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Status of Debt For Pharmacists, Medical Professions

Like their nonmedical counterparts, pharmacists and other college graduates in other medical professions are affected by student debt woes, though they may not be its main drivers, researchers say. Studies from various sources have chronicled the tuition amounts, extent of student loan debt and general career prospects for a variety of white-collar medical professional and allied health fields.

Firstly, the American Journal of Pharmacy carried an article this year titled “Pharmacy Students Debt and Return on Investment of a Pharmacy Education.”

The study and article were co-authored by researchers Jeff Cain, EdD, MS; Tom Campbell, PharmD; Heather Brennan Congdon, PharmD; Kim Harricock, PhD; Megan Kain, PharmD; Paul R. Locknan, PhD, and Lee Evans.

The report was meant to describe the current landscape within the profession of pharmacy regarding student tuition, indebtness, salaries and job potential. Pharmacy tuition and student debt data were obtained through the American Association of Colleges of Pharmacy Institutional Research website.

For research purposes, tuition was defined as average first-year tuition and fees for accredited schools.

Researchers found that in-state tuition at public schools rose an average of $1,211 whereas out-of-state tuition at public schools rose significantly faster at $1,838 — a significant development given that many college students are looking to government-run colleges to rein in costs.

They continued that average tuition cost for pharmacy school has increased 54 percent in the last eight years.

As a result, rising tuition and student debt require emergency attention from a number of stakeholders, including students, faculty members, universities, accreditation and government entities, they said.

Meanwhile, researchers pointed out that the average pharmacist salary has risen from $75,000 to over $112,000 since 2002. The number of pharmacist jobs in the United States has risen from 215,000 jobs in 2013 to 275,000 in 2010.

In 2011, the average debt amount for pharmacy students was $114,422 against a greater-than-average first salary of $112,160.

Kantrowitz said that his own work reports the average debt at graduation of $111,307 for students in the field of pharmacy for just graduate loans and $134,132 for both graduate and undergraduate loans. (The research can be found on page 4 of the report on the Edvisors website at http://www.edvisors.com/media/files/studentaidpolicy/20140107-debt-at-graduation.pdf )

“These figures are averages among those who graduate with debt,” he said. “Student loan debt may be used to pay for room and board in addition to tuition and fees.”

Secondly, the Bureau of Labor Statistics showed an average growth rate for all medical occupations for the years 2010 to 2020, projected to be 14 percent. (Figures on medical occupations may be accessed at http://www.bls.gov/ooh/healthcare/home.htm)

The bureau stated that the number of job prospects holds at 168,300 for physicians, 32,200 for dentists and 69,700 for pharmacists. The rate of growth is as fast as follows: physicians at 24 percent; dentists at 21 percent, and; pharmacists at 25 percent.

Thirdly, the American Association of Colleges of Pharmacy tuition data on Institutional Research, the U.S. Department of Labor and the Bureau of Labor Statistics show a slowing of salary increases.

For example, the average of growth of health jobs was 49 percent, the three sources found. Physical therapy jobs grew from 130,000 to 185,000 jobs over the last 10 years. Salaries for this and similar titles increased by 31 percent from $158,000 to $189,000.

At the same time, student debt across the health professions — both white-collar medical specialties and allied health titles — increased over the last five years, they said.

This is a result of a rise in the amount of money borrowed by medical students with the fastest increase in the last five years occurring among pharmacist students at 23 percent, medical students facing 47 percent and dental students at 8.5 percent.

Consequently, researchers with the bureau and the association said that the research yields many questions about academic and government policy as it does findings.

They asked whether the high number of accreditation requirements led to increases in tuition of pharmacy education.

They pondered whether there is excessive competition among pharmacy colleges and schools to use the best marketing approaches, new facilities and new technology, leading to the tuition increases.

They questioned whether federal regulators aided the student loan increase along with changes in loan eligibility, interest rates, repayment rates and deferment requirements.

The researchers connected a decrease in state funding to government schools with a greater burden of payment on students and their families.

They pointed to faculty curricula that cuts into the amount of free time students have to find employment during winter and summer breaks to pay off loan debt.

They also assigned responsibility to students adopting more expensive lifestyles than previous years during pharmacy school before graduation.

Similarly, these researchers observe that, with four years of undergraduate study, four years of medical school, two years of residency and two to four years of fellowship, physicians must wait long before entering their fields. As a result, a medical student and future physicians may face a debt of $300,000 by graduation, which doubles the amount incurred over the past 30 years.

Fourthly, in like fashion, the National Council of State Boards of Nursing found that an associate degree program may yield $6,000 to $100,000 in student debt and a bachelor of science program in nursing may lead to $40,000 to $200,000 in similar obligations. This includes fees for the nursing NCLEX-RN exam and state license for licensed vocational nurse and registered nurses. (Report figures on nursing school, tuition, salaries and student debt may be accessed at https://www.ncsbn.org/NCSBN_2013-14_Environmental_Scan.pdf )

Physician assistants, too, will undergo medium-level training for two years from costing$2,300 to $70,000. For high-level training at two years at private universities, they face starting costs of $60,000.

