Medical Education Debt/Loan Repayment- Forgiveness // ACEPIntroduction. Steady increases in medical school tuition and living expenses for medical students have resulted in high levels of graduating student indebtedness, a matter of concern to the Association of American Medical Colleges (AAMC) and many specialty society organizations, including the American College of Emergency Physicians (ACEP), and to resident organizations, including the Emergency Medicine Residents' Association (EMRA). In response to this concern, ACEP's Academic Affairs Committee (AAC), in collaboration with EMRA, developed a module, the . We also provide preliminary information on current programs that are available to address medical education debt and loan repayment forgiveness for resident trainees. Background. ACEP staff met with the leadership of the National Health Service Corps (NHSC) in September 2. EPs) in underserved areas. The NHSC has always been focused on providing primary/outpatient care to underserved areas/populations. Under- service is characterized by Health Professions Shortage Area (HPSA) designations that are generated from physician/population ratios. The Public Health Act (PHA) is the controlling statute for HPSA designation and NHSC and explicitly identifies family medicine, obstetrics/gynecology (OB/GYN), and general pediatrics, internal medicine, and psychiatry as eligible physician specialties. This means that the law would have to be changed to add emergency medicine to the list of physicians eligible for scholarship and loan repayment. Less than 4,0. 00 clinicians are currently supported by NHSC, which includes nurses, counselors, dentists, and other health care personnel. While the American Hospital Association's (AHA) Small and Rural hospital section director stated that members would welcome more board- certified emergency physicians, the NHSC physicians generally become employees of the Federally Qualified Health Clinics or set up private, office- based practices subsidized by the communities. In recent years, NHSC's annual budget has remained fairly stable at $1. M. The funds have been shifted to loan repayment while scholarship dollars have dwindled and are largely directed to racial/ethnic minorities. NHSC requires a minimum 2- year commitment in order to receive partial debt relief, though many clinicians remain for five years in order to receive full loan forgiveness. ACEP's Public Affairs staff have monitored the provisions of the PHA (including NHSC and HPSA designation criteria) as they came up for reauthorization in 2. Lobbying efforts to include emergency medicine as a primary care specialty eligible for NHSC funding have not been successful. Continued efforts to lobby for this designation are limited by available NHSC funding, attempts of multiple other specialties trying to qualify for primary care loan reimbursement, and other high priority issues (access to care, overcrowding, etc.) with limited time and resources available for lobbying. To obtain more information/data on the need and demand for EPs in rural or underserved areas, subcommittee members and ACEP staff have contacted members of the ACEP's Rural Section and other organizations such as the Rural Appalachian Organization, and the National Rural Health Association. From the supply side, in 2. EMRA conducted a resident survey to obtain information on EM residents' interest in loan forgiveness programs and their willingness to work in rural and underserved areas. The Council for Emergency Medicine Residency Directors (CORD) also conducted a survey on program interest in rural EM and support for resident electives in rural EM. Results of EMRA's survey are noted below. EMRA Rural EM Survey, 2. N= 3. 14 respondents). Ohio Physician Loan Repayment Program. The 2016 application cycle closed on June 30, 2016. Information on the 2017 application cycle will be posted as soon as it is available. The goal of the Ohio Physician Loan.
