Anna Tucker will graduate from the Medical University of South Carolina in May facing $250,000 in student-loan debt.

Physician compensation

Average national annual salary:

Orthopedics: $405,000

Cardiology: $357,000

Dermatology: $306,000

General surgery: $279,000

Oncology: $278,000

Emergency medicine: $270,000

Obstetrics/gynecology: $242,000

Internal medicine: $185,000

Family medicine: $175,000

Pediatrics: $173,000

Source: Medscape 2013 Physician Compensation Report

She said her husband Michael, also a fourth-year medical student, borrowed about the same amount.

The total bill won't need to be paid immediately, but still, what they owe is formidable. These two 26-year-old students on the brink of their medical careers are staring at $500,000 in debt before they've made one dime as doctors.

"I think a lot of people outside the medical world think that doctors make a lot of money, but it's because they don't know the truth," Anna Tucker said. "We're not going to be millionaires in five years - or ever - and we don't want to be. That's not the reason why we chose to be physicians."

Doctors graduate from MUSC with an average debt of $192,073 - $32,000 more than the national average, said Dr. Etta Pisano, dean of the College of Medicine, at a recent MUSC Board of Trustees meeting. School administrators believe it may be one of the reasons fewer medical school graduates choose to pursue a career in primary care medicine.

Primary care physicians, including family doctors, pediatricians, internists and general surgeons, make less over their careers than most doctors who practice in specialized fields.

During one year alone, orthopedic surgeons will earn an average $405,000 - more than twice what family physicians make, according to Medscape's 2013 physician compensation report.

While MUSC administrators do not counsel medical students to make career decisions based what they could earn, the number of residency positions in South Carolina shows there are fewer opportunities for new physicians to train in a primary care field.

Last year, of the 1,385 residency slots available in South Carolina, 803 were geared to train doctors in medical specialities, while 582 were designated to train doctors in primary care. At Medical University Hospital, the largest teaching hospital in South Carolina, only 31 percent of residency positions were in primary care.

Those numbers need to change, according to a report published last week by the South Carolina Graduate Medical Education Advisory Group. This state needs more primary care doctors, the report indicates, particularly ones who want to practice in rural, underserved areas.

The report lists 11 recommendations that may soon require MUSC and other teaching hospitals in South Carolina to figure out how to fix this shortage of primary care physicians. Some of the ideas include recruiting more students from rural South Carolina to go to medical school, and admitting more students who indicate they eventually want to become primary care doctors.

Dr. Pat Cawley, executive director of Medical University Hospital and a member of the advisory group, said all this is easier said than done - particularly because the state government isn't offering more money to create new primary care residency positions.

"It's more than a maldistribution problem. It's a total numbers problem," Cawley said.

MUSC receives $108 million a year in state and federal Medicaid funds - more than any other hospital in South Carolina - to help pay for graduate medical education.

The advisory group suggested that Medicaid withhold up to 15 percent of the money that teaching hospitals in South Carolina receive to ensure that the recommendations in the new report are addressed.

It has been sent to the state Medicaid director and the Legislature for discussion.

While state leaders consider these recommendations, Anna and Michael Tucker are waiting to plan their next career move.

Both are pursuing residencies in primary care next year, and hope to stay at MUSC to continue their training. The Tuckers won't find out where they will end up until Match Day on March 21.

Anna wants to become a pediatrician; her husband wants to be an internist. While Anna said those decisions are based on their passions, not their earning potential, she said she knows their choices will impact their financial future.

"It's daunting to have this much debt coming out of school," she said. "We want the same things that other people want. We want a house. We want to raise a family. We don't want to be in debt for the rest of our lives."

Reach Lauren Sausser at 937-5598.