The shortage of doctors in the US after COVID is creating a health care crisis lurking

The U.S. healthcare industry is poised to boom over the next decade, but that doesn’t mean its workers will reap many benefits. Even doctors are not safe from the weight of debt anymore. Consider Julian Hirschbaum, a fifth-year resident in internal medicine and pediatrics at the University of Southern California Medical Center in Los Angeles and regional vice president of the Southern California Intern and Resident Committee with the feds SEIU workers.

“I owe $200,000 in student loans and that’s just medical school,” he told The Daily Beast. “On a personal note, it’s something you think about every day. It adds to the stress you may experience when trying to do your best to care for a patient. It affects you when you pay your rent at the end of the month. It affected when I was able to get married and affected my ability to buy a home.”

Hirschbaum works at a safety net hospital in Los Angeles, and he explains that signing up for student loan forgiveness programs isn’t easy — even for a needy employee like himself. “Before my residency, I applied to an organization called the National Health Service Corps.” I said. “One or two students out of the 150 that I joined were able to get that scholarship.”

The US was already facing a shortage of healthcare workers before COVID-19, but the problem has become more severe. When the pandemic hit, the country maintained its health care system by hire a doctor and nurse from all over the world, especially from countries like India, Pakistan and Philippines.

What the country failed to do, however, is turn the crisis into an opportunity to reform the student loan system, which has left healthcare workers in debt and continues to become barriers for many people who want to pursue a career in medicine.

In 2013, the Journal of Ethics of the American Medical Association found that the average debt burden of medical students is $161,290. Much of this debt is due to the potential costs that cause new doctors to start over time, such as compound interest, licensing and maintenance costs, and board exam fees.

As of 2020, that number has grown to an average debt level of $207,003according to the Association of American Medical Colleges.

Nothing particularly surprising. The average cost for four years of medical school in 2021 is $259,347 at a public school and $346,955 at a private institution. Many students have to take out a loan to cover their residence and relocation costs, which amounts to about $12,000 per person.

In other departments of health care, dental school graduates have average out of debt $304,834. For nurses, who often face the same stressors as doctors on much lower salaries, it’s $57,600 student loan debt. Nurses pursuing a PhD can accumulate more than $100,000 in debt.

Bryan Hansberger, a clinical psychologist based in Wellesley, Massachusetts, told The Daily Beast that hospitals are rife with trauma. Doctors are taught coping mechanisms to help them block their emotions and do their jobs well. However, the COVID-19 pandemic has added additional stressors that have pushed these coping strategies to their limits.

Finances, already a major source of stress for people in the United States, add to the burden on health care workers and accelerate burnout, or contribute to negative effects on health such as anxiety or gastrointestinal problems. ONE Research 2020 via Local and regional anesthesia found that one in three healthcare workers faced burnout. Student debt is even thought to be a contributing factor increase in suicides among doctors.

“Financial stress changes the decision calculation in someone’s head,” says Hansberger. A person must weigh every decision about how they spend their money. There is an increase in symptoms of depression and anxiety, and trouble sleeping in some situations. “

Cindy Zolnierek, CEO of the Texas Nurses Association, had a nursing career 40 years ago when the cost of nursing training rose to the levels we are seeing today. She was fortunate enough to have her student loan debt forgiven, and later landed an internship to pay for her master’s degree in mental health nursing from Wayne State University. But she told The Daily Beast that she doesn’t see a great future for nursing unless people can go to school without taking on the huge debt that will cost them years – perhaps decades. century – pay off.

Many nurses don’t retire as soon as they want, Zolnierek said. They are forced to work overtime or choose jobs with higher wages. In her experience, almost every nurse has considered contracts with travelers because these contracts can be very lucrative. The tourist nursing contract is agree among licensed nurses, agencies and hospitals looking to meet a specific need, such as parental leave or the retirement of an experienced nurse. The wage for these contracts can be from $44,000 to $100,000.

Nurses can apply for special loan repayment programs such as Nurse Corps loan repayment program and National Health Corps loan repayment program if they work in underserved areas, but nurses may not always be aware of their options and may simply choose larger cities by default. “We have a nursing shortage reduction program that has been cut every two years since 2009,” says Zolnierek. “That program gives schools money to increase production of nurses and them. could use that money to provide nurses to award scholarships to students.”

