The road to becoming a doctor in this country is full of obstacles. The most formidable roadblock is the financial costs of tuition and preparing to become competitive for admissions.
For instance, until February, when I became eligible for Public Service Loan Forgiveness, my loans totaled $339,529.66. (PSLF is an income-driven loan forgiveness program for professionals who work for government and/or not-for-profit organizations.) This amount doesn’t include the more than $250,000 that my family paid out of pocket and with private loans to send me to Yale for my undergraduate education because we didn’t qualify for financial aid. That is a steep financial curve for anyone to overcome.
The Biden Administration’s initial plan to forgive student debt was struck down by the Supreme Court. But, if the federal government can offer Paycheck Protection Plan loan forgiveness for businesses and bail out large banks, then it can also stimulate the economy by offering additional avenues for student debt forgiveness — which also happens to be a very effective way to ensure diversity in higher education and the medical field.
Black students graduate college with $25,000 more in student loans than their white counterparts, resulting in Black graduates owing on average of 188 percent more in loans than their white peers four years after graduation. When a significant amount of your income goes to student loan payments, there is less left to spend on a mortgage, start a family, or send your own children to school.
The weight of student loan debt is further exacerbated by race-based income discrepancies. According to a 2021 Forbes article, Black Americans earn 30 percent less than white Americans as a result of being overrepresented in lower paying jobs. In addition to having fewer opportunities to pursue higher paying jobs, Blacks get paid less than their white counterparts who do the same jobs with the same qualifications. For instance, according to the Society for Human Resource Management, Black men earn 87 cents for each dollar earned by white men with equal qualifications. Not surprisingly, the pay gap is worse for Black women who only earn 63 cents for each dollar paid to white men for the same work. Compounding factors such as disproportionate amounts of student debt, decreased access to high paying jobs, and inequitable pay for the same work puts Black college graduates at a disadvantage. This leads to fewer Black students in college, less disposable income, and an inability to close the generational racial wealth gap.
Each year, financially inexperienced teenagers are saddled with the decision to acquire debt to attend college. According to a 2021 article in the Journal of College Access, 54 percent of first-generation college students are racial minorities. These students are more likely to be from lower-income homes, as college graduates make 84 percent more than those who only hold a high school diploma. They by definition cannot rely on their parents’ personal experience to help them to navigate the college application and student debt process. As a result, these students may be deterred from applying to more costly schools at which they could be academically competitive — and these higher learning institutions lose the benefit of the racial and socioeconomic diversity that these students offer. In the worst case scenario, such students may feel that they can’t attend college at all.
These problems don’t end after obtaining a bachelor’s degree. Students who could become brilliant lawyers or physicians may make other plans due to the high cost of a professional degree. The Journal of Blacks in Higher Education recently showed that 95.5 percent of Black medical residents have some form of debt, more than any other racial group. Furthermore, the American Medical Association shows an inverse relationship between the amount of educational debt and the intent to enter primary care. Primary care fields often pay less than other medical specialties. Fewer Black doctors in primary care leads to worse health outcomes for all patients. As a result, student debt lowers diversity at higher learning institutions and in life-saving medical specialties.
What is to be done? Schools can ease student debt by making tuition free for lower income students. For example, Princeton offers free tuition for students whose families make less than $75,000 a year, and families who make up to $100,000 a year contribute at most 10 percent of their income.
The government should expand its definition of primary-care medical specialties, which currently only includes internal medicine, family medicine, pediatrics and geriatrics. This expansion would make emergency medicine physicians eligible for National Health Service Corps loan forgiveness, a program currently only available to primary care specialties. It could also decrease the number of unfilled emergency medicine residency spots, which sat at an unprecedented 555 as of March of this year.
Some income-driven repayment plans require 20 to 25 years of repayment. This should be decreased based on factors such as public sector work, income, location of practice, the decision to buy a home, start a small business, or the need to care for children/elderly family members.
The road to equity in higher learning institutions and competitive careers requires a multifaceted approach from private and public institutions. This is even more crucial as state and federal governments retract diversity, equity, and inclusion programs and the ability to use race as one of the many variables in admissions. Student debt relief will play a key role in providing equitable access to higher learning for all students.
Katrina Gipson, MD, MPH is an assistant professor of Emergency Medicine at Emory University School of Medicine. She practices at Grady Memorial Hospital and is a thought leader in health advocacy as a Public Voices Fellow of Academy Health in partnership with The OpEd Project.