SDN Members don't see this ad. (About Ads) This post is a continuation from another thread "How to quit a residency", I thought needed redirecting. I am not a professional blogger(whatever that is-does one get paid?), So I won't put into quotes your comments and then comment individually. I do have to admit it does look nice though. Aprogramdir, your interesting comments may be your experience in medicine, and I surely wouldn't deny it. Some medical students may even believe your words (or just have to believe in order to complete their arduous medical journey). Certainly, more experienced individuals, whom have worked outside of medicine, in professional and non-professional fields would have plenty to say otherwise. I would be in that category. So my words are not empty or subjective in content. From what I have seen, most medical students/residents/physicians went the traditional route. Never worked prior to getting their undergraduate degree/never during their undergraduate/never worked prior to medical school/never worked during medical school/then get a job as a resident/graduate and then practice medicine. This is the most practical and envious route to the beloved medical career. Although it can make for a very narrow educational life experience. I am a nice guy, in fact I believe it is part of my downfall. I don't get in peoples business, or tear them down, strategize how I am going to get ahead of someone else or other things that probably would have helped me get "ahead". I like to teach, and learn. I like to be paid for what I do and enjoy doing it. Call me nuts/crazy/loco... If I get paid less for doing medicine in one field and another makes twice....who cares, don't have time for it. I just love science and learning. I went to a foreign school, and before everyone laughs or gets up tight(saying well that is your fault), I needed to fulfill something I wanted to do since I was young. I had a good career in finance until I was 30 years old. I thought I needed to do more for people and myself. I felt I had learned enough about finance. I never applied to a US school as I was already several years out from my bachelors and most wouldn't accept a student like me. I am half Swedish anyway(US citizen). So, I found myself looking at schools in Europe where I would be closer to relatives. I found a few medical schools that seemed to fit my guidelines and so I applied. Easy enough. I was accepted and away I went. My first attempt to apply at a residency was 2007. I applied to over 100 anesthesiology programs. In the fall, I failed to recieve an interview. Anesthesiology, as everyone knows now is very competitve...is it due to the pay?? It certainly was hated in the nineties when the pay was less than half it is now. I just enjoyed the science of it all. Pay me half, send the rest to the Ukraine to help the chernobyl babies (don't know about them....Google it). I read through the many postings here and elsewhere trying to see what I could do just get a job. It seemed most people apply for a "backup". In the end, it seemed the right thing to do. I will try for a backup. Most people stated that anyone with a pulse can get Family Practice. Family practice....I don't like pregnant women, the screaming and yelling....and so on. Frankly, I don't really care for the many treatments and drugs in primary care either. I was nervous and decided to heed the advice and see if I could muster some love for Family Practice. Oh, and what do you know, I was selected for an interview for Family Practice within a week. I was delighted that someone, somewhere loved my application/me. I was not crazy about Family Practice, but it seemed that was the thing to do. Be a man as they say. When March rolled around, I never did get an invite for Anesthesiology. I felt disheartened and utterly beat. I did match into Family Practice. "What does this mean", I wondered to myself. "Do I actually have to go or can I tell them no". "What about these huge loans"? "Does this mean I cannot do what I really wanted to do"? From the looks of it, I was going to Family Practice. During those months in between the match and July 1st, I struggled with the idea. I did find to my surprise that there were many parts to Family Practice that I could enjoy. I was feeling better. I arrived ready to work, until, I had to learn how to take care of that hemorrhaging pregnant lady!!! I was terrified. "Could this woman die and her child at the same"?? "Nope, can't do this!" "Crazy stuff....get me out of here". I have to admit, I have been diagnosed with Generalized Anxiety Disorder since 1997. I treat it, but with many things of this nature, are not completely corrected. A little anxiety can be a good thing, so says my doc. The next day, I told the program director that I was not engaged for this residency. I needed to regroup and try something else. He mentioned something about funding from medicare/medicade that I was not familiar with. He let me go without to much fuss with the agreement to finish until the end of the month. I later researched the rule about the funding and found that I started my pay clock. I never