Extensive training requirements and lower wages lead healthcare professionals to accrue more debt than other workers, according to a recent analysis published in JAMA Health Forum.
The study, which used 2018 through 2021 data from the U.S. Census Bureau’s Survey of Income and Program Participation, found physicians and registered nurses are more likely to have student loan debt. Nursing aides and environmental service workers have more medical debt. Clinicians often attend school and receive care at the same academic medical centers where they work, said Dr. Kathryn Himmelstein, lead author of the study and infectious disease physician at Massachusetts General Hospital in Boston.
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“There's just something particularly ironic about folks being in debt to their own employers and healthcare workers being in medical debt,” Himmelstein said. “Many, if not all of the healthcare employees I work with, are struggling with debt.”
Here are five things to know about how debt impacts healthcare workers.
Educational and medical debt are common
Nearly 14% of healthcare workers had some form of medical debt, compared with 11% of workers in other industries, according to the study. Other workers were also less likely to have educational debt, with only 17% having student loan debt versus 27% of healthcare professionals.
The average tuition cost for a two-year associate's degree in nursing is $24,600, according to the National Center for Education Statistics. Medical students typically pay upwards of $50,000 per year, graduating with more than $200,000 in debt, the American Association of Medical Colleges found.
Healthcare workers’ billions in debt surprised researchers
Healthcare workers collectively owe more than $150 billion in debt, most of which is driven by educational costs.
“The scope of the indebtedness among healthcare workers is really striking,” Himmelstein said. “This is a workforce that has gone into debt both to obtain healthcare for themselves and to get the education they need in order to care for other members of their community.”
Healthcare workers had an average of $10,642 in student loan debt, totaling $134.4 billion nationwide. The average medical debt among all healthcare workers was $1,567 for a total of $19.8 billion.
Medical debt is higher for low-paid healthcare employees
Nearly one in five nursing aides and assistants had medical debt, compared with 12% of registered nurses and 3% of physicians, the study found. Additionally, 15% of female healthcare workers had some form of medical debt versus 9% of their male coworkers.
A significant portion of the healthcare workforce is composed of women, as well as Black and Latino individuals, who provide direct care to seniors and keep facilities safe and clean for extremely low pay, Himmelstein said.
These individuals are at greater risk for infectious diseases and musculoskeletal injuries, and they also are often have poor benefits with insurance or copays they can’t afford, she said.
As a result of inadequate compensation, home health and nursing home personnel are more likely to have medical debt than hospital or clinic workers, Himmelstein said.
Black clinicians burdened by educational debts
Younger healthcare workers and those with higher levels of education are generally more likely to have educational debt, and Black clinicians are more burdened with student loans.
Compared with their white counterparts, Black individuals have a greater than 50% chance of holding more educational debt, Himmelstein said. This could be due to various socioeconomic factors as well as a lack of loan forgiveness opportunities, she said.
Across healthcare occupations, registered nurses are the most likely to have student loan debt.
Debt impacts health outcomes
Healthcare workers with educational and medical debts are at risk for worse mental health issues and chronic physical conditions, Himmelstein said. Debt may also deter healthcare professionals from seeking medical care or accepting certain roles in the industry.
Health system leaders have the power to positively change their employees’ social determinants of health by ensuring workers have access to living wages, housing, healthy food and debt reduction options, Himmelstein said.
“When folks are thinking about setting salaries and designing benefits packages, they need to do so in a way that's not going to put their own workers into debt for seeking the care that they provide every day,” she said.