The same goes for the doctors themselves. Daniel Derksen, a professor of public health, medicine and nursing at the University of Arizona, told The Daily Beast he has seen doctors in his state flock to places like Phoenix and Tucson in large numbers. where wages are higher. In these metropolitan areas, residents and doctors are able to find more reliable employment and allow doctors to pay off student loans and other goals they have deferred during their studies. , such as getting married or buying a house.

On the other hand, this has created a shortage of doctors in rural and underserved areas of the state. “We have certainly seen this protracted pandemic strain existing health infrastructure in rural areas,” Derksen said.

And the high costs of entering the health industry have hampered efforts to diversify healthcare. About 75 percent of medical school students in the United States from the two highest income brackets. In his home state of Arizona, Derksen said he has witnessed how Black, Latino and Native American students are barred from studying medicine because of the cost of it.

Dexter Samuels, executive director of the Center for Health Policy at Meharry Medical College, told The Daily Beast he has seen a similar situation unfold in Nashville, where the school is based. . Students were surprised at the unusually high cost of living in a southern city.

“The number one issue our students are dealing with is the financial pressure to pay for education. The other issue we’re having is the cost of living in Nashville,” said Samuels. “All students often choose careers based on compensation versus their passion.” He has tracked several graduates with more than $400,000 in student debt.

Vanderbilt University Medical Center

Vineet Arora, dean of medical education at the University of Chicago’s Pritzker School of Medicine, has witnessed this barrier first-hand as a first-generation immigrant from India. Although medical school isn’t as expensive now as it was when she was a student 28 years ago, she still has to take out loans, apply for scholarships and work part-time jobs to make ends meet.

“First day at Washington University School of Medicine in St. Louis, they asked everyone who needed financial support to stay in class,” said Arora. “I was shocked when it felt like half the students got up and left.” She also handles unforeseen expenses. “I had to buy a car for my third year to rotate. I know a lot of people, myself included, who have exhausted their credit cards.”

Barriers to diversity don’t simply create obstacles for future doctors — they also promote worse health care for patients who may be missing out. Get treatment from providers who understand their struggles or who can communicate with them in their native language. US Department of Health and Human Services 2017 report show that All ethnic minorities, with the exception of Asians, are underrepresented in health care practices related to the treatment and diagnosis of health conditions.

And patients are taking on medical student debt in other ways, too. Eli Perencevich, professor of Internal Medicine at Iowa Carver College of Medicine, points out that the high costs also keep students from entering specialties that may not pay as well as other specialties.

As a student, Perencevich studied infectious diseases, one of the lowest-paying specialties in medicine (an astonishing fact that serious infectious disease specialists do. during the pandemic). Given the greater amount of debt he would face if he were entering medical school now, Perencevich isn’t sure if he’d make the same decision today. Other underpaid specialties such as endocrinology and nephrology are facing similar shortages.

And at its core, medical student debt is a very American problem. “Very few other countries have this problem where medical school graduates are in such debt,” Perencevich said.

As the pandemic drags on, President Biden continues to face mounting pressure to cancel student loan debt for all US borrowers, even though the administration has only proceeded with it. with limited steps. The pause on student loan payments at the start of the pandemic (initiated under former President Trump and extended by Biden) has been helpful for borrowers. For example, Harnsberger was able to pay a fortune for a home and even start a business that allowed him to hire mental health professionals and pay them accordingly.

Hirschbaum, a resident at USC Medical Center, estimates that pausing student loan payments has allowed him to save up to 10% of his annual salary for the time being. “I can’t imagine having to scramble for payments during the height of the pandemic,” he said.

But ultimately, in the absence of loan forgiveness, medical students must rely on their own discretion, luck, and a little grace from their own schools. For example, a recent gift to Meharry Medical College allowed the school to reduce the debt burden of 280 medical students. The school also made headlines when they decided to put some money into the CARES . Act directly into the pocket of the students.

Unions like Hirschbaum advocate something more radical: total and complete forgiveness of all borrowers. “Our elected leaders really need to take the really trivial steps of clearing student loan debt for frontline service providers,” said Hirschbaum.

Whatever the solutions, we need to start implementing them soon. The pandemic has highlighted how dire life is for healthcare workers in this country. There will be more public health crises for sure — and we’ll need more doctors ready to help.