Racial Disparities in Debt Burden among Underrepresented Medical Students Matched into Orthopaedic Surgery Residency

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.064

Lancelot Benn MD, Bianca Audrey Duah BA, Gonzalo F. Del Rio Montesinos MS, Addisu Mesfin MD

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引用次数: 0

Abstract

Introduction

The rising cost of medical education in the United States has outpaced inflation over the past two decades, leading to significant financial burdens on students, particularly those from underrepresented in medicine (URiM) backgrounds. Recent data shows that the average educational debt for medical graduates has surged, with Black students anticipating more debt than their peers. This financial strain influences career choices, potentially deterring URiM students from pursuing specialties like orthopedic surgery. This study examines the racial disparities in anticipated debt and financial stress among URiM students who matched into orthopedic surgery during a single match cycle.

Methods

Study Participants: This retrospective cohort study included 45 URiM medical students who matched into orthopedic surgery residency in March 2023. Data were collected via a 42-item Google survey distributed by the J. Robert Gladden Orthopaedic Society in June 2023, adapted from a previous study on racial disparities in medical student debt. The survey captured demographics, student debt, USMLE scores, and ERAS metrics. All 45 respondents met inclusion criteria, including one graduate from a Caribbean medical school.

Results

This study analyzed 45 URiM medical students who matched into orthopedic surgery residency in 2023. The cohort was evenly split between males and females (49% vs. 51%), with the majority identifying as Black (87%) and the remainder as Hispanic/Latino (9%). Most participants were allopathic graduates (87%) and attended public medical schools (53%), with 84% coming from institutions with an affiliated orthopedic residency program. The majority (89%) carried medical school debt, with an average burden of $203,315, while 60% also had undergraduate debt averaging $43,451. USMLE scores showed weak inverse correlations with debt: Step 1 (-0.20) and Step 2 (-0.15) scores tended to decrease slightly with higher debt levels. Specifically, students with higher medical school debt (> $200,000) had lower mean Step 1 (220.3) and Step 2 (234.3) scores compared to those with lower debt burdens. Black students, who made up the majority of the cohort, also had higher debt burdens, with a mean medical school debt of $193,882.

Conclusion

Orthopedic surgery remains one of the least diverse specialties. Financial barriers contribute to the underrepresentation of URiM students in orthopedic surgery. High debt burdens and costly applications can discourage qualified URiM students. Findings align with national data: Black students consistently report higher debt burdens. Home programs or medical school locations did not mitigate debt levels. Application process costs add further financial strain. Diversity in orthopedic surgery is critical for improving patient care outcomes in underserved populations.

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在代表性不足的医学生中，债务负担的种族差异与骨科住院医师相匹配

在过去的二十年里，美国医学教育成本的上升速度超过了通货膨胀的速度，给学生带来了巨大的经济负担，尤其是那些来自医学背景的学生。最近的数据显示，医学毕业生的平均教育债务激增，黑人学生预计比同龄人背负更多的债务。这种经济压力影响了学生的职业选择，可能会阻碍他们选择整形外科等专业。本研究考察了在单一匹配周期内匹配入骨科手术的URiM学生在预期债务和财务压力方面的种族差异。研究对象：本回顾性队列研究纳入45名于2023年3月入组骨科住院医师的URiM医学生。数据是通过j·罗伯特·格莱登骨科学会（J. Robert Gladden Orthopaedic Society）于2023年6月发布的一项42项谷歌调查收集的，该调查改编自此前一项关于医学生债务中种族差异的研究。该调查涵盖了人口统计、学生债务、USMLE分数和ERAS指标。所有45名答复者均符合列入标准，其中包括一名加勒比医学院毕业生。结果本研究分析了2023年匹配入骨科住院医师的45名URiM医学生。该队列平均分为男性和女性（49%对51%），其中大多数为黑人（87%），其余为西班牙裔/拉丁裔（9%）。大多数参与者是对抗疗法毕业生（87%），就读于公立医学院（53%），其中84%来自附属骨科住院医师项目的机构。大多数人（89%）背负医学院债务，平均负担为203,315美元，而60%的人还背负本科债务，平均为43,451美元。USMLE得分与债务呈弱负相关：步骤1（-0.20）和步骤2（-0.15）得分倾向于随着债务水平的升高而略有下降。具体来说，与债务负担较轻的学生相比，医学院债务较高（20万美元）的学生在第一步（220.3）和第二步（234.3）的平均得分较低。黑人学生占这一群体的大多数，他们的债务负担也更高，医学院的平均债务为193,882美元。结论骨科仍是多样化程度最低的专科之一。经济上的障碍导致了URiM学生在骨科手术中的代表性不足。高额的债务负担和昂贵的申请费用可能会阻碍合格的URiM学生。调查结果与全国数据一致：黑人学生的债务负担一直较高。家庭项目或医学院所在地并没有减轻债务水平。申请流程成本进一步增加了财务压力。骨科手术的多样性对于改善服务不足人群的患者护理结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.