For low-level training, dental hygienists may study and pay $950 to take the clinical board exam. For medium training with an associate degree, hygienists face $4,600 in in-state costs and $10,000 to $21,000 in tuition, out of state. For high-level training with a bachelor’s degree, they are responsible for $20,000 to $27,000 in in-state tuition. Their average salaries range from $36,000 to $99,200.

“[The] six-figure debt is primarily limited to law, medicine and pharmacy,” Kantrowitz said.

By comparison, allied health professions take on lesser costs and may not factor into the student loan crisis at all, researchers found.

For instance, medical assistants undergo low-level training for $1,200 to $4,200, medium-level training with a one-year certification for $2,500 to $10,000 and high-level training running $600 to $5,490 to $10,800. The certified medical assistant exam is administrated by the American Association of Medical Assistants.

Certified nursing assistants may obtain low-level training for free. With formal programs, medium training can last six to 12 weeks, costing $200 to $350. For high-level training, vocational schools can run $825 to $1,200. When they obtain their certification and leave school, nursing assistants can serve as home health aides in patients’ homes with the remaining CNAs working in hospitals or nursing homes.

Pharmacy technicians can undergo medium-level community colleges training from costing $460 to $2,600 and high-level training costing from $600 to $21,900.

Dental assistants can be trained for $850 to $7,560. Financial obligations vary by state and school. Books and supplies average $1,600 in costs in lieu of the dental assistant exam after obtaining high school diplomas. Registration costs $125.

Connection of Debt To Health by Other Studies

Aside from the student debt loan study by Sweet and her fellow investigators, other research in recent years have connected financial obligations with reduced quality of physical and mental health.

Firstly, in 2000, researchers Dreantea and Lavrakas released Ohio-based research on credit card debt, stress and health, finding debt-income ratio and stress being associated with worse self-reported health and physical functioning. (Figures and findings may be found at http://www.sciencedirect.com/science/article/pii/S0277953613002839 )

They stated that clients of credit counseling are more at risk for becoming overweight or obese than the general public.

Secondly, in a similar vein, researchers McEwen and Seeman published in 1999 research discovering that stress impacts health indirectly by influencing habits concerning diet, physical activity and substance abuse.

Researchers stated that individuals who experience stress are known to undergo short- and long-term psychological changes that lead to the onset of several diseases, especially cardiovascular and metabolic conditions.

They said that, for research purposes, subgroups were over-sampled. Physical exams were performed of whites, blacks, Asians, Native Americans and Hispanics.

Health conditions and risk factors included smoking; level of health insurance; physical limitations using hands, arms, legals or feet for physical activity such as bicycling, dancing and playing sports; general health; and depression.

Additionally, researchers examined psychological health; sociodemographics; self-reported height and weight; body mass index; educational attainment, whether on the high school, some college, college degree and post-college levels; employment status in the last five years, whether employed, partially employed, temporarily employed or unemployed; and homeownership.

Thirdly, in November 2011, the Journal of Affective Disorders published a study and an article titled “Socioeconomic Status and Risk of Psychological Distress and Depression in the Stockholm Public Cohort: A Population-Based Study.” The study and article were co-authored by researchers K. Kosidory, C. Dalman, M. Lundberg, J. Hallquest, G. Isacsson and C. Magnusson. (Research can be accessed at http://www.sciencedirect.com/science/journal/01650327/134 )

The study involved a random sample of Stockhom County residents aged 18 to 84 years in 2002 and a 12-item health questionnaire. Questionnaire results were released in 2007.

Participants were categorized by socioeconomic status at baseline and followed up for the onset of psychological distress and depression.

The study compared unskilled married manual workers with higher-skilled non-married workers for men but not for women.

Researchers commented that limited evidence exists on whether the association between low socioeconomic status and the risk of common mental disorders varies with symptom severity, type of socioeconomic indicator or gender.

Occupational class was not associated with psychological distress, regardless of severity of symptoms, with women. However, class was closely tied to distress with male respondents.

Income was associated with the risk of onset of all medical outcomes and risks increased with symptom severity.

In the end, investigators found that women were best protected from depression with the highest household incomes and education was unrelated to men and women.

Fourthly, researchers S. Bridges and R. Disney released the study and article “Debt and Depression” in the Journal of Health and Economy.

The study concentrated on the effect of household debt on psychological well-being using a large household survey of families with children in Britain.

Researchers for the study found that existing studies linking debt and depression tend to use small and highly selective samples of people and measures of financial stress.

From more data, they said that they constructed a set of measures of financial stress to support individuals’ self-reported indicators.

