Although it takes a certain amount of passion for one to be a doctor, prospective doctors do not, and cannot, remain untouched by financial motivations.

Over the last 30 years, the US has seen an almost threefold increase in tuition fees for private medical schools. Prospective doctors in public medical schools fare worse, bearing tuition fees that has quadrupled.

These increases that drastically outpace the inflation rates. Within that time, the average student debt at graduation increased from USD $25,000 to USD $166,750, as salaries for resident physicians remained stagnant. Even physicians’ salaries have been declining.

Financial pressure felt since medical school

A survey of medical students at US News and World Report’s top 10 ranked private and public US medical schools was conducted, with 812 of the 3,752 students surveyed responded.
The survey revealed that 6% of first- and second-year students had stopped pursuing certain medical specialties based on their projected income as physicians. This percentage increased to 43.3% for third- and fourth-year students.

Moreover, 17.5% of third- and fourth-year students indicated that they felt medical school was a poor financial investment, compared to 6% of first- and second-year students.
Clearly, financial worries begin in medical school; as medical students advance through their medical training, the financial pressure increases.

After leaving medical school, those who want to become board-certified must pick up experience as residents. However, these do not offer good pay in exchange for hectic work schedules. By the time medical students become full-fledged physicians, they bear great financial burden in addition to other potential stressors, which eventually pave the way towards burnout.

There is a strong link between debt and depression and suicidal behaviours, according to results gathered from over 65 studies worldwide. The analysis found that individuals struggling with debt are nearly three times more likely to be depressed and almost six times more likely to have attempted or completed suicide.

Physician burnout causes standards of patient care to suffer

Heavy debts for physicians mean bad news not only to themselves, but also to their patients. In a study which surveyed 16,394 internal medicine residents in the US in 2008 to 2009, it was discovered that prospective doctors with more than USD $200,000 in debt had mean scores that were 5% lower than debt-free colleagues on a standardised exam.

Clearly, heavy student debts impact the ability to learn, due to higher levels of burnout. This would translate directly to physicians lacking in medical knowledge and having poorer standards of patient care.

"Physician well-being is extremely important for the physician, but also for patients," said general internist and biostatistician Colin West, MD, PhD, co-director of the Mayo Department of Medicine Program who supervised the study.

Interestingly, rather than the amount of debt per se, a medical student’s subjective financial strain was a stronger predictor of burnout, concludes a study of over 260 radiology residents.

Hence, one way to prevent finance-related physician burnout, short of capping tuition fees, increasing pay and federal funding, would be to have better financial counselling programmes for pre-medical students. This will help guide their choices as to which medical schools and programmes they can apply to.

"We hope that now that we have established national numbers for these distress variables, we can perhaps focus less effort on documenting the problem and turn greater attention to how best to improve the situation," said West. MIMS

Read more:
5 warning signs physicians could be heading towards burnout
Given a choice, would you choose medicine all over again?
Britain’s trainee medical professionals at risk of burnout