment programs for physicians who choose to practice in state or federally designated shortage areas. The AMA also will draft legislation allowing for 100% tax deductibility of student loan interest.

In his June 15 speech at the AMA Annual Meeting, President Obama acknowledged the onus that high medical education costs place on access to care and highlighted the need to "make medical training more affordable ... so [doctors] aren't drowning in debt when they enter the work force."

Obama pointed to federal efforts to tackle the issue. The most recent federal stimulus package included a $500 million investment in the National Health Service Corps, a federal program that offers scholarships and loan reductions to medical students and physicians who commit to primary care practice in federally designated shortage areas.

AMA delegates testified that medical school debt strains students' personal, as well as professional, lives.

Because loan payments typically start during residency training, students often are forced to moonlight to pay their bills, or choose shorter residencies, delegates from the Young Physicians Section said.

When the federal hardship deferment option went away, Dr. Nezgoda had to restructure his outstanding debt. "The day that happened, all my credit cards got canceled," he said. "Now, if I want to open a practice or buy a house, who knows what that's going to do to my credit?"

ADDITIONAL INFORMATION

Meeting notes: Other actions

Issue: Significant work-force shortages across multiple specialties persist.
Proposed action: Ensure that actions to bolster the physician work force are part of any comprehensive federal health system reform proposal. Work to expand graduate medical education slots and rescind related caps to respond to projected access-to-care needs. [Adopted]

Issue: There are some similarities between allopathic and osteopathic medical education systems.
Proposed action: A report calls for collaboration between MDs and DOs and exploring opportunities to align relevant medical education and training practices. [Adopted]

Issue: The Accreditation Council for Continuing Medical Education continues to impose additional requirements and increased fees on CME providers.
Proposed action: Study the impact of new accreditation criteria to determine whether it adds value or could reduce access to local CME providers who cannot afford to comply. Urge the ACCME to reconsider proposed fee increases. [Adopted]

New AMA leadership
Texas cardiologist J. James Rohack, MD, was inaugurated as president. Florida internist Cecil B. Wilson, MD, was named president-elect. Elected to the Board of Trustees were Missouri family physician David O. Barbe, MD; Wisconsin plastic surgery resident Raj Ambay, MD, DDS, as resident/fellow member; and Ohio State University medical student Justin B. Mahida as medical student member. Re-elected to the board were Colorado psychiatrist Jeremy A. Lazarus, MD, as speaker of the house; Pennsylvania hand surgeon Andrew W. Gurman, MD, as vice speaker; Kentucky internist and infectious disease specialist Ardis Dee Hoven, MD, as chair-elect; and Virginia reproductive endocrinologist and obstetrician-gynecologist Robert M. Wah, MD. The new board chair is California anesthesiologist and pain management specialist Rebecca J. Patchin, MD.