14 Apr Why the Coronavirus Should Prompt the U.S. to Cancel Clinician Debt
Dispatches from hospitals overwhelmed by the coronavirus pandemic read like fictional accounts that were hard to imagine not long ago. Strained resources and droves of dying patients haunt the United States healthcare system. Pleas for more ventilators, more masks, more help dominate the national conversation. And at the center of this tragedy are the healthcare professionals—from decorated physicians and young residents to nurses and medical assistants—who live this horror, a new normal no one ever wanted, every day.
So what does it feel like to work on the front lines in the fight against COVID-19? Across social media and national news outlets, healthcare professionals are outlining the health risks and emotional toll ingrained in the response to the coronavirus.
“Just getting home from the ER,” Craig Spencer, MD, MPH, the famed Ebola virus survivor who works as an emergency department physician in hard-hit New York City, recently wrote. “It was brutal. Something you never want to see or experience, I promise.”
Over the past month, Spencer has described in heart-wrenching detail the “new reality” facing physicians and other healthcare professionals. It’s a world where tents stand outside some of the best hospitals in the U.S., housing patients as intensive care units fill and the burden clogs up emergency rooms. Hospitals caught in the coronavirus pandemic are filled with the sounds of coughing—one patient after the other, in a twisted, off-key chorus. This new world is all but unbearable.
There’s really no way to describe what we’re seeing.
Our new reality is unreal.
The people and places we’ve known so long & so well have been transformed.
Our ERs are ICUs.
Everything looks, sounds and feels different.
Just one week and it’s a whole different world.
— Craig Spencer MD MPH (@Craig_A_Spencer) April 3, 2020
Meanwhile, healthcare professionals are taking on roles they never considered filling, Spencer noted. They’re working under the constraints of limited personal protective equipment, attempting to determine which patients will live if sent home, and holding up smartphones so that families can say goodbye to patients who are about to be disconnected.
Patients are dying in ways and settings that resemble Spencer’s time in West Africa, where he contracted the Ebola virus in late 2014. Doctors are dealing with the mental anguish and physical risk inherent to a cruel and sweeping pandemic.
Your hands upon theirs.
You think of their family. At home. Sobbing.
Someone starts saying a prayer.
You can’t help but cry.
This isn’t what we do.
You stand by. You wait.
This isn’t what we do.
You stand by. You wait.
Time of death: 7:19pm
— Craig Spencer MD MPH (@Craig_A_Spencer) April 3, 2020
Across the world, including in this country, that risk is leading to death for more and more healthcare professionals. But without their service and sacrifices, the public would be helpless against the coronavirus.
We Can Help Our Healthcare Heroes
Last week, after a New York nurse died from COVID-19 complications, a petition began circulating online. It calls for Congress to pass a law forgiving student debt for all physicians and clinicians who are responding to the coronavirus pandemic, building on recent legislation that freezes student loan interest and allows payment breaks for all Americans for the next six months. “Student debt is only one of the many burdens faced by those combating COVID-19 to save as many patients as possible,” the petition’s organizer wrote, “but it is one Congress has the power to ease.”
The call for student debt forgiveness immediately attracted 50,000 supporters. Within two days, 100,000 people endorsed the cause. As of this writing, just shy of 150,000 supporters have signed the petition.
Not long ago, most people would’ve considered student loan forgiveness for physicians and other clinicians unlikely, if not absurd. But trillion-plus-dollar stimulus packages and a clear shortage of healthcare professionals amid dire need have made such an action conceivable.
Physicians, clinicians, and even medical school students are taking incredible risks to protect patients amid the coronavirus pandemic. Some are volunteering without pay. Our healthcare professionals’ actions will save lives and maintain our society today. But if history is any judge, we may well turn our backs on them tomorrow. Student debt places an unacceptable burden on the caregivers who are leading the nation through an unprecedented crisis, contributing to burnout and other hardships. That’s why the U.S. needs to cancel debt for all clinicians who are responding to the coronavirus pandemic.
If there were ever a time to take such a step, it’s now.
