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September 12, 1990

The Debt and the Cash Flow of Residents: I. The Grim Present

Author Affiliations

Eastern Virginia Medical School Norfolk

Eastern Virginia Medical School Norfolk

JAMA. 1990;264(10):1247. doi:10.1001/jama.1990.03450100037006

To the Editor.—  The recent JAMA article about the effect of student loan indebtedness on resident cash flow1 and the Resident Forum2 that was published in the same issue address important issues facing today's house staff. Student loan indebtedness is a growing area of concern as the number of students who borrow and the amount of indebtedness at the end of medical school continue to increase. Careful examination of the model of Hernried et al1 reveals other stressful points. At many or most levels of indebtedness examined in the model, even eliminating loan payments as a yearly expense through deferment would not make up the cash-flow deficit for that year. This implies that annual stipends are not only inadequate to begin paying back loans, but also inadequate to meet annual basic living expenses.One alternative offered is to defer loan payments during residency. As the Resident