Tuesday, December 31, 2019 Small-Scale Study Finds Large-Scale Debt Among Recent DPT Grads In this review: The Debt Burden of Entry-Level Physical Therapists (manuscript e-published ahead of print in PTJ, December 2019) The message It's a limited study—based on a small number of respondents who are early-career APTA members in Florida—but the conclusions might sound familiar to recent graduates of DPT programs: The average amount of educational debt owed by entry-level PTs is equal to almost two years’ average salary, a 197% debt-to-income ratio. That's more than the average debt-to-income ratio for newly minted family medicine physicians and veterinarians, according to the study's author, and a burden that may affect a PT's choice of practice setting. The study The analysis was developed from surveys administered to members of the Florida Physical Therapy Association's Early Professional Special Interest Group (SIG) in 2016, all of whom were entry-level professionals (0-5 years after graduation) and practicing as PTs in Florida. The final results were based on responses from 86 individuals (out of approximately 350 PT SIG members) who answered questions related to income, amount of debt held, and clinical practice choices. The study asserts that the sample reflects "all major practice settings." The study was authored by APTA member Steven Ambler, PT, DPT, MPH, PhD. Findings Average (mean) salary for respondents was $69,328. Salaries ranged from $55,000 in a school setting to $82,659 in a home health setting. The most frequently reported debt amount related to the DPT ranged from $100,000 to $124,999, with "relatively small" amounts of pre-DPT or non-educational debt reported. Monthly income dedicated to loan repayment averaged 10%—a figure that skewed lower because several subjects reported 0% repayment based on income-based repayment or loan repayment that had not begun. When those respondents were factored out, the average amount of income devoted to loan repayment per month was closer to 22%. While 83% of respondents indicated that the setting itself was the most important factor in deciding where to practice, 28% said that debt was a barrier to practicing in the setting of their choice. Overall, 57% of respondents acknowledged that student debt had affected their practice choice, with that relationship growing stronger as levels of debt increased. Why it matters The issue of student debt in general has grown in national prominence, with some studies showing that the levels of debt burden are affecting the overall US economy. Student debt for PTs and PTAs is a major focus for APTA, which views the cost of physical therapy education as a potential barrier to achieving greater diversity in the profession, and a burden that can contribute to burnout and attrition. The association has established a Financial Solutions Center that provides opportunities for loan refinancing as well as financial literacy. APTA also is advocating for federal programs, such as the inclusion of PTs in the National Health Services Corps, that would offer debt relief to participants. More from the study The 197% debt-to-income ratio identified in the study was more than double the estimated average ratio for family medicine physicians, which ranged from 80% to 90%, and surpassed the average debt-to-income ratio for veterinarians, which studies have estimated at 160% to 180%. Additionally, the average of 22% of monthly income spent on loan repayment among the PTs studied place them in a "hardship category of greater than 20% monthly income-debt ratio," which, Ambler indicates, has been shown in other research "to delay marriage and other personal decisions among young professionals." Keep in mind… The study has a small sample size, is limited to a single state, and is further narrowed by the fact that respondents were members of the state chapter of APTA and a particular special interest group. Further, the survey questions evaluated what the author describes as "personal, family, and institutional characteristics" that may offer further insights on debt burden. Finally, because information was collected via an anonymous survey, the author acknowledged that the results "are subject to selection bias." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.