The American Association of Colleges of Osteopathic Medicine (AACOM) annually administers a voluntary survey to all graduating students in all colleges of osteopathic medicine. This survey gathers information on graduate demographics, anticipated career path, debt, and other metrics. Questions about anticipated practice location, practice population, and current level of indebtedness have remained consistent over the years; however, questions regarding loan forgiveness or repayment, or both, changed substantially from 2007 through 2016 with the addition of new answer choices to the survey, such as Public Service Loan Forgiveness (PSLF) with federal education policy adoption. We obtained deidentified data, with the permission of AACOM, from 2007, 2010, 2013, and 2016 survey results. This time frame was chosen to specifically examine not only recent data but also how specialty selection has changed longitudinally. The year 2007 also marked the first year that medical trainees could enroll in PSLF, and we were interested in how this loan forgiveness/repayment program would affect decision-making.
Responses to the following questions from 2007, 2010, 2013, and 2016 were analyzed:
To analyze the potential impact of indebtedness on the selection of a primary care specialty, respondent answers were divided into PCP or non-PCP specialty groups. As defined by AACOM, primary care comprises the disciplines of family medicine, general internal medicine, and general pediatrics.
23 Our categorizations are consistent with this definition, with the addition of geriatric medicine because most geriatricians identify as PCPs.
26 Student responses to anticipated practice type were divided into quartiles for the 4 years based on summation of undergraduate, graduate, and medical school indebtedness. Top and bottom quartiles were compared and contrasted. Those students who received loan forgiveness/repayment or tuition waivers as part of a service repayment program and graduated with a net indebtedness of $0 were included in the denominator of those with debt to capture the effect of these programs on behaviors. A separate analysis of specialty selection between individuals with top and bottom quartiles of indebtedness (excluding individuals who used a loan forgiveness/repayment program) was performed, the thought being that loan forgiveness/repayment acts as a normalizing external factor between debt extremes.
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