Stephen C. Shannon, DO, MPH
President
Student Debt, the National Health Service Corps and Other Programs that Can Help
One of the biggest challenges facing today’s osteopathic medical students is the significant debt burden most of them carry into their first years as physicians. From 1999 to 2008, DO graduate self-reported mean educational debt grew by 54 percent, from $116,700 to $179,790.
Of course, physician salary levels have grown some during this period as well. But this growth has been inconsistent and specialty specific – what little growth occurred in primary care median income levels in recent years did not keep up with inflation. For example, the median salary for a family medicine physician changed from around $145,000 in 2001 to $159,000 in 2009, an increase of roughly 10 percent. During the same period, inflation in the United States was around 20 percent. In addition, during their early years in practice, physicians’ earning power is not as high as it will be later in their careers, which may make it particularly difficult for new physicians to balance living expenses and loan repayment.
A wide variety of loan repayment and scholarship opportunities provide some relief, and greater knowledge of these programs among current and potential medical students could serve the dual purposes of reducing debt load and beefing up the nation’s primary care workforce (and the physician workforce in general).
The recently revamped and re-energized National Health Service Corps (NHSC), for example, may be a solution for some young physicians. The new administration has prioritized an expansion of primary care services for rural and underserved populations as a part of the American Reinvestment and Recovery Act (ARRA or ‘Stimulus’ funding), which has resulted in a doubling of NHSC funding for its Loan Repayment Program. In addition, the application process has become more ‘user friendly,’ with ongoing electronic applications accepted on a rolling (rather than annual) basis. Primary care graduates may find that this program offers a good path toward loan repayment along with a rewarding clinical experience serving populations with real needs. The program provides $50,000 (or the outstanding balance of qualifying student loans if it is less than $50,000), tax free, to primary care medical, dental and mental health clinicians in exchange for two years of service at an approved site in a Health Professional Shortage Area.
The NHSC also offers a scholarship that covers tuition, required fees, and some other education costs, tax free, for as many as four years of medical training. Recipients also receive a monthly (taxable) living stipend ($1,269 in 2009-2010). National Health Service Corps scholars must serve one year for each year of support (minimum of two years of service) at an approved site in a high-need Health Professional Shortage Area soon after they graduate, serve a primary care residency (family medicine, general pediatrics, general internal medicine, obstetrics/gynecology or psychiatry for physicians) and be licensed.
The Indian Health Service (IHS) Loan Repayment Program (LRP) also provides financial relief to new physicians. The IHS is an agency within the Department of Health and Human Services responsible for providing health care services to American Indians and Alaska Natives. The LRP awards up to $20,000 per year for the repayment of qualifying health professions education loans. Award recipients agree to a two-year obligation to practice at an Indian health program site.
The IHS offers the Health Professions Scholarship Program to American Indian and Alaska Native students who are members of their Tribe (federally recognized only) and enrolled in health professions and allied health professions programs. Students incur service obligations and payback requirements on acceptance of funding from this program. Scholarships are awarded for a one-year period (12 months of support), with re-application required for each year of continuation.
Various branches of the U.S. armed services offer similar loan repayment and scholarship programs, in exchange for service obligations. Several states, particularly those with large rural or other high-need populations, also offer similar programs for students who agree to serve in those states following graduation.
This is a particularly good time for students and potential students to apply for these opportunities, as many programs have been recently expanded as part of the administration’s stimulus initiatives. Thus, I encourage faculty and administrators to help spread the word regarding these programs, and students and potential students to explore whether they might minimize their debt while serving the nation’s high-need populations. The bottom line is a win-win for students and the U.S. health care system alike.
Editor's Note: In the February issue of Inside OME, AACOM will provide in-depth information on the loan repayment and scholarship programs offered through both the National Health Service Corps and the Indian Health Service, and how these programs serve osteopathic medical students and new osteopathic physicians.