The AAOS Office of Government Relations (OGR) recently joined 15 other medical specialties in expressing support for legislation to provide student loan relief for interns and residents. The bill (H.R. 5734), introduced by Rep. Brian Babin, DDS (R-Texas), would allow interest-free deferment on student loans for borrowers serving in a medical or dental internship or residency program.

At the time of graduation, many orthopaedic interns and residents have accrued considerable debt. According to studies published in the journal Orthopedics, student loan debt for graduating medical students continues to rise due to yearly tuition increases. One study found that medical education debt exceeded $100,000 for 48 percent of the orthopaedic residents surveyed (postgraduate years 1–5). According to the National Center for Education Statistics, the average medical student debt for graduates in 2015 was $176,348. The authors concluded that debt not only affects orthopaedic interns and residents financially but also may cause stress and hinder their medical training.

“The cost of graduate-level medical education is substantial for the vast majority of students,” said AAOS Council on Advocacy Chairman Wilford K. Gibson, MD. “And those who undertake several additional years of residency are facing very low pay for that time period. Couple low pay with student loan debt, and the burden is significant.”

Debt also can influence intern and residents’ lifestyle choices. Medical Education Online reported that students with higher aggregate amounts of medical student loan debt were more likely to delay getting married, and many said they may not have chosen to become a physician if given the opportunity to revisit the choice. Increases in both aggregate and relative debt also were associated with delays having children or buying a house. In addition, many residents said they worry about how to manage their debt and noted that it would influence their choice of specialty.

Medical school graduates who undertake several years of internship and residency with very low pay often are unable to begin repaying student debt immediately. As a result, they qualify to halt payments during residency through deferment or forbearance processes; however, interest continues to accrue and is added to the loan balance. Rep. Babin’s bill, the Resident Education Deferred Interest Act (REDI Act), is an important part of student loan repayment reform. It would save physicians and dentists in internship or residency thousands of dollars in interest. Relief from interest accrual during residency also would make opening practices in underserved areas or entering faculty or research more attractive and affordable.

“Student loan debt can be a significant source of stress for all residents, especially those in longer training programs such as orthopaedic surgery. The 75 percent of us who carry education debt upon graduating medical school watch our loan burden multiply during residency due to the continued accrual of interest,” explained Kevin Cronin, MD, chair of the AAOS Resident Assembly Health Policy Committee. “Carrying a so-called ‘second mortgage’ may affect some residents’ decisions to practice in underserved areas, pursue a career in academic medicine, or volunteer. The REDI Act would provide my colleagues and me with much-needed relief. I am one of the many residents who have large student loan bills from undergraduate medical training, and it is reassuring to know that AAOS is supporting efforts for student loan relief through support of this legislation.”

Additionally, AAOS joined the Pediatric Orthopaedic Society of North America and numerous other medical specialties in supporting the Ensuring Children’s Access to Specialty Care Act (H.R.3767, S.989), which would modify the National Health Service Corps loan repayment program to allow pediatric subspecialists working in underserved areas to participate. This legislation recognizes the serious shortages that exist in pediatric subspecialties and would give the Health Resources and Services Administration the ability to begin to address them in a meaningful way.

The OGR is actively working with stakeholders to advocate for passage of both pieces of legislation.

Julia Williams is a senior manager in the AAOS OGR. She can be reached at jwilliams@aaos.org.

References:

1. Hwang JS, Beebe KS, Benevenia J, et al: Financial debt of orthopedic residents. Orthopedics 2012;35:e549-54.
2. Johnson JP, Cassidy DB, Tofte JN, et al: Orthopedic surgery resident debt load and its effect on career choice. Orthopedics 2016;39:e438-43.
3. Rohlfing J, Navarro R, Maniya OZ, et al: Medical student debt and major life choices other than specialty. Medical Education Online 2014;19:25603.