Physicians and the Student Loan Burden
It’s expensive to become a healthcare professional, and that’s especially true of physicians. Doctors who graduated medical school in 2016 carried an average of $251,600 in student loan debt, most of which came from medical school, according to the National Center for Education Statistics. The weight of debt has been high for decades, but it has skyrocketed in recent years. In 2000, physicians graduated with roughly $130,000 in student loan debt. Twelve years later, that figure soared to $200,000, for a 54% increase.
To the general public, these statistics might elicit a response like, “So? Doctors make a lot of money. Their student loans are an investment.”
To which James M. Dahle, MD, who runs the website The White Coat Investor, replies: “The required IQ and work ethic, the late start caused by 10-15 years of low (or even negative) income, the constant liability concerns, and the large amount of care that is simply donated out of the goodness of your heart merit a reasonably high income, which most physicians eventually obtain. Earning a high income, however, is not the same as being wealthy, which relates to your net worth.”
In 2018, Medscape found that most physicians have a net worth of less than $1 million, which includes property, savings, and even workplace retirement plans. Sky-high debt often merges with living expenses to create poor debt-to-income ratios—or, as Dahle wrote, “debt slave ratios”—even for financially prudent physicians.
This is all to say that despite their impressive incomes, not every physician is wealthy. Some are fighting to stay afloat, just like the rest of us.
And not every healthcare professional is a physician. Physician assistants, advanced-practice nurses, nurses, and other healthcare workers take on student loan debt to enter their field, and they typically receive far less in compensation.
A Pandemic of Problems
The challenge that student loan debt poses to the individual is clear, but vast student loan debt affects healthcare in ways that affect everyone. First, the high cost of medical school bars some students, particularly low-income people, from taking a spot in class. Second, student loan debt contributes to physician burnout. That condition reduces care quality and the number of practicing doctors, while increasing healthcare costs and the likelihood of physician suicide.
Exorbitant student loan debt harms the healthcare system in every way through which we gauge its effectiveness. That was true before the coronavirus pandemic. But as doctors and nurses fall ill and hospitals struggle to treat patients, this shortcoming is more apparent than ever.
I spoke with a nurse last week who described what she faces every day she walks into the hospital. Her colleagues are coughing, their loved ones are taking up beds, and everyone is afraid. “Everyone’s just waiting to get it,” the nurse, who asked not to be named for fear of retribution from her employer, told me. “It’s kind of like a ticking time bomb right now.”
Our healthcare professionals are fighting a battle they didn’t anticipate. They thought their hospitals would be safe, supplies aplenty, and safety all but guaranteed. They didn’t think they were entering a war zone. Yet here they are.
Some medical schools, like those at Harvard and Columbia, are graduating students early. They’re not getting a free month to hang out and hunker down. They’re grabbing their diploma and heading to the front lines. These doctors are headed to places where exposure is certain, illness is likely, and death is possible. But they’re doing it because we need them now more than ever.
“There are so many people who are in need right now, thousands of people all over the country who are sick and need someone to help take care of them,” Mark Cort, MD, an early graduate of New York University’s medical school, said. “This is one of those moments that will define the rest of your career and your life.”
Healthcare Student Loan Forgiveness Could Help Everyone
When the coronavirus pandemic subsides, the U.S. will still need people to enter school and doctors, nurses, and clinicians to come out the other side. The promise of good pay and the chance to help others will be enough for some aspiring healthcare professionals. But others will hear word of mounting debt, physician burnout, and the lackluster response to COVID-19 and think twice.
At the very least, forgiving healthcare professional student loan debt could better prepare us for the nation’s next medical crisis. If Congress erases student loan debt for healthcare professionals who are fighting against the coronavirus, existing healthcare professionals and future medical students might see a sign of hope—a reason to enter a frayed career. They might see that the nation understands and appreciates their sacrifices.
Not unlike the GI Bill, which provided education and other benefits to returning World War II soldiers, this sort of legislative action could simultaneously inspire hope in a greater American good and reward people who have already proven their indispensable value to the country. At a time of tremendous fear and uncertainty, isn’t hope and thanks something we ought to consider?
The Sharp Index runs a scholarship program for physicians and other students. To join us in our fight for well-being, click here.
And if you want Congress to forgive healthcare student loan debt, sign the petition here.
— Jack Murtha. Connect with him on Twitter.