The problem of debt repayment for entry level radiologist is not just one of financial challenge for the borrower. Rather it is an issue for all of Radiology as indebtedness directs career choices. And with the costs of college and medical school increasing coupled with relatively low salaries and mandated expenses throughout residency, average educational loan obligations of newly minted radiologist are well over $100,000. This has caused some trainees to consolidate their debt into a 30 year pay back agreement that allows the lender to alter the interest rate according to circumstance and opportunity.

An upshot of this phenomenon is the decision of some recent graduates of Radiology residencies to seek employment in private practice initially, even though their predilections might be for an academic position. The entry level differences between the two, average $50,000. Hence as behavior often follows the money, the lure of private practice is siren like. The issue of indebtedness affects the majority of residents. Perhaps to an even greater degree it is a constraint for minority residents because their debt load tends to be higher.

In this two part review, I will attempt to place resident debt in a socioeconomical context, offer data on the extent of the crisis for radiologists and for Radiology and also provide a few remedies.

The subject of this presentation is the debt crisis in education. What you might say, has this to do with Radiology practice and, on first glance perhaps for many of you who are outside academia, you might also say, what this has to do with me? Well, our specialty, like all others needs to maintain a modus vivendi among research, education and the provision of care. Ignore any of the three and the specialty would wither from lack of attention to new knowledge in a competitive environment among all specialties, lack of adequate training of those who will become our investigators and practitioners and lack of protection for practitioners as they seek opportunities to maintain and expand the fruits of their expertise. So we are all inextricably linked. A crisis in one should be an issue for all. And now there is indeed a crisis that bears upon the vitality of academic radiology although it also may appear to confer a Janus-faced benefit to private practice—a short term gain but a long term deficit.