Reduce Medical Student Debt by Levone

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									Reduce Medical Student Debt
Invest in Programs that Support the Primary Care Pipeline
The Impact of Medical Student Debt on Primary Care The demand for primary care in the United States is expected to grow at a rapid rate while the nation’s supply of primary care physicians is dwindling and interest by U.S. medical school graduates in pursuing careers in primary care specialties is steadily declining. The reasons behind this decline in primary care physician supply are multifaceted and complex, including the rapid rise in medical education debt. The Association of American Medical Colleges estimates that over 86% of graduating medical students have educational debt. The average U.S. medical school graduate in 2008 carried a debt burden of over $145,000 for students at public medical schools and $180,000 for those at private medical schools. Unless steps are taken now, there will not be enough general internists to take care of an aging population with a growing incidence of chronic diseases. The Need for Loan Deferment The elimination of the 20/220 economic hardship deferment pathway, the pathway that most residents relied upon, presents an additional financial burden to young doctors. The 20/220 is a debt-to-income ratio pathway that enabled many residents to qualify for economic hardship deferment, and defer payment for three years without accruing interest on subsidized loans. Residents qualified for 20/220 rule if their debt burden was greater than 20 percent of their income, and if their income minus their debt burden was not greater than 220 percent of the federal poverty level for a family of two ($13,690). Approximately 67% of residents relied on the 20/220 pathway to defer loan repayment during their residency training. Unfortunately, while deliberating higher education issues in 2007, Congress decided to eliminate the 20/220 loan deferment pathway in the College Cost Reduction and Access Act (P.L. 110-84). Strengthen Programs to Help Restore the Primary Care Pipeline The National Health Service Corps (NHSC): The NHSC scholarship and loan repayment programs provide payment toward tuition/fees or student loans in exchange for service in an underserved area. The programs are available for primary medical, oral, dental, and mental and behavioral professionals. Participation in the NHSC for four years or more greatly increases the likelihood that a physician will continue to work in an underserved area after leaving the program. Title VII Health Professions: Title VII of the Public Health Service Act offers several programs that provide vital training for physicians in the field of primary care. These programs include: the Primary Care Loan (PCL) program, the Faculty Loan Repayment program, and the Scholarships for Disadvantaged Students program. Sustaining and improving these programs through increased funding is critical in the effort to produce more primary care physicians. Conclusion The federal government should address the problem of rising medical student debt and create incentives for medical students to pursue careers in primary care and practice in areas of the nation with the greatest need. This can be done by developing or expanding programs that reduce or eliminate student debt for physicians choosing primary care, including:    New loan repayment and medical school scholarship programs in exchange for primary care service in critical shortage health facilities and geographic areas; Increase funding for scholarships and loan repayment programs under Title VII; Increase funding for National Health Service Corps scholarships and loan repayment programs; and Restore the 20/220 pathway, as addressed in legislation (S. 646/H.R. 1615) introduced by Senator Richard Burr (R-NC) and Rep. Vernon Ehlers (R-MI).

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