The study made the association between a person’s measures of his or her own financial and psychological well-being and the authors stated that individuals differ in their psychological responses to a variety of household financial situations. They also examined how a person may simultaneously handle financial and psychological health issues.

Fifthly, in March 2009, researchers H. M. Orpara, L. Lemvre and R. Gravel released the article and study, titled “Income and Psychological Distress: The Role of the Social Environment,” in the journal Health Report.

The study examined the ties between lower income and the risk of experiencing high distress over 12 years.

Data from the first 12 years of the longitudinal National Population Health Survey, using sets from 1994/1995 through 2006/2007, were analyzed.

A special research approach known as propositional hazards modeling was conducted to determine whether lower household income was connected with a greater risk of experiencing high distress, when accommodating certain sociodemographic characteristics and baseline health studies.

The study examined the ties between reporting a source of stress and experiencing one incident of distress.

Ultimately, researchers found that sources of stress, also known as stressors, made up 27 percent of the relationship between low income and distress for men and over a third for women.

Sixthly, researchers D. Rai, P. Kitko, K. Jones, J. Lynch and R. Arava authored the study and article, titled “County- and Individual-Level Socioeconomic Determinants of Depression: Multi-level Cross-National Comparison” for the Journal of Psychiatry. The article saw print in March 2013. (The study may be accessed at http://bjp.rcpsych.org/content/early/2013/01/19/bjp.bp.112.112482.abstract?related-urls=yes&legid=bjprcpsych;bjp.bp.112.112482v1 )

The study’s authors found that prevalence of depression differed across countries. They attributed these differences to country-level income or inequalities.

Research was focused on associating depression with socioeconomic factors at the country level, taking income inequality and gross national income and individual factors such as education, employment, assets and spending into account. Investigators wanted to probe their contributions to the variation in prevalence of depression across countries.

About 187 to 496 individuals from 53 countries who took part in the World Health Organization health surveys were studied.

Researchers found that depression prevalence varied between 0.4 percent and 15.7 percent across countries. There were factors for 86.5 percent of this variance but there was also reasonable variation at country level — namely, 13.5 percent — which increased with decreasing development of mental illness.

They also found that gross national income or country-level income inequality was not linked to depression. At the individual level, lower education, being a member of the female gender, economic inactivity and being divorced or widowed were the true triggers for mental illness. Greater household spending also increased the odds.

Seventhly, the Journal of Psychological Medicine released the study and article, titled in “Debt, Income and Mental Disorders in the General Population,” in October 2008. The work was co-authored by researchers R. Jenkins, D. Bhugra, P. Beddington, T. Bhugra, M. Farrell, J. Coid, T. Kryers, S. Weich, N. Singleton and H. Meltzer.

They stated that it is widely known that poor mental health and poverty are tied but the mechanisms involved are not well-understood.

The study aims to make the association between income and mental illness and worsened by debt and its financial hardship. It was a national and cross-sectional, household survey in England, Scotland and Wales, assessing 8,580 participants aged 16 to 74.

Psychosis, neurosis, alcohol and drug abuse were identified as applicable mental conditions. Researchers asked participants questions about income, debt and financial hardship.

About 23 percent were in debt, 8 percent were without disorders and 10 percent had a household utility service disconnected.

The findings pointed to a link between low income and mental disorder. The more debts respondents had, the more likely they were to suffer from mental disorders. Additionally, researchers wrote, debt to six different creditors meant a six-fold increase in mental disorders after adjustment for income.

Eightly, in February 2013, the European Journal of Public Health printed the study and article, “The Relationship Between Personal Debt and Specific Common Mental Disorders.” The report was co-authored by researchers H. Meltzer, P. Beddington, T. Brugha, M. Farrell and R. Jenkins. (The study may be accessed at http://library.nhsgg.org.uk/mediaAssets/PHRU/New%20Current%20Awareness%20February%202013.pdf )

They recognized personal debt as one of several factors linked to mental illness. Their goal was to measure the prevalence of specific mental disorders on the International Codex of Diseases (ICD-10) diagnostic criteria instrument by type of debt and the influence of addiction.

They took a random probability sample comprised of 7,461 respondents to be interviewed for the third survey of psychiatric illness among adults in England that was performed in 2001.

Respondents were asked about sources of debt and borrowing. Researchers found that a, in 2007, about 8.5 percent of adults were in debt. Those with financial obligations were three times more likely than those not in debt to be afflicted with mental illness.

The increased odds were found for all types of mental disorders and the source of debt — housing, utilities and purchases — was not a factor.

For many study participants, their circumstances became worse with alcohol or drug addiction or problem gambling.

Most especially, those with numerous sources of debt and who had to obtain cash from pawnbrokers or lenders exhibited the highest rates of mental illness.

As a result, researchers concluded that debt is one of the major risk factors for mental illness. They added that this has implications for both health and financial services providers, both of which entities must be mindful of the connection and adapt and train their services so those with debt can access help for mental illness.

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Last updated August 2014