© 2006 American Thoracic Society
Total Educational Debt May Be More Important than Monthly Debt Payments on Career ChoicesFrom the Authors:We appreciate Dr. Gelbman's interest in our recent study (1). We borrowed the idea of monthly debt-to-income ratio from the home mortgage industry, which, for most physicians, is the personal loan experience most comparable to educational borrowing. United States' lenders focus more on the affordability of monthly payments (monthly home payments should not exceed 28% of gross income) than total cost of the loan, which is usually more than twice the initial principal. We decided to use a similar approach after talking with a small convenience sample of fellows: they knew the original principal amount they borrowed during medical school and their current monthly payments, but they didn't know the current principal or total cost of the loans. Dr. Gelbman raises the possibility that the fellows may be paying each month a relatively small component of their total outstanding debt burden and that the total outstanding debt, rather than the monthly payment relative to income, may impact their perceived (and actual) likelihood of pursuing an academic research–oriented career. This is indeed a possibility, but we felt that it was not possible to have a large survey obtain a high response rate with high-quality, detailed, and complex financial data assessed through multiple parameters. We agree with Dr. Gelbman that additional studies of this question, and the effects of actual and perceived debt, would be interesting and useful. We strongly encourage further research on the relationship of educational debt (estimated in different ways) and career choice in medicine. As we noted in our article, it is unknown whether the relationship between fellows' household income and current monthly debt payments is causal or in which direction the causality arrow points. We agree that it is difficult to characterize the debt burden of the one-quarter of fellows in partial or full deferment, but this does not change our main conclusion that educational debt is not a major burden for faculty at the assistant professor rank. It is conceivable that some individuals with very high debt decided not to pursue academics at the end of fellowship and are not included in our faculty sample. However, almost none of the junior faculty were deferring loan payments, and it is unlikely that many were making reduced payments 7 to 14 years after medical school. If there are second- and third-year fellows (we didn't survey first-year fellows) who are deciding against a 30-year career in academic pulmonary/critical care/neonatology because of their current tight finances, then our data show that their situation is likely to be very short lived: almost all faculty households that have educational debt are paying it off relatively easily. This suggests that barriers to an academic medicine career lie elsewhere.
University of Minnesota, Minneapolis, Minnesota
SUNY Buffalo, Buffalo, New York
University of Minnesota, Minneapolis, Minnesota FOOTNOTES Conflict of Interest Statement: None of the authors have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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