Evaluating Loan Burden in Minorities in Anesthesiology and its Impact: A Nationwide Survey

Niti Pawar, BA1, Christy K. Boscardin, PhD1,2, and Odmara Barreto Chang, MD, PhD1

1Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, USA

2Department of Medicine, University of California San Francisco, San Francisco, USA

Introduction: The average debt after medical school graduation has been dramatically increasing, now at a median of $225,000. A multi-factorial effect of debt on well-being, academic performance, career preparation, career choices, and patient care has been demonstrated in many studies with medical students1-9 and could similarly pose a barrier to equity in anesthesia. Previous studies evaluating the effects of loan burden in anesthesia residents highlighted the increased vulnerability of first-generation and underrepresented in medicine (URM) medical students to loan burden.

Aim: In this study, we investigated the differential impact of loan burden on residents in anesthesia by gender, race and first-generation status as well as their impact on career and personal life decisions, moonlighting, and well-being.

Project Design/Methods: We conducted a national cross-sectional online survey study with residents utilizing the American Society of Anesthesiologists database. Demographic information, loan burden, the Harvard MHC-SF for wellness assessment, moonlighting status, and career aspiration were assessed. Chi-square and t-tests were conducted to determine if minorities by race, first-generation status, or gender had statistically significant differences in loan burden or its impact.

Results: 380 responded (27.6% response rate) and 330 with complete data. First-generation residents (OR 3.94; 95% CI, 2.34-6.63; p=0.031) and minority residents had higher loan burden compared to non-minority residents (89% vs. 73%; p=0.025). Residents with higher loan burden perceiving repaying debt as a significant financial burden (89.4% vs. 50.1%; p<.001), influencing job choice (93.3% vs. 55%; p<.001), delaying buying a home (82.3% vs. 53.7%; p<.001), delay getting married (55% vs. 47.4%; p=.011), delay having kids (68.2% vs. 52.04%; p<.001), and delay enjoying activities outside work (78.5% vs. 53.2%; p<.001). Higher loan burden was not statistically significant factor in wellbeing (x1=45.3; sd=12.62; x2=44.7; sd=11.1; p=0.684)
Discussion: First generation and minority residents in anesthesia have significant higher loan burden and differently impacting their career and life decisions. To increase equity and retention in anesthesia, the impact of economic burden on minoritized residents needs to be considered.

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