Medical student debt and primary care specialty intentions.

BACKGROUND AND OBJECTIVES This study's purpose was to evaluate the relationship between medical student debt and primary care specialty choice, while examining the potentially confounding effects of family income and race/ethnicity. METHODS A cross-sectional survey was offered to all students at three medical schools between 2006 and 2008. The survey assessed students' anticipated educational debt and intended specialty choice. The relationship between debt and primary care or non-primary care specialty choice was assessed for all students and also for all students stratified by year in medical school, family income level, and racial/ethnic group. RESULTS A total of 983 students participated (response rate 64.1%). Students from lower income families and under-represented minority students anticipated more educational debt. There was no relationship between anticipated debt and career plans when participants were analyzed as a whole. However, among students from middle income families, those anticipating more debt were less likely to plan primary care careers. CONCLUSIONS Confounding factors, including income of family of origin, may mask a relationship between debt and specialty choice in observational studies. This study suggests that medical students from middle income families are sensitive to debt when making career choices.