For as long as I can remember, I’ve wanted to be a physician.

My journey to medicine is not unique. My motivations ring familiar to all health care workers. Many medical students are cut from the same cloth in this regard. We want to help people, to use science to alleviate human suffering, and to push the envelope of medical research. But we also want to earn a living and have a stable career. We carry open minds regarding our future specialties, and we want to pursue specialty training in a field that we love. Unfortunately, the harsh reality that primary care is becoming more of a specialty that will not pay the bills weighs on the minds of all U.S. medical students. While this seems hard to believe given that physicians are among the top earners in America, I will explain the path to become a physician in the U.S. for those who are unfamiliar with it.

Medical students in the U.S. attend undergrad university for four years, earn a degree, then attend medical school for another four years.

After that, students enter a residency training program for a specific specialty for another two to seven years. When the dust settles, medical students have exhausted around eleven to thirteen years to become a practicing physician. After bidding a reluctant adieu to your 20s, and spending a residency earning anywhere from $12 to $15 an hour while working 80 hours a week, practicing physicians deserve to be compensated for their skills. The problem lies in the fact that not all physician specialties offer pay and lifestyle which offset the attendant opportunity cost of becoming a physician. This opportunity cost comes in the form of time and a massive debt accrual.

Since 1998, the average debt that an American medical student accrues over four years of medical school has increased by around $80,000 when adjusted for inflation.

Additionally, since 2001, indexed year-over-year percentage change and fees revenue increased by 81 percent across all medical schools. Essentially, medical school tuition and fees have even outpaced inflation. Even living within my means, and choosing to attend medical school at the cheapest institution which accepted me, I myself will still graduate with almost $300,000 worth of debt in tuition alone—to say nothing of living expenses. When I graduate, I predict that I will be around $400,000 in debt.

The following thought naturally passes through the minds of many U.S. students:

Why would I go into primary care when I am in at least $250,000 worth of debt (this number is significantly higher for many), the pay is low given how overburdened primary care is with patients, and Medicaid and Medicare reimbursement cuts continue to climb? This thought is not hyperbolic. All of these problems—administrative burden, low pay, debt, and inadequate reimbursement—are real. In the end, it becomes more financially feasible to pursue a high-paying specialty that allows you to pay off that debt much sooner.

I want to be positive, but when I hear predictions from experts that there will be a shortage in America of between 17,800 and 48,000 primary care physicians by 2034, it seems hard to be optimistic.

Every year Congress attempts to pass some sort of compromise that would increase Medicare physician pay, but when these deals become fully realized they never fully cover the cut in Medicare fees.

A critic may point out that educational loan repayment programs, offered through the government or an employer, can sometimes pay up to $100,000 toward a physician’s debt.

While true, these programs are not offered to all primary care physicians, they are not easy to obtain, and they do not cover every type of loan.

So what is to be done?

The American Medical Association (AMA) has highlighted the many steps that can be taken to fix the debt problem, and has even pledged to address the cost of medical education. Here, I will list a couple of these solutions:

• Something should be done to allow medical students to qualify for interest-free deferment on student loans while they are in residency. Congress has even drafted different legislation to address this issue.
• Something must be done in the way of advocacy to cap or reduce medical school tuition.
• Encourage and advocate for the expansion of federal and state loan repayment programs.

Unfortunately, medical students are reluctant to talk about this because discussing compensation, lifestyle, and debt distracts from the noble merit of the profession.

However, we need to normalize the realities of the profession. If we cannot make progress in this issue, the primary care shortage will only worsen.

Alexander Camp is a medical student.