WASHINGTON - Nida Degesys is about to become a doctor. Her husband, David, is a lawyer. Between them, they have $400,000 in student loans.
A fourth-year student at Northeast Ohio Medical University near Akron, Degesys says the prospect of paying off that kind of debt is "a little stressful and challenging" as she tries to complete her training over the next few years.
Degesys, a vice president of the American Medical Student Association (AMSA), is hardly alone. Medical students graduating this year face average loan debts in excess of $162,000.
There's growing concern that bright but middle- or lower-class students may not be willing to take on such a burden. At the same time, the country is estimated to need an additional 20,000 to 60,000 doctors over the next two decades.
At 28, after postgraduate work, a stint in the Peace Corps in Panama and medical school, Degesys still has several years of residency ahead, where she can expect to earn around $50,000 a year -- and pay at least 10 percent of it toward her loans.
"It's one thing making ends meet on that in Akron, another if you do a residency in New York or San Francisco," she said. Her husband is an assistant law professor and manager of a nonprofit. "By no means will there be any new cars, anything like that."
Dr. Elizabeth Wiley, 34, is a lawyer-doctor and master of public health who recently graduated from George Washington University and is completing her term as president of the AMSA. And she's considering what she must do to pay some $300,000 in student-loan debt.
"Medical education is already out of reach for many bright and talented students because they face hundreds of thousands in debt that we aren't able to pay during our residencies," Wiley said. A recent report from the Federal Reserve Board estimated that the total outstanding student loan debt in the U.S. exceeds $1 trillion.
While there have been no broad federal loan guarantees for medical education since the Health Education Assistance Loan program ended in 1998, there are still a number of options tied to financial need or willingness to practice in an underserved area.
The National Health Service Corps (NHSC) provides both scholarships and loan forgiveness, including an option that allows primary-care doctors, dentists and other professionals to earn up to $60,000 to repay student loans in exchange for two years of service in facilities in underserved cities and rural areas.
Although the NHSC has been around since 1970, it's grown sharply under the Obama administration.
There are nearly 10,000 professionals in the program now, almost triple the number in 2008. There are also some scholarships and need-based loan programs run through medical schools.
Officials say less than 1 percent of the students and professionals default or fail to complete their assignments today, although there were more defaults early in the corps program. "There are some pretty severe penalties for default, and we work closely with the professionals if they have some hardship," said Rebecca Spitzgo, director of the corps, which is run through the Health Resources and Services Administration.
Spitzgo also said surveys of corps alumni show that roughly 80 percent of them stay in the underserved area after their obligation ends.
There are also loan-forgiveness programs for professionals who work for government and qualified nonprofits, and a new income-based repayment option that keeps payments low while students complete training and establish careers.
Wiley, who's planning to join the NHSC herself, said the loans were crucial in encouraging medical graduates to take up family medicine and other primary-care fields. Otherwise, many would go into higher-paying specialties just to cover their debts.