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    Paying the piper

    Implications of high levels of medical student indebtedness

    Peter J. McDonnell, MD
    A while ago, I wrote here that we academicians were discouraging young ophthalmologists from following in our footsteps. This is because of the many years of study (medical school, internship, residency, and fellowship) and the associated high level of student loan debt.

    The average American medical student graduated with $140,000 in debt in 2007. Apparently cumulative student loans of as much as $250,000 are not unheard of. Many trainees have young children by the time they finish fellowships and feel they cannot pursue academic careers because of the lower payscale relative to private practice.

    My proposed solution: reduce the number of years for training. Some loyal Ophthalmology Times readers vehemently disagreed with me, accusing me of being anti-academic, but others agreed.

    Recently my daughter, who is a first-year medical student, told me that newspaper reporters were inquiring of her fellow students if any of them were sex workers.

    According to a recent study of British students published in the British Medical Journal, male and female students are working as prostitutes or escorts to make ends meet.1 Ten percent of students surveyed reported knowing a classmate who had worked as a prostitute or escort in 2010.

    Prostitution is legal in England, and The English Collective of Prostitutes reports having medical students in its network and is receiving "an increased number of calls from students considering sex work."2

    A French student union claims that as many as 40,000 students work as prostitutes in that country, an assertion the author of the British study describes as "difficult to prove."

    "Jobs in retail stores and bars that students might take instead are increasingly scarce and offer low pay," according to the English Collective. It turns out that the American reporters were contacting my daughter's schoolmates in response to this European study.

    Is it an issue?

    "Is prostitution an issue for American medical students?" I wondered. It occurred to me that my friend, Bill, an ophthalmologist in private practice and volunteer faculty member in a prestigious California medical school, might be able to provide information, so I gave him a call.

    Me: "Hi, Bill. I need some information on prostitution."

    Bill: "Are you thinking about a certain amount of time, or specific acts?"

    Me: "I'm not sure what you mean. Actually, I am curious about prostitutes who are medical students or physicians."

    Bill: "Sorry, can't help you. I gave that up years ago when my practice got really busy."

    Me: "Bill, what are you talking about?"

    Bill: "What are you talking about?"

    Me: "There is a study just published indicating that medical students in Europe are becoming prostitutes in order to pay their tuition. I was trying to find out if that is happening in this country. What did you think I was asking about?"

    A long pause ensued.

    Bill: "Oh, nothing."


    1. Dixon J. Medical schools' attitudes towards student prostitution. BMJ. 2012;20;e913.

    2. Are med students turning to prostitution to pay tuition? http://vitals.msnbc.msn.com/_news/2012/02/28/10533696-are-med-students-turning-to-prostitution-to-pay-tuition/

    By Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

    He can be reached at 727 Maumenee Building 600 N. Wolfe St. Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail:

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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