Student Loan Burden and Its Impact on Career Decisions in Dermatology
Dermatology departments in the United States face difficulties in recruiting dermatologists to academic positions, raising concerns for the future of dermatology education and research. This preliminary study aimed to explore the impact of student loan burden on career plans in dermatology and to determine if the Public Service Loan Forgiveness (PSLF) program can be used as a recruitment tool for academic positions in dermatology. Results from this electronic survey, which was distributed to dermatology residents and attending physicians, revealed that debt burden may influence career decisions in dermatology. Dermatologists may not be fully educated on loan repayment options. With increased awareness, the PSLF can potentially be used as a recruitment tool for academic positions in dermatology.
Practice Points
- Academic dermatology departments are facing challenges in recruiting physicians, raising concerns for the future of dermatology education and research.
- Large amounts of student loan burden may influence career plans in dermatology.
- Dermatologists may not be fully knowledgeable of loan repayment options; thus, education on this topic should be prioritized by dermatology training programs.
Comparison of Respondents Interested in Careers in Academia vs Private Practice
There were differences in financial circumstances between respondents interested in academia versus those interested in private practice. Compared to respondents interested in academia, those interested in private practice were more likely to have more than $200,000 in student loan debt (24 [53.3%] vs 6 [24.0%]; P<.05), have more than half of their education paid with student loans (38 [84.4%] vs 15 [60.0%]; P<.05), and state that student debt affected their career goals (28 [62.2%] vs 3 [12.0%]; P<.001)(Table 3). Demographic characteristics including gender, marital status, parental status, and current annual household income were not associated with a specific career goal.
Subgroup analysis was performed on respondents who were initially interested in academic careers but subsequently decided to pursue private practice (n=15).
Residency program experience also may influence career trajectory. The majority (n=41 [58.6%]) of respondents indicated that their residency program experience affected their dermatology career goals. Of those, 41.7% and 58.5% stated that their residency program experiences dissuaded and persuaded them into academic positions, respectively. Those interested in academic dermatology were more likely to state that their residency program experience influenced their career goals (80.0% [20/25] vs 46.7% [21/45]; P<.05). Furthermore, those interested in academic positions responded with higher overall residency program satisfaction ratings on a scale of 1 to 10 (1 indicated the lowest satisfaction) than those interested in private practice, but the difference was not significant (mean [SD] score, 8.2 [2.3] vs 7.2 [1.9]; P=.07).
Respondents were asked to rate their interest in the following dermatology-related professional interests on a scale of 1 to 5 (1 indicated the least enjoyment): medical dermatology, dermatologic surgery, dermatopathology, cosmetics, and lasers. Those interested in private practice versus those interested in academic dermatology found more enjoyment in dermatologic surgery (mean [SD] score, 4.0 [0.8] vs 3.4 [1.3]; P<.05), cosmetics (3.4 [1.2] vs 2.6 [1.4]; P<.05), and lasers (3.7 [1.0] vs 2.8 [1.2]; P<.05)(Table 4).
Respondents also were asked to select primary motivating factors for their career goals (ie, academia or private practice) and to indicate reasons for not choosing the alternative. The majority of those pursuing academia were motivated by opportunities to collaborate with colleagues (23 [92.0%]), teach and mentor (20 [80%]), and manage complex cases (17 [68.0%]). Most of the respondents who were pursing private practice were motivated by focus on patient care and clinician duties (36 [80.0%]), flexible work hours (35 [77.8%]), higher income (33 [73.3%]), and location flexibility (29 [64.4%]). Among those interested in academic dermatology, the top factors for disinterest in private practice were running a business (9 [36.0%]) and high patient turnover (9 [36.0%]). Most of those interested in private practice indicated that they were not interested in an academic position because of lower income (31 [68.9%]) and research duties (31 [68.9%])(Table 5).
Awareness of and Attitudes Toward the PSLF Program
The majority of respondents were aware of PSLF (53 [75.7%]); however, only 1 respondent endorsed current plans to use PSLF for loan repayment. Respondents were asked how likely they would be to pursue an academic position if given the option to have their student loans forgiven by the PSLF program. Overall, 44.6% (n=25) of respondents indicated that this option would have no effect or would unlikely convince them to pursue an academic position, and 55.4% (n=31) of respondents indicated that they were somewhat likely, likely, or very likely to pursue academia if PSLF was an option. Of those who stated that they would consider enrolling in PSLF, 64.5% (20/31) of individuals were pursuing careers in private practice. Neither current student loan burden nor career goal was associated with likelihood of enrolling in the PSLF.
