As the Daily Mail's Zack Harold reported this week, the average debt of medical school graduates in West Virginia is $186,000 - $156,425 at West Virginia University, $162,010 at Marshall University, and $240,283 at the West Virginia University School of Osteopathic Medicine.
That does not include student loan debt incurred for undergraduate education.
Doctors have to recover those costs somehow.
Med school officials told Harold that some do military work. Others contract with hospitals in return for debt reduction. Others sign up with the National Health Service Corps, which helps new doctor repay loans in exchange for serving in high-need areas.
But will physicians plant roots where West Virginia needs them if they can't make a decent living there? That's an open question.
It's all very well for politicians to have visions like "Health insurance for all!"
But in the end, the public has to pay the people who provide health care enough to cover the cost of their education, their operation, and their families - or they won't do it at all.
Reality is like that, and it can't be escaped.