knew about this pay clock issue. I went to a foreign school, they don't teach anything about this. I decided to look more closely at other fields of medicine. Pathology was just up my alley....all the science and learning I loved and wanted to do. I wish I would have spent more time in the Pathology as a medical student. In fact, I don't think people spend enough time in many fields of medicine to really know what they do. Anyway, I obtained an elective month in pathology and obtained two excellent letters at the same time. I submitted the LORS to ECFMG along with all the other documents and away I went towards another match season. I applied to 85 programs, you may think, "why do you apply to so many". I didn't match last year and unfortunately USIMG's don't match well in the United States. I am currently studying for the Step 3 to see if program directors will take notice. You may say, "wow, you didn't complete a residency, and you are studying for Step 3....how did you do that??" Just apply through a state that does not require an intern year to be completed. Next, you may say "what if the program director does not accept this new incredible change in your application....wasn't that just a waste of time??" No my friends, just another notch on my pistol (Its the Viking in me!). The Match All one has to do is look at the data from the NRMP. In 2007, USIMG active applicants were 2,694, matched 1347(50.0%), Non-US citizenIMG active applicants 6,992 , matched 3,180(45.5%). In 2008, USIMG active applicants were 2,969, matched 1,541 (51.9%). Non-US citizenIMG active applicants 7,335, matched 3,108(42.4). Now, I will add the USGrad information, 2007, active applicatants 15,206, matched 14,201(93.4). 2008, active applicants 15, 242, matched 14,359(94.2). According to the NRMP, USIMG applicants matched 50.0%(US Grad 93.4%) overall in the 2007 match. Again, in 2008, USIMG applicants matched 50%(US Grad 94.2%). Even though USIMGs are US citizens, foreign born IMG applicatants match better in total numbers (FMG-Total matched for 2007, 3,180; 2008, 3108). When looking at the data, it is very hard to come to terms why around 2,500 US citizens were not able to match. Certainly, there were enough spots. As one can see for example in 2008, 3,108 Foreign citizens were matched. A question for Program Directors on this site. Have you ever hired a foreign citizen before a US citizen? If you did, were you aware that they do not normally have any debt. Unlike the USGrad or USIMG. Have you ever hired a foreign citizen that was already trained as an attending in the chosen residency? If you did, how do you compare a fully trained attending to a medical student. Do you view a residency as a job or training? How many residents do you currently have that are foreign citizens? Did you have adequate applications from US citizens to fill your spots? Statistics can show a lot of interesting trends and so on, but they don't convey emotions. The remaining non-matched students are left wondering what happened. How to pay for enormous debt. How to explain to Grandma, that they cannot work in medicine for another year. How to explain to the kids that Mom or Dad has to find something to do for a year or longer before getting a job to pay the 200K+ loans back (most US Grads and USIMG grads, most foreign born IMG grads do not have loans). More money than many people pay for their house. Many students regardless of where they went to school will never match. What to do with the massive debt. The gatekeepers (Program Directors) have done their job, hopefully picking the most competant and prepared students to work for them. The rest fend for themselves with the highest student loan debt known to man on the face of the earth. Around a 1,000 US graduates....these are those that are supposed to match...what do you tell them? Sorry out a luck??? Pay your loans anyway?? Just to put those numbers into perspective, that is based on an average of 200k per student, around two hundred million dollars ($200,000,000) per year! Add the loans of USIMG, roughly the same amount of debt is taken to fund their education, except there are more students that don't match per year than the USGrads, they number 1,500 roughly. Another three hundred million ($300,000,000). For a grand total of a half a billion dollars per year $500,000,000. Based on these numbers, it would seem prudent to do all that is possible to match US citizens. Currently, there are no protections in place to increase the matching of US citizens. Everyone that is familiar with the US system of healthcare knows that we have costs that are extremely high compared to other countries. Most understand that the tuition costs are incredibly high here in the US vs. other contries. Everyone knows that a fresh MD out of school needs to have completed a residency in ordere to "practice" medicine. Everyone knows that the salary that is paid to residents and programs comes from the Federal US Government (Medicare/Medicaid). Is it time to add some protections for US citizens? Should we consider the impact of not being able to pay back the loans of many US citizens who were