# A U.S. based survey of loan burden among anesthesia trainees and its impact on well-being

## TL;DR

This study finds that U.S. anesthesia trainees from underrepresented and first-generation backgrounds face higher loan burdens, which affect their life decisions and well-being.

## Contribution

The study is the first to examine loan burden disparities among underrepresented, first-generation, and female anesthesia trainees and their impact on well-being and life decisions.

## Key findings

- Trainees from underrepresented and first-generation backgrounds have significantly higher odds of high loan burden.
- High loan burden is strongly associated with delaying major life decisions like buying a home or having children.
- Disparities in life decisions persist even after adjusting for loan burden, particularly for female-identifying trainees.

## Abstract

Loan burden presents a significant barrier for trainees in different
medical fields. However, disparities in loan burden of anesthesia trainees
of underrepresented in medicine (URiM), first-generation and
female-identifying backgrounds have not been studied. Moreover, it is not
known whether membership in these groups is associated with well-being or
life decisions after controlling for loan burden.

In this cross-sectional observational study, an online survey was
disseminated by the American Society of Anesthesiologists (ASA) to
anesthesia trainees in the United States (U.S.) from October to November
2022. Demographic information, Harvard Mental Health Continuum-Short Form
(MHC-SF) well-being scores, and whether trainees perceive loan burden as
delaying buying a house or having children were all collected. We evaluated
associations between demographic group memberships, probability of having
high loan burden, and delayed life decisions and well-being before and after
adjusting for high loan burden.

The study represents 952 of 6,502 U.S. trainees (14.6%). The
respondents had a mean age of 31 years, and 385 identified as female
(40.4%), 150 as URiM (15.8%), and 634 as first-generation college (FGC)
trainees (66.6%). The proportion of trainees with high loan burden was
higher in the URiM 138 (92.0%) and FGC groups 565 (89.1%). Trainees in the
high loan burden group were more likely to delay having children (OR = 3.69,
95% Simultaneous Confidence Interval (SCI) 2.38–5.73) and delay
buying a home (OR = 5.27, 95% SCI: 3.45–8.05). Once loan burden was
adjusted for, many disparities persisted in associations: URiM delaying
buying a home (OR = 2.14, 95% SCI: 1.01–4.54), FGC delaying buying a
home (OR = 1.56, 95% SCI: 1.02–2.38), female-identifying delaying
children (OR = 1.49, 95% SCI: 1.04–2.13) and female-identifying
well-being (Diff = −3.47, 95% SCI: −5.83, −1.11).

FGC and URiM anesthesia trainees have significantly higher odds of
having high loan burden and continue to experience disparities in life
decisions after controlling for loan burden. Female-identifying trainees
have significantly higher odds of delaying childbearing and have lower
well-being after controlling for loan burden.