Original Contribution  |   June 2020
How Trainees Finance Their Medical Education: Implications of Higher Education Act Reform
Author Notes
  • From the Department of Internal Medicine (Dr Scheckel) in the Division of Community Internal Medicine (Dr Poole) at the Mayo Clinic in Scottsdale, Arizona; the Department of Internal Medicine (Dr Richards) and the Division of Infectious Disease (Dr Newman) at the University of Kansas Medical Center in Kansas City; and the Department of Internal Medicine at the University of Texas Southwestern in Dallas (Dr Fangman). 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Jesse R. Richards, DO, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 2027, Kansas City, KS 66160-8500. Email: jesserichardsdo@gmail.com
     
Article Information
Original Contribution   |   June 2020
How Trainees Finance Their Medical Education: Implications of Higher Education Act Reform
The Journal of the American Osteopathic Association, June 2020, Vol. 120, 370-379. doi:https://doi.org/10.7556/jaoa.2020.058
The Journal of the American Osteopathic Association, June 2020, Vol. 120, 370-379. doi:https://doi.org/10.7556/jaoa.2020.058
Abstract

Context: The Public Service Loan Forgiveness (PSLF) program is among several repayment programs currently available for recipients of federal student loans. Medical education debt has continued to expand at a rapid pace in the decade since PSLF was created. Proposed changes to the Higher Education Act would substantially transform how future medical trainees finance and repay medical education debt.

Objective: To better understand relationships between debt and personal stress, as well as between repayment- and forgiveness-program use, in the context of competing legislation.

Methods: Surveys were sent to all Accreditation Council for Graduate Medical Education−accredited internal medicine residency programs (osteopathic and allopathic).

Results: From a potential pool of 579 residents, data were obtained from 403 unique respondents (response rate, 69.6%) at 12 residency programs, for a program response rate of 2.2%. Of these respondents, 290 (71.9%) completed the demographic portion of the survey. Median education debt was $225,000. Residents with the top quartile of debt burden were more likely to use PSLF (odds ratio [OR], 3.27; P=.02), more likely to enter loan forbearance (OR, 2.14; P=.03), and indicated a higher level of stress (OR, 5.94; P<.001) compared with those in the second and third quartiles.

Conclusion: Proposed legislative changes to the Higher Education Act would scale back loan repayment options and also eliminate PSLF for future borrowers. Our data suggest that higher debt burdens are associated with increased debt-related stress. Given program popularity and growing use, along with growing concerns of physician burnout, policy makers should weigh the potential downstream effects of policy change on prospective future physicians.

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