Student debt, Parkinson's disease and neurological care: an Impending crisis
Who is Abhimanyu Mahajan?
Abhimanyu Mahajan, MD, MHS is a movement disorders neurologist. After medical school, Dr. Mahajan obtained a Masters in Epidemiology with a concentration in aging at the Johns Hopkins Bloomberg School of Public Health and a certificate in gerontology from the Johns Hopkins Center of Aging and Health in Baltimore, MD. He completed his Neurology residency at Henry Ford Hospital in Detroit and Movement disorders fellowship at the University of Cincinnati. He works at Rush University in Chicago.
Is my doctor in debt and why does it matter?
Three out of four doctors who graduated from medical school in 2020, graduated with debt. Among those, the mean educational debt was around $200,000 and this number has been increasing every year. In addition to the total amount, disparities in debt have worsened.(1) The number of student graduating with debt has reduced (from 82% to 69%) but nearly a quarter of students graduate with debt greater than $200,000.(2) This discourages those students who are financially disadvantaged from pursuing and practicing medicine.
The NY times recently ran an article on student debt in medicine.
Does this affect their choice to be a neurologist?
Neurologists, especially those who see persons with Parkinson’s disease and other movement disorders, and those at academic centers, are among specialists with a lower pay.(3) Medical students with a debt of more than $150,000 are more likely to choose higher paying specialty, with nearly a third making that decision as late as final year of medical school.(4) Not surprisingly, those clinicians who choose neurology often have to face lower salary expectations.(3)
Time magazine recently reviewed the perils of debt.
Is my neurologist more “burned out” out because of this?
During training, those clinicians with higher debt report a worse quality of life and lower satisfaction with work-life balance.(5) In addition to their rigorous training, these doctors are perhaps more likely to pursue supplementary sources of income, which may affect their training. Higher debt may lead to greater pessimism, emotional exhaustion and other symptoms of burnout.(6) It influences the timing of personal decisions such as marriage, children and buying a house.(7) It is conceivable that these issues may spill over in to the care they provide at work.
Boston Globe recently did a piece on being burned out.
Does this affect our path to a cure?
Research in Parkinson’s disease is largely carried out at academic centers— which offer a lower salary.(8) Student debt heavily influences a doctor’s decision to work at such a center. Over half the neurologists who choose jobs outside of academic centers may reconsider— if a mechanism existed to help with their student loans.(9) We need neurologists to invest more time and energy in to researching Parkinson’s disease care and possible treatments.
How does this affect clinical care in Parkinson’s
disease?
There are more than 1 million Americans living with Parkinson’s disease, and this number is expected to substantially increase in the coming years. There are an estimated 572/ 100,000 people over the age of 45 years, living with Parkinson’s disease.(10) And this number does not include those people that are unable to see a neurologist. Per available estimates, there are only 5 neurologists/ 100,000 people in the U.S.(11) This presents a daunting gap in healthcare. We need more doctors and need more of them choosing neurology as a specialty. High student debt makes realizing that goal a real challenge and must be pro-actively addressed.(12)
To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside
He also serves as the Medical Advisor for the Parkinson’s Foundation.
To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.
The blog artist is Jonny Acheson.
Selected References
1. AAMC. Medical Student Education: Debt, Costs, and Loan Repayment Fact Card for the Class of 2020 2020. Available from: https://store.aamc.org/downloadable/download/sample/sample_id/374/.
2. Grischkan J, George BP, Chaiyachati K, Friedman AB, Dorsey ER, Asch DA. Distribution of Medical Education Debt by Specialty, 2010-2016. JAMA internal medicine. 2017;177(10):1532-5.
3. Gutmann L, Cahill C, Jordan JT. Characteristics of graduating US allopathic medical students pursuing a career in neurology. 2019;92(17):e2051-e63.
4. Grayson MS, Newton DA, Thompson LF. Payback time: the associations of debt and income with medical student career choice. Medical education. 2012;46(10):983-91.
5. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. Jama. 2011;306(9):952-60.
6. Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Annals of internal medicine. 2002;136(5):384-90.
7. Rohlfing J, Navarro R, Maniya OZ, Hughes BD, Rogalsky DK. Medical student debt and major life choices other than specialty. Medical education online. 2014;19:25603.
8. AAN. Neurology Compensation and Productivity Report: 2019 Executive Summary 2020 [cited May 29, 2021]. Available from: https://www.aan.com/siteassets/home-page/tools-and-resources/practicing-neurologist--administrators/benchmarking-data/neurology-compensation--productivity/19-neurocompprod-execsummary-v307.pdf.
9. Doherty MJ, Schneider AT, Tirschwell DL. Will neurology residents with large student loan debts become academicians? Neurology. 2002;58(3):495-7.
10. Marras C, Beck JC. Prevalence of Parkinson's disease across North America. 2018;4:21.
11. Sacco RL. Neurology: Challenges, opportunities, and the way forward. Neurology. 2019;93(21):911-8.
12. Mahajan A, Davalos L, Schneider L, Bailey M, Khan J, London Z. The impact of student debt on neurological practice. Journal of the neurological sciences. 2021;427:117536.