The proportion of medical students graduating without debt is increasing while scholarship funding is declining, suggesting a high concentration of students with wealthy backgrounds, according to a new analysis published in JAMA Internal Medicine.

After observing an increase in students graduating without any debt, Justin Grischkan, BA, and Benjamin P. George, MD, MPH, and colleagues gathered data from the 2010-2016 Association of American Medical Colleges Graduation Questionnaire, focusing on data regarding self-reported medical education debt.

Of a total 13,904 respondents in 2010, 12,786 reported having graduated with debt vs 13,610 of 15,232 respondents in 2016. The mean amount of debt also rose from $161,739 in 2010 to $179,068 in 2016.

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However, the number of graduates reporting no debt also increased, from 16.1% in 2010 to 26.9% in 2016. This group also experienced the largest absolute increase by specialty. Six specialties reporting the largest increase in no-debt graduates were radiology (17.1% in 2010 vs 30.4% in 2016), dermatology (23.1% vs 36.1%), neurology (18.1% vs 30.7%), obstetrics and gynecology (11.5% vs 24.7%), ophthalmology (26.3% vs 39.9%), and pathology (20.8% vs 34.8%).

In addition, among those graduating without debt, the mean amount of scholarship funding is declining, going from $135,186 in 2010 to $52,718 in 2016. Although the increase in student loan debt is a well-known issue, the study offers some new findings:

  • Because the amount of students graduating without debt is increasing while the amount of scholarship funding they receive is decreasing, it is likely there is a higher concentration of medical students with high-income backgrounds.
  • Student loan debt may be concentrated in fewer individuals when you pair the study findings with an increase in aggregate per capita debt. This concentration masks individual debt burden behind aggregate data estimates that are lower than an increasing number of students are facing.
  • Primary care-orientated fields seem to have fewer students graduating without debt.

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Although there is no clear association between proportions of graduates without debt in specialties and the income typical of those specialties, the researchers conclude that it does seem that specialty choice and indebtedness are linked and that “we need to begin to examine second-order debt effects and, in particular, its distribution across specialties.”


Grischkan J, George BP, Chaiyachati K, Friedman AB, Dorsey ER, Asch DA. Distribution of medical education debt by specialty, 2010-2016 [published online September 5, 2017]. JAMA Intern Med. doi: 10.1001/jamainternmed.2017.4023