Factors influencing studentsʼ borrowing that may affect their specialty choices and other after-graduation behaviors

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Abstract
To assess the factors that influence medical students' borrowing and how these factors may affect access to the profession, specialty choice, and medical graduates' repayment behaviors. The borrowing patterns of the 3,495 indebted students enrolled at Jefferson Medical College of Thomas Jefferson University between 1989-90 and 1994-95 were analyzed. (Debt included both subsidized and unsubsidized debt.) These borrowing patterns were assessed in relation to changes in the cost of education, family (i.e., parents') income, availability of grant funding, legislative changes to loan-eligibility criteria (specifically, the Higher Education Amendments of 1992), and average interest rates on federal unsubsidized loans. The annual changes in average debt levels suggest that while cost of education, family resources, and availability of grant funding may be significant factors, changes in loan eligibility and prevailing interest rates on unsubsidized loan source also influence medical students' borrowing. A comparison of the borrowing patterns for three income groups (low, middle, high) further demonstrated that while overall fluctuations for low-income group mirrored changes in the cost and resource variables, annual borrowing fluctuations for the middle- and high-income groups were more reflective of the expansion of loan eligibility and reduced interest rates on unsubsidized loans. From 1989-90 to 1994-95 the average cost of education increased by $2,368. Average unsubsidized debt increased by $1,544 for the low-income group, $3,960 for the middle-income group, and $4,439 for the high-income group. The percentage of unsubsidized funding included in the borrowers' financing packages increased by just under 6% for the low-income group but almost 10% and 11% for the middle- and high-income groups, respectively. The results suggest that medical students borrow for a variety of reasons, ranging from financial need to personal financing or lifestyle choices. These reasons should be considered in relation to institutional and governmental financial aid policies and future research on the relationship between debt and speciality choice.

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