Influence of student debt on health career location and specialty
Steven Ling 1 , Robert Jacobs 2 , Rhys Ponton 3 , Julia Slark 4 , Antonia Verstappen 5 , Craig S. Webster 6 , Phillippa Poole 71 Faculty of Medical and Health Sciences, University of Auckland, New Zealand
2 School of Optometry and Vision Science, University of Auckland, New Zealand
3 School of Pharmacy, University of Auckland, New Zealand
4 School of Nursing, University of Auckland, New Zealand
5 Centre for Medical and Health Sciences Education, University of Auckland, New Zealand
6 Centre for Medical and Health Sciences Education and Department of Anaesthesiology, University of Auckland, New Zealand
7 Department of Medicine, University of Auckland, New Zealand
Correspondence to: Phillippa Poole, Room 12-073D, Support Building, Auckland Hospital, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand. Email: p.poole@auckland.ac.nz
Journal of Primary Health Care 10(1) 54-61 https://doi.org/10.1071/HC17052
Published: 2 February 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: In New Zealand (NZ), there are shortages of health professionals in rural areas and in primary care.
AIM: This study aims to examine the association of student debt levels of medical, nursing, pharmacy and optometry students with: (1) preferred geographical location of practice, specifically preference to work in urban vs. rural areas; and (2) preferred career specialties, specifically interest in primary health care.
METHODS: Medical, nursing, pharmacy and optometry students completed a questionnaire at graduation that included questions about levels of New Zealand Government Student Loan debt and preferences regarding location of practice and career specialty. In an additional survey, medical students were asked to self-rate the effect of financial factors on their career choices.
RESULTS: Debt patterns varied across programmes. Medical and pharmacy students with high debt were significantly more likely than students with low debt to prefer rural over urban practice (P = 0.003). There was no difference in level of interest in a primary care specialty by debt level for any programme. Medical students reported little influence of debt on career choice, although students with high debt levels were less concerned over career financial prospects than students with lower levels of debt.
DISCUSSION: Current levels of student debt do not deter students from planning a career in rural or primary care settings. Somewhat surprisingly, higher levels of debt are associated with greater rural practice intentions for medical and pharmacy students, although the underlying reasons are uncertain.
KEYWORDS: Student debt; rural practice; career preference; primary care; health professional
References
[1] The University of Auckland. Undergraduate Fees for Domestic Students. Auckland: The University of Auckland; 2017 [cited 2017 January 27]. Available from: https://www.auckland.ac.nz/en/study/fees-and-money-matters/tuition-fees/undergraduate-domestic-fees.html[2] Ministry of Social Development. Student Loan. Wellington: Ministry of Social Development; 2017 [cited 2017 January 27]. Available from: https://www.studylink.govt.nz/products/a-z-products/student-loan/index.html#null
[3] Ministry of Social Development. What happens to your loan. Wellington: Ministry of Social Development; 2017 [cited 2017 January 27]. Available from: https://www.studylink.govt.nz/finished-study/your-loan.html#null
[4] Ministry of Business, Innovation and Employment. Pharmacists. Wellington: Ministry of Business, Innovation and Employment; 2017 [cited 2017 December 14]. Available from: http://occupationoutlook.mbie.govt.nz/social-and-community/pharmacists/
[5] Careers New Zealand. Dispensing Optician. Wellington: Careers New Zealand; 2017 [cited 2017 January 27]. Available from: https://www.careers.govt.nz/jobs-database/health-and-community/health/dispensing-optician/
[6] Ministry of Health. Health of the Health Workforce 2015. Wellington: Ministry of Health; 2016 [cited 2017 January 27]. Available from: http://www.health.govt.nz/system/files/documents/publications/health-of-health-workforce-2015-feb16_0.pdf
[7] Lawrenson R, Reid J, Nixon G, Laurenson A. The New Zealand Rural Hospital Doctors Workforce Survey 2015. N Z Med J. 2016; 129 9–16.
[8] Nicholls G, Bagshaw P, Begg E, et al. Medical education: investment or cost? N Z Med J. 2001; 114 459
[9] M2 Communications. Scheme helping to fill hard-to-staff health roles. Auckland: M2 Communications; 2017 [cited 2017 December 14]. Available from: http://go.galegroup.com.ezproxy.auckland.ac.nz/ps/i.do?8id=GALE|A4932661818v=2.18u=learn8it=r8p=ITOF8sw=w8authCount=1#
[10] Moore J, Gale J, Dew K, Davie G. Student debt amongst junior doctors in New Zealand; part 2: effects on intentions and workforce. N Z Med J. 2006; 119 21–28.
[11] Gill D, Palmer C, Mulder R, Wilkinson T. Medical student debt at the Christchurch School of Medicine. The New Zealand Wellbeing, Intentions, Debt and Experiences (WIDE) survey of medical students pilot study. Results Part 2. N Z Med J. 2001; 114 465–7.
| 1:STN:280:DC%2BD38%2FjtlCisQ%3D%3D&md5=73258711999fe6020c599696d2716b06CAS |
[12] Myhre DL, Bajaj S, Jackson W. Determinants of an urban origin student choosing rural practice: a scoping review. Rural Remote Health. 2015; 15 3483
[13] Royston PJ, Mathieson K, Leafman J, Ojan-Sheehan O. Medical student characteristics predictive of intent for rural practice. Rural Remote Health. 2012; 12 2107
| 1:STN:280:DC%2BC38fmsVWqtQ%3D%3D&md5=498520c289b15669b18e2f99df43f467CAS |
[14] Ministry of Health. Voluntary Bonding Scheme; Wellington: Ministry of Health; 2017 [cited 2017 January 27]. Available from: http://www.health.govt.nz/our-work/health-workforce/voluntary-bonding-scheme
[15] Webster CS, Ling C, Barrow M, et al. A cross-disciplinary assessment of student loans debt, financial support for study and career preferences upon graduation. N Z Med J. 2017; 130 43–53.
