Scheckel CJ, Richards JR, Newman JR, Fangman BD, Poole KG. How Trainees Finance Their Medical Education: Implications of Higher Education Act Reform. J Am Osteopath Assoc 2020;120(6):370–379. doi: https://doi.org/10.7556/jaoa.2020.058.
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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.
To better understand relationships between debt and personal stress, as well as between repayment- and forgiveness-program use, in the context of competing legislation.
Surveys were sent to all Accreditation Council for Graduate Medical Education−accredited internal medicine residency programs (osteopathic and allopathic).
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.
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.
a 290 respondents (71.9%) completed the demographic portion of the survey.
Abbreviation: PGY, postgraduate year.
a Data are given as No. (%).
b Stress levels were significantly different (χ2 test) when comparing those with and without any educational debt (P<.001) and comparing those with debt, stratified by quartiles (P<.001).
c Quartile 1, less than $175,000; quartile 2, $175,000 to $225,000; quartile 3, $225,000 to $300,000; and quartile 4, greater than $300,000.
a Data are given as No. (%) unless otherwise indicated.
b Quartile 1, less than $175,000; quartile 2, $175,000 to $225,000; quartile 3, $225,000 to $300,000; and quartile 4, greater than $300,000.
Abbreviations: IBR, income-based repayment; ICR, income-contingent repayment IDR, income-driven repayment; NHSC/IHS, National Health Service Corps/Indian Health Services; PAYE, pay as you earn; PSLF, public service loan forgiveness; RePAYE, revised pay as you earn.
Abbreviations: IDR, income-driven repayment; OR, odds ratio; PAYE, pay as you earn; PSLF, Public Service Loan Forgiveness; Q, quartile; RePAYE, revised pay as you earn.
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