By Janet Lorin
NEW YORK — Mark Moy came to the United States from China, paid his way through medical school at the University of Illinois in the 1970s and became an emergency room physician.
His son Matthew, a third-year medical student, has racked up $190,000 in debt and still has a year to go. Accrued interest on his medical-school loans has swelled his balance by 13 percent over three years.
"When I think about it, it will keep me up at night," said Matthew Moy, 28. "I'm dreading the exit interview when I will find out exactly how much I'll have to pay back."
The next generation of U.S. physicians is being saddled with record debt amid a looming shortage of doctors needed to cope with a rising elderly population. The burgeoning debt burden may be turning students away from primary care, which pays about $200,000 a year, toward more lucrative specialties and scaring off low-income and minority students fearful of taking on big loans.
Median tuition and fees at private medical schools was $50,309 in the 2012-2013 academic year, more than 16 times the cost when Moy's father became a doctor. The median-education debt for 2012 medical-school graduates was $170,000, including loans taken out for undergraduate studies and excluding interest. That compares with an average $13,469 in 1978, said Jay Youngclaus, co-author of a February 2013 report on medical school debt.
Even Federal Reserve Chairman Ben Bernanke's son can't expect to escape the debt burden. The elder Bernanke testified before Congress last year that his son is on track to leave medical school with $400,000 in loans. The figure may include accrued interest and undergraduate costs. His son attends Weill Cornell Medical College in New York, according to the school directory. Bernanke, through a spokeswoman, declined to comment.
The median four-year cost to attend medical school — which includes outlays like living expenses and books — for the class of 2013 is $278,455 at private schools and $207,868 at public ones, according to the Association of American Medical Colleges, a nonprofit group of U.S. schools.
Record numbers of students still want to become doctors. First-time applicants to U.S. medical schools rose to 33,772 in 2012 from 24,884 a decade earlier, according to AAMC. New enrollment at U.S. medical schools grew 1.5 percent to 19,517 students, the highest ever.
The U.S. faces a shortage of more than 130,000 physicians by 2025 as the population ages and 32 million more Americans obtain insurance under health-care reform, the AAMC estimates.
Medical school is still worth the cost, said Cornell University President David Skorton, a cardiologist who took two decades to pay off his debt from college and medical school.
"The best investment I ever made was to borrow that money," Skorton said in an interview. He received his medical degree from Northwestern University in 1974.
The majority of medical scholars — like most graduate students — finance their educations with loans. The interest rate on federal loans for graduate students is 6.8 percent for Stafford or 7.9 percent for Grad Plus, far higher than the benchmark U.S. 10-year Treasury note, which was 1.78 percent at one point last week. Congress sets student-loan interest rates, which are typically higher than mortgages and car loans because they don't require collateral and are given to borrowers who have no credit histories.
Interest on most medical-school loans continues to accrue on at least a portion of the balance during the multiyear residency period that students undergo after graduation if they don't make full interest payments. That means a higher balance at the end of training, said Paul Garrard, president of PGPresents, an independent student-loan consulting company that specializes in medical debt.
A residency for internal medicine is three years. A specialty such as cardiology or nephrology can be another two to four years while neurosurgery is typically a total of seven.
David Lin, an anesthesiology resident at St. Barnabas Medical Center in Livingston, N.J., owes about $325,000. Because of accrued interest, the figure has risen 25 percent since he graduated from Chicago Medical School two years ago. He makes payments of about $450 per month.
"I'm barely touching the principal at all," said Lin, 30, who had no debt from his undergraduate years at the University of California, Berkeley.
Black medical-school graduates from 2012 reported the highest median debt, $184,125. Blacks and students from Puerto Rico had the lowest median parental income.
Low-income students may shy away from entering medical school, said Ami Bera, a Democratic congressman from California and one of 20 physicians in Congress. Bera served as a dean of admissions at the medical school at University of California, Davis.
"You probably are pricing out a whole segment of lower- income kids that have the ability and the intellect to succeed," said Bera, who left medical school at the University of California, Irvine, with less than $10,000 in loans in 1991.
LeAnne Roberts, a black fourth-year student at the University of Medicine and Dentistry of New Jersey, said she would have a hard time recommending medical school to the low- income high-school students she tutors in Newark.
"They have these goals of wanting to become a physician, and I'm almost not making it," said Roberts, 27, who grew up in Sacramento and whose parents are retired schoolteachers. "I don't want to sell them a false dream. All of these things are attainable, but it's very difficult to pay for."
Grants rarely cover the entire cost of attending medical school, and there are very few "full-ride" scholarships available, according to the AAMC report. Billionaire entertainment executive David Geffen endowed a full scholarship for as many as 33 students a year at the University of California, Los Angeles, medical school for $100 million in December. They are based on merit.
Medical students are starting to lobby to reduce debt loads. The medical school division of the American Medical Association passed a resolution in November calling for the reduction of the federal-loan interest rate to a variable rate capped at 5 percent. About 150 American Medical Student Association members in white coats lobbied their legislators in Washington last month.
Jacob Burns, 23, a first-year medical student at the University of Florida, expects to owe at least $220,000 at graduation. Because of his debt, he said he has almost ruled out primary care including pediatrics for a higher-paying specialty such as pediatric or cancer surgery. About 27 percent of 2012 medical school graduates polled by AAMC said their debt load affected their choice of specialty.
"It's a lot of money to pay off and then when you look at the different salaries for different specialties, you kind of lean one way," Burns said.
Students argue that interest rates could be lowered because default rates on medical-school loans are very low: For schools that report data to AAMC, the average is about 1 percent, with a quarter of schools reporting zero.
"In the regular private market, taking out a lot more money when you are guaranteed to pay it back would have a lower interest rate," said Matthew Shick, a senior legislative analyst with AAMC.
Michael Burgess, a Republican Congressman and obstetrician from Texas, said changing the interest rate for physicians may be too narrow a focus.
"Cheap money never solves a problem," said Burgess, who estimates he left medical school in 1977 with about $4,000 in student loans. "You make a lot of easy money available and someone will do you a favor and take it off your hands."
Matthew Moy, the Chicago medical student, said he'd like to follow in the footsteps of his father and specialize in emergency medicine. In addition to the $190,000 he already owes, he expects to have to borrow almost $50,000 to pay tuition and fees for his fourth year at Chicago Medical School, part of Rosalind Franklin University of Medicine and Science.
To save money, he is using textbooks handed down by his brother, who is four years ahead of him on the medical training track, and living with his parents.
"Their help, it's kind of huge," he said.