ACEP should be making real efforts to encourage residency trained physicians to look at opportunities in rural areas, and loan repayments are a great way to start. I'm from a small town, and would love to go back. Loan repayment for ED in rural areas is an absolute necessity as these facilities are grossly understaffed. We all seem to recognize the need in the dense urban populations, but fail to remember that the rural poor suffer from inadequate preventative care as well. The Ohio Physician Loan Repayment Program offers loan repayment assistance to primary care physicians who agree to practice in a Health Professional Shortage Area (HPSA) or Health Resource Shortage Area of Ohio, accept. Unfortunately, there seems the need for some incentive to care for this population in order to offer the clinician a competitive place in the field. In September 2. 00. ACEP President Frederick C. Blum, MD, FACEP, FAAP, sent a letter to the three organizations updating them on ACEP's continued efforts to address a council resolution relating to this issue. Other advocacy activities have also been initiated by ACEP. In June 2. 00. 6, ACEP sent a letter to the Centers for Medicare and Medicaid Services (CMS) in response to its proposed changes to the hospital inpatient prospective payment system. Unfortunately, CMS subsequently determined that ED rotations away from the parent institution will not be allowed to be credited in the parent institutions accounting of resident service for which the parent institution may receive Medicare GME funding, thus the barrier to rotations in rural ED settings still exists for the vast majority of training programs. On March 2. 2, 2. ACEP submitted a follow up response to this decision to the CMS leadership in a continued effort to convince them to change their interpretation of the allocation of Medicare GME funds to parent institutions for away ED clinical rotations. This change, if implemented, would eliminate a major financial barrier for programs that choose to provide residents with rural EM training experience(s). The Problem. Medical School Tuition and Young Physician Indebtedness. All rights reserved. Reproduced with permission of the Association of American Medical Colleges. How do students expect to finance their medical education? Data from the AAMC Matriculating Student Questionnaire demonstrate that student expectations for financing their medical education have shifted substantially toward loans and scholarships (see figure below). In 1. 98. 7, the average student expected to pay 4. By 2. 00. 3, expectations of support from family, personal and other sources had all substantially declined, with the aggregate percentage for these sources reduced to 2. This change is an indication that the cost of a medical education is becoming more difficult for students and their families. Medical School Tuition and Young Physician Indebtedness. All rights reserved. Reproduced with permission of the Association of American Medical Colleges. The Current Landscape: Paying for Medical School. Scholarships that offset medical education costs. A. Medical school- provided scholarships are significant. Scholarships are a significant help to students in coping with the cost of medical school attendance, amounting to 2. For students in public medical schools, tuition costs are lower than in private schools, but the other costs of attendance are roughly the same. Because scholarships provide only 1. B. Non- medical school- provided scholarships available to students. The 1. 70 graduates of the class of 2. Uniformed Services University of the Health Sciences paid no tuition and were paid while students as commissioned officers in the Army, Navy, or Air Force. A total of 1. 95. The National Institute of Health (NIH)- sponsored Medical Scientist Training Program provides full support for almost 9. MD- Ph. D program, and there are state- supported scholarships with a service requirement as well. The National Health Service Corps provides scholarships and a stipend for students willing to practice in a health professions shortage area. Programs of this type may account for a substantial part of the group of students graduating with little or no medical school debt. Unfortunately, this scholarship program has recently seen major cuts in funding and is virtually not available for new students, though funding is still available for the NHSC loan repayment program (see below) Note: EM residents do NOT qualify (the NHSC programs are only available to primary care specialties; our ACEP lobbying efforts have not been successful in getting EM included in the primary care category). Debt repayment (forgiveness) programs for students/residents. In addition to the scholarship program, the National Health Service Corps (NHSC) also has a program to repay a part of a graduating student's debt in return for contracted service in a shortage area. In fact, the NHSC program now expends most of its funds, $3. In 2. 00. 3, there were 7. A program like this can ease the repayment burden for new physicians, especially those with high educational debt. There are more applicants than can be accommodated, however, and the program is quite small in relation to the need. The loan forgiveness program is handled internally by the HIS Recruitment Office and an interested physician applies at the IHS Rockville, MD office. Once accepted to the program, the physician secures an EM job in one of the IHS or Tribal Hospitals/Service Units (SU). That SU would submit their endorsement for this EM candidate annually; currently, candidates are eligible for a two year loan replacement currently set at $2. For more information, contact: David R. Over 7. 0 programs are operated by states, and the ACEP AAC Subcommittee, with the assistance of state ACEP chapters, should assemble a list of these programs. While many states get matching dollars from the Federal government, some are totally state- funded and have more flexibility to choose which specialties to support. Specific examples include: Kansas: The Kansas Medical Student Loan is awarded on an annual basis in return for agreements to practice medicine in the state. The Kansas Medical Student Loan provides payment of tuition and living expenses of up to $1. Kansas. Arkansas: An Arkansas resident who has been accepted to or enrolled in the University of Arkansas College of Medicine may be approved (post interview) by the Arkansas Rural Medical Practice Student Loan and Scholarship Board to receive $1.
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