denied access to medical residency? What about the loan companies, don't they deserve to be repaid? Does the loan industry understand that a fresh US citizen MD graduate cannot practice medicine without a license. Does the US government understand the unique situation the fresh US citizen MD graduate is placed in? This is a dire prediciment, it is does not bode well for the economic and social security of the United States. I made some comments about bankruptcy in the previous thread "How to quit a residency". I do this only as a way to educate some less fortunate people and those who may become unfortunate in the future. Now, I will digress my focus to something for meaningful. The Student If all goes well, college graduates earn significantly more money than those with high school degrees. However, this is not always the result. Some may find that theirprofessions are not as lucrative as they hoped or may lose their jobs. Others will confrontunexpected life traumas such as disability, divorce, or death of a family member. Still others will choose career paths where success is not measured in dollars. The problem is that borrowers are allowed very little margin for error and can easily become overwhelmed by student loan debt. When student loan payments are more than borrowers can afford, they cannot save for retirement, buy a home, enter important fields like teaching and public service, or afford to start a family. Without meaningful alternatives, some borrowers default, which not only ruins their credit and causes long-term damage to their family's financial situation, but also means the government must pay collection fees and other costs on top of the defaulted amount. For all too many students seeking to advance themselves through education, thestudent loan programs are similar to a bait and switch scam. They are lured in at the outset, usually when they are quite young, by flexible underwriting and eligibility standards and the promise of economic rewards through education. After school ends,this aura of benevolence quickly disappears. Clearly borrowers should understand that they will likely have to make sacrifices to repay their loans. The problem is the extent of these sacrifices. Many borrowers simply find that they are facing a lifetime of debt with little or no chance of escape. Student loans in bankruptcy Some history...bear with me, I know this gets painful! During the sixties and seventies many graduates of US universities were enjoying their social revolution. Free love, sex, drugs....you get the picture. After graduating university, many of these students learned that it is hard to get a job and work is optional anyway! So they looked to the bankruptcy courts and POOF! No more student loans. Of course the tuition then was beans, but it caught the attention of the US government. Student loans were dischargeable in bankruptcy prior to 1976. With the introduction of the US Bankruptcy Code (11 USC 101 et seq) in 1978, the ability to discharge education loans was limited. Subsequent changes in the law have further narrowed the dischargeability of education debt. The exception to discharge for private student loans evolved over time. Prior to 1984, only private student loans made by a "nonprofit institution of higher education" were excepted from discharge. This was intended to protect the National Defense Student Loan Program (NDSL), the predecessor to the Perkins Loan Program. Those loans were made by colleges using a revolving loan fund created using matching federal contributions. The Bankruptcy Amendments and Federal Judgeship Act of 1984 made private student loans from all nonprofit lenders excepted from discharge, not just colleges, by striking the words "of higher education". Pre-1998 language also allowed for the discharge of education loans after seven years in repayment. Not anymore........ The New and Improved...not for you....Bankrupcty Law of 2005 The Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 (BAPCA) expanded this to include all "qualified education loans", regardless of whether a nonprofit institution was involved in making the loans. Here is the current legislative language, as amended by Section 220 of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005, P.L. 109-8, effective October 17, 2005: 523(a) Exceptions to discharge ... A (8) unless excepting such debt from discharge under this paragraph would impose an undue hardship on the debtor and the debtor's dependents, for -- an educational benefit overpayment or loan made, insured, or guaranteed by a governmental unit, or made under any program funded in whole or in part by a governmental unit or nonprofit institution; or B an obligation to repay funds received as an educational benefit, scholarship, or stipend; or any other educational loan that is a qualified education loan, as defined in section 221(d)(1) of the Internal Revenue Code of 1986, incurred by a debtor who is an individual; Federal Loans (Staffords, ETC.) The government has extraordinary powers to collect student loans, far beyondthose of most unsecured creditors. The government can garnish a borrower's wages without