Student loan debt, long hours tied to increased burnout in early-career family physicians

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A new national study from the American Academy of Family Physicians suggests that high medical school debt and long work weeks are fueling burnout among early-career family physicians, raising concerns about the sustainability of the primary care workforce.

Published in the Annals of Family Medicine by researchers from the Medical College of Georgia at Augusta University and the American Board of Family Medicine, the study linked survey responses from 4,905 U.S. family physicians who were three years into practice. The study determined that physicians carrying the heaviest debt loads were more likely to work longer hours, and both factors were independently tied to symptoms of burnout.

Debt and workload pressures

Just 18% of surveyed physicians had no educational debt at the time of residency graduation, while 16% reported owing more than $350,000. Debt correlated with work hours: physicians with higher balances were more likely to work 60 or more hours per week.

Overall, 44% of respondents reported symptoms of burnout — feeling burned out or more callous toward people at least weekly. Rates of burnout rose in stepwise fashion, with both increasing debt and increasing hours worked.

After adjusting for other factors, physicians with $250,000 to $350,000 in debt had 24% higher odds of reporting burnout symptoms compared with those with no debt. For those owing more than $350,000, the odds were 47% higher.

Working 60 or more hours weekly was linked to nearly triple the odds of burnout compared with working less than 40 hours a week.

What it means for primary care

The study underscores tension at the heart of family medicine. Physicians in primary care often earn less than specialists, making debt repayment more difficult and potentially requiring longer hours in practice settings where demand is already high. For new physicians trying to establish themselves in outpatient continuity care, this combination can accelerate burnout and limit retention.

Dean A. Seehusen, M.D., M.P.H., department chair at the Medical College of Georgia at Augusta University, led the research team. In their discussion, the authors noted that debt may represent a “double risk” for young physicians: direct financial stress and pressure to work longer hours to pay it down.

Notably, women and international medical graduates were more likely to report burnout symptoms, and family physicians in Federally Qualified Health Centers (FQHCs) and managed care organizations had higher odds of burnout compared with those in independently owned practices.

Policy and practice considerations

Family medicine graduates have some of the highest debt burdens in medicine. According to past studies, this influences both specialty choice and career paths. Rising debt may push medical students away from primary care or discourage family physicians from pursuing academic or leadership roles, further straining a workforce already facing shortages.

Physicians in the Southern United States were somewhat less likely to report burnout than their peers in the West, though the reasons for this difference are unclear.

Participation in loan repayment programs was common — more than half of respondents were enrolled in some form of repayment plan — but the study found that these programs did not erase the correlation between debt and burnout.

“Health system leaders, policymakers and legislators should explore additional ways of reducing this burden on early-career family physicians,” the study authors wrote, concluding that “finding ways to reduce the educational debt burden on early-career family physicians may therefore be an especially potent way to reduce burnout symptoms.”