[16] McHardy KM, Janssen A, Poole P. Female medical students may accrue less student loan debt than their male colleagues in New Zealand. N Z Med J. 2008; 121 37–44.
[17] Moore J, Gale J, Dew K, Davie G. Student debt amongst junior doctors in New Zealand; part 1: quantity, distribution and psychological impact. N Z Med J. 2006; 119 12–20.
[18] O’Grady G, Fitzjohn J. Debt on graduation, expected place of practice and career aspirations of Auckland Medical School students. N Z Med J. 2001; 114 468–70.
| 1:STN:280:DC%2BD38%2FjtlCitg%3D%3D&md5=08c36be2feb322eed9baef53f4c8a863CAS |
[19] Gil JA, Waryasz GR, Liu D, Daniels AH. Influence of medical student debt on the decision to pursue careers in primary care. R I Med J. 2016; 99 19–21.
[20] Grayson MS, Newton DA, Thompson LF. Payback time: the associations of debt and income with medical student career choice. Med Educ. 2012; 46 983–91.
| Payback time: the associations of debt and income with medical student career choice.Crossref | GoogleScholarGoogle Scholar |
[21] Rosenblatt RA, Andrilla CH. The impact of US medical students’ debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire. Acad Med. 2005; 80 815–9.
| The impact of US medical students’ debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire.Crossref | GoogleScholarGoogle Scholar |
[22] Phillips JP, Weismantel DP, Gold KJ, Schwenk TL. Medical student debt and primary care specialty intentions. Fam Med. 2010; 42 616–22.
[23] Poole P, McHardy K, Janssen A. General physicians: born or made? The use of a tracking database to answer medical workforce questions. Intern Med J. 2009; 39 447–52.
| General physicians: born or made? The use of a tracking database to answer medical workforce questions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MrktF2lug%3D%3D&md5=326fc84f5a9fb0e6ba19ca506be23b70CAS |
[24] Kaur B, Carberry A, Hogan N, et al. The medical schools outcomes database project: Australian medical student characteristics. BMC Med Educ. 2014; 14 180–9.
| The medical schools outcomes database project: Australian medical student characteristics.Crossref | GoogleScholarGoogle Scholar |
[25] Medical Deans Australia and New Zealand. MSOD and Data Linkage. Sydney: Medical Deans Australia and New Zealand; 2017 [cited 2017 February 2]. Available at: http://www.medicaldeans.org.au/projectsactivities/msodproject
[26] Beasley TM, Schumacker RE. Multiple regression approach to analyzing contingency tables: Post hoc and planned comparison procedures. J Exp Educ. 1995; 64 79–93.
| Multiple regression approach to analyzing contingency tables: Post hoc and planned comparison procedures.Crossref | GoogleScholarGoogle Scholar |
[27] Gill D, Palmer C, Mulder R, Wilkinson T. Medical student debt at the Christchurch School of Medicine. The New Zealand Wellbeing, Intentions, Debt and Experiences (WIDE) survey of medical students pilot study. Results Part 1. N Z Med J. 2001; 114 461–4.
| 1:STN:280:DC%2BD38%2FjtlCisA%3D%3D&md5=29570aa87945d74ac8aa8ddab811d96bCAS |
[28] O’Connor T. Student debt is profoundly affecting nursing. Nursing N Z. 2003; 9 12–3.
[29] Verstappen A, Poole P. Rising levels of New Zealand medical student debt. N Z Med J. 2017; 130 38–44.
[30] Ministry of Education. Student Loan Scheme Annual Report 2015/16 [Internet]. Wellington: Ministry of Education; 2016 [cited 2017 February 6]. Available from: https://www.educationcounts.govt.nz/__data/assets/pdf_file/0007/180709/Student-Loan-Scheme-2016-131216.pdf
[31] Ministry of Education. Looking at the employment outcomes of tertiary education. New data on the earnings of young graduates. Wellington: Ministry of Education; 2013 [cited 2017 February 10]. Available from: https://www.educationcounts.govt.nz/__data/assets/pdf_file/0014/115430/moving-on-up-what-young-people-earn-after-their-tertiary-education.pdf
[32] Education New Zealand. New Zealand Optometrist Salaries. Wellington: Education New Zealand [cited 2017 April 10]. Available from: https://www.enz.org/salary-optometrist.html
[33] District Health Boards. NZ Resident Doctors Association and 20 District Health Boards Multi Employer Collective Agreement 21 January 2015 to 29 February 2016. Auckland, New Zealand Resident Doctors’ Association; 2015 [cited 2017 February 6]. Available from: http://www.nzrda.org.nz/wp-content/uploads/RDA-and-DHBs-MECA-21-1-15-to-29-2-16.pdf
