Forgiven but not Relieved: US Physician Workforce Consequences of Changes to Public Service Loan Forgiveness.
Public Service Loan Forgiveness (PSLF) was established in 2007 for public sector and nonprofit enterprise employees to pursue educational loan forgiveness. Under PSLF, graduates are offered complete loan forgiveness after 120 qualifying monthly payments while employed at public or nonprofit institutions, including payments made during residency for physicians. In response to concerns that PSLF will heavily subsidize lawyers, doctors, and other professionals, the President's 2017 budget proposes limiting maximum forgiveness. Using data from the Association of American Medical Colleges Graduation Questionnaire (n = 55,905; response rate of 80 %), we found that intended participation in PSLF among medical school graduates grew 20 % per year since 2010. Future primary care physicians intend to use PSLF more than programs that were historically designed to promote primary care, such as the National Health Service Corp (NHSC). The federal government's projected cost of PSLF will reach over $316 million for 2014 graduates (net present value), approximately seven times the annual contributions from the NHSC. The proposed cap will reduce the total anticipated forgiveness by nearly two-thirds and substantially reduce subsidies for physicians. More targeted measures of loan forgiveness could be considered, such as making forgiveness contingent on pursuing specialties that society needs or practicing in shortage areas.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Ari B
AB
Friedman
University of Rochester School of Medicine, Rochester, NY, USA.
Justin A
JA
Grischkan
Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY, 14642, USA.
E Ray
ER
Dorsey
Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 673, Rochester, NY, 14642, USA. Benjamin_George@URMC.Rochester.edu.
Benjamin P
BP
George
D002321:Career Choice; D004501:Education, Medical / Q000191:economics*; D061347:Forgiveness; D006801:Humans; D009939:Organizations, Nonprofit; D010820:Physicians / Q000600:supply & distribution; D011320:Primary Health Care; D017150:Public Sector; D014146:Training Support; D014481:United States; D000078329:Workforce
health economics; health finance; loan forgiveness; medical education; medical education debt; medical students; physician manpower; physician shortage; primary care workforce; student loan repayment