Availability of PSLF-eligible jobs after residency

[ZenScientist]

Hi everyone,

I'm an MS-IV who will be matching into Neuro this year and am trying to weigh PSLF vs private refinance for loan repayment. I know the neuro job market is hot right now, but unfortunately I don't have a good grasp of the availability of academic or non-profit jobs after residency which are PSLF compliant. I was wondering if anybody on here could help shed some light on how easy it is to find these opportunities once I'd be done with residency? So far it seems like WCI's advice on trying to go for PSLF and invest in a side fund if it goes belly up seems wisest, but I don't want to commit 4+fellowship years into PSLF to find I have no eligible non-profit jobs once I'm done training.

There is also an additional confounder insofar as my wife is also interested in academics (different field than neuro), but she is also willing to practice in private practice/groups if that's how the cards fall (she will luckily have no debt). I imagine having two people look for an academic jobs further narrows your choices.
Thanks for any advice y'all can provide!

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[Thama]

Most academic centers will be PSLF-compatible, though not universally. I've personally interviewed with one fairly prestigious institution where the faculty practice is its own for-profit entity and your primary employer, so most faculty there don't qualify for PSLF. It's something to ask about early in the process when looking for jobs. Academic jobs are not difficult to come by, especially clinical academic jobs in areas outside of competitive coastal metros.

Private practices will usually not be PSLF-compatible unless you're in a very underserved area and take a lot of Medicare/Medicaid. Even if you admit to a non-profit community hospital, your physician group will probably be for profit.

Make sure you start the PSLF clock during residency as you will almost certainly qualify while in training. You can be over half done after 4 years of residency and 1-2 years of fellowship if you maximize your time.

Relying on PSLF means that you'll be limiting your opportunities to some degree, but there are plenty of positions out there that qualify. If you're sure you want to do academics it's a pretty safe bet. If you plan to live in a nice area and go into private practice, then don't count on it.

 

[ZenScientist]

Thanks for the sage advice, I'm definitely trying to take my time to research the best route to handle my debt!

As a follow-up question, I was wondering if anyone could tell me how employment via teleneuro or telestroke works? I'd imagine that most of these jobs are not through non-profit employment and I'm not sure how I'd feel about locking myself out of that path if I opted for PSLF.

 

[Postictal Raiden]

For PSLF, you need to be employed and your paycheck needs to be written by a nonprofit organization

For example, I did a neurohospitalist job at a county hospital (nonprofit) but I was directly employed by a private group that contracted with the hospital. None of my payments during that employment counted towards PSLF

Tele doesn’t qualify. Most outpatient jobs don’t either since you’ll be part of a group.

The only jobs that I see qualifying for PSLF are university ones and jobs where you’re directly employed by a nonprofit hospital.

One of my friends is doing multiple fellowships: NCC + a year of epilepsy + now applying for NIR. By the time he’s done, he would have 9 years of his repayment period done in nonprofit university hospitals. He will only need to work one year at some academic center to qualify for PSLF.

 

[Telamir]

NCC + Epilepsy + NIR? Jesus Christ.

 

[CnsCrit]

One thing to consider is inpatient vs outpatient. If you choose an inpatient field, many of even the non-academic options will be nonprofit. Search your local community hospitals and you'll probably find most are nonprofit. Obviously there are some exceptions like Alnafis mentions.

During residency, just work towards PSLF anyways by enrolling in an IBR option and doing the PSLF paperwork. If you have to refinance with a private company afterwards, you're no worse off. Refinancing private at this point would be a huge mistake, imo. Bottom line is there are tons of nonprofit and private options in your future, but its too early for you to be deciding on one or the other at this stage.

 

[ZenScientist]

Thanks for the replies everyone, I really appreciate the information! It seems like I was mistaken about the timelines of refinancing. It sounds like my best bets would be to consolidate currently at around 5.3% and do REPAYE/PAYE during residency (which would count toward PSLF). Afterward if I decide to do fellowship and have a better idea of whether I want to work for a group vs non-profit I could pivot toward refinancing then.

My main concern was taking any actions now that would box me out of certain possibilities or practice styles later on, but it seems like I can kick that can down the road and decide once I'm better informed.