The average medical school debt today, according to the Association of American Medical Colleges, is $156,456.

The United States is the only country in the world were future doctors have to bear such a financial burden of their education.  That places significant strain on any relationship involving an American medical student.

Recently, there was an interesting piece in the New York Times discussing this very issue. The article profiled a female medical student who had amassed $250,000 of school debt:

Still, if she and [her boyfriend] Mr. Kogler are going to move in together and get engaged, she wants their financial arrangements to be clear and fair. But how do you define fair when you’re bringing a quarter of a million dollars in debt to a relationship?

Indeed. It’s an issue that’s rarely discussed, yet frequently encountered by medical students. With that degree of debt, there is little room for flexibility should one’s future plans change. You have to continue working to pay off the loan.

For instance, what if this female student, who now says she intends to continue working full-time while raising a family, changes her mind later? Or something unforeseen happens, like having twins or triplets?

These often unspoken issues place significant strain on relationships. And it gets uglier should divorce enter the picture:

… if [a divorce lawyer] was representing someone like [the profiled student Kerrie] Tidwell’s boyfriend in a divorce, she would argue that he deserved a sort of refund for everything he paid toward household expenses even if Ms. Tidwell were making the loan payments out of her salary alone.

So, a word of advice to anyone currently dating an American medical student. Debt will enter the picture, and it may be better to discuss its implications on your relationship sooner rather than later.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on Facebook, Twitter, and LinkedIn.