Abstract:
Introduction/background: The sustainability of a health system depends on having health professionals in rural areas and in primary care. Little is known about how student debt affects career choice. Aim/objectives: To examine the association of student debt levels of health professional students with: (1) Preferred location of practice, specifically urban vs. rural; (2) Preferred career specialty, specifically an interest in primary health care. Methods: Medical, nursing, pharmacy and optometry students from one NZ institution completed a questionnaire at graduation. There were questions on levels of Government Student Loan debt and preferences regarding location of practice and career specialty. In another survey, medical students were asked to self-rate the influence of financial factors on their career choices. Results: From 2006 to 2016, over 3,000 students reported their student debt level which varied across programmes. Medical and pharmacy students with high debt were significantly more likely than those with low debt to prefer rural practice over urban practice (P = 0.003 and < 0.0001 respectively). There was no difference in interest in a primary care specialty by debt level for any of the programmes. Medical students reported little influence of debt on career choice; those with high debt levels were less concerned regarding career financial prospects than those with lower levels of debt. Discussion: Somewhat surprisingly, higher levels of debt at the time of graduation were associated with greater rural practice intentions for medical and pharmacy students. There are several possible explanations for this. Conclusions: Current levels of student debt do not deter students from rural or primary care.
