Presented By: Ashin Mehta, Medical College of Wisconsin
Co-Authors: Alejandro Rivas, Medical College of Wisconsin
Robert Treat, Medical College of Wisconsin
Jeffrey Whittle, Medical College of Wisconsin

Purpose
Medical school debt has been rising at a rate beyond inflation for the past several decades. In 2003, median debt was $100,000 for public medical school graduates and $135,000 for private school graduates. In 2021, the average medical school debt had increased to $203,062. IM residents have multiple subspecialty options with significant differences in expected income. The goal of this study is to understand IM residents' attitude towards debt and its potential impact on subspecialty selection.

Methods
626 United States IM program directors and their administrators were sent a de-identified Qualtrics survey to distribute to post-graduate year 3 (PGY-3) IM residents. The survey queried debt amount, debt's influence on subspecialty choice and practice type, stress levels from debt, past education, and whether the resident had a plan to pay off their loans.

Results
115 PGY-3 IM residents responded. Average respondent debt was $187,415, with 23.5% of residents reporting no debt. The average debt amongst those with debt was $240,659. Only 46% of residents stated debt had no impact on their subspecialty choice, and 6% of responders reported it influenced their choice "A lot." 52% stated debt impacted their practice type. The average stress score on a scale of 0-10 caused by student debt was 4.7. The average planned time to fully pay off debt was 7 years.

Conclusion
Rising student debt burdens medical graduates, and influences subspecialty choice and practice type in over half of internal medicine residents. Limitations of our study include a small sample size and a possible response bias due to individuals who feel more strongly about student debt being more likely to respond to the study.