The effect of education debt on PAs' specialty choice or preference.

Objective: This study investigated educational debt, repayment strategies, and other factors potentially related to recently certified physician associates/assistants' (PAs') choice or preference for primary care versus all other specialties.

Methods: A national dataset from 2023 of recently certified PAs was used to conduct quantitative and qualitative analyses. Analyses were conducted separately for PAs who had accepted a clinical position and those who had not accepted a clinical position.

Results: Overall, 88% of respondents reported having educational debt, with 13.5% owing $200,000 or more. PAs from backgrounds underrepresented in medicine had accrued higher educational debt than their counterparts. Educational debt was significantly associated with specialty choices/preferences: PAs with higher debt were more likely to opt for nonprimary care specialties. Qualitative analyses revealed that PAs rely on different strategies for repaying their loans, depending on whether they choose or prefer primary care or nonprimary care specialties.

Conclusions: These results suggest that educational debt plays a role in specialty selection, but other factors also are significant.