a judgment, seize his tax refund, even an earned income tax credit, seize portions of federal benefits such as Social Security, and deny him eligibility for new education grants or loans. Even in bankruptcy, most student loans must be paid. Unlike any other type of debt, there is no statute of limitations. The elimination of the statute of limitations for student loans in 1991 placed borrowers in unenviable, rarified company with murderers, traitors, and only a few violators of civil laws. Even rapists are not in this category since there is a statute of limitations for rape prosecutions, at least in federal law and in most states. Currently, there are certain criteria and programs that allow borrowers to qualify for full or partial cancellation of their student loan debt. There are fraud-related cancellations including closed school, false certification, and unpaid refund; disability and death cancellations; and profession-oriented cancellations (becoming a public teacher, peace corps). While helpful for those who are eligible, these programs are very limited in scope and difficult for borrowers to find out about. NOTE: These provisions for cancellation are not for Private Loans!!!! Private loan companies have little or no cancellation opportunities for borrowers. In fact, many have provisions in their promissory note stating that even upon death, these loans will not be cancelled. It is incorrect in stating that it is when you have a co-signer. No, in fact your family, heirs or whomever is your assigned to distribute your property during probate is responsible for that loan, even if you did not have a co-signer. Ability to discharge by "Undue Hardship" The disability standards used are not from Social Security Administration or Department of Veteran's Affairs. Instead the courts have used different standards ranging from a test established in Brunner v. New York State Higher Education Servs. Corp. to a more flexible "totality of the circumstances" test. The Brunner test requires that 1) the debtor cannot maintain, based on current income and expenses, a "minimal" standard of living for the debtor and dependents if forced to repay the loans;2) additional circumstances exist indicating that this state of affairs is likely to persist for a significant portion of the repayment period and 3) the debtor has made good faith efforts to repay. Regardless of which test is used, most courts are quite restrictive in determining which borrowers qualify for discharge. Often, only borrowers very close to poverty level with little or no hope for improvement are considered eligible. It is also common for courts to reject the discharge in cases where a borrower chose a "low paying" occupation, such as a musician or even a minister, and even if the loan was incurred to pay for relevant education. What to do if you ever get in trouble with your Private Loans. The private loan non-dischargeabilty provision is new and it is still too early toanalyze how it will be interpreted. In fact, the statute includes a few limits to the new private loan provisions. These limits are derived from the Internal Revenue Code definition of a "qualified education loan," which is explicitly referenced in the bankruptcy law. Only "qualified education loans" will be non-dischargeable under this new category. The term "qualified education loan" is defined in 11 USC 523(a)(8)(B) by cross-reference to 26 USC 221(d)(1), which defines it in terms of other sections of the Internal Revenue Code of 1986 and the Higher Education Act of 1965, including definitions of "qualified higher education expenses", "cost of attendance", "eligible educational institution" and "eligible student". This may allow borrowers that incur debt for education that is mingled with other types of debt to argue that the debt was not incurred solely to pay higher education expenses and is thus dischargeable. Thus, all residency and relocation loans are not "qualified educational loans" and are eligible for discharge. In order to be considered a qualified education loan, the loan must also be incurred to pay expenses for education furnished during a period in which the recipient was an eligible student. There are circumstances in which a student may take out a loan to attend school, but not necessarily be an eligible student. Medical residents are not students, but professional employess as defined by the IRS. Medical residents receive a salary, pay taxes(Federal, State, FICA (except Minnesota-a separate discussion), receive benefits, and provide professional services. There may also be some wiggle room in the definition of qualified higher education expenses. There are two parts to this definition. First, the expenses must fit within the federal Higher Education Act (HEA) category of items and services considered to be "the cost of attendance." Second, the expenses must be for attendance at an "eligible education institution." The HEA definition of cost of attendance is quite broad, including tuition and fees and costs for rental or purchase of equipment, materials and supplies. It also includes room and board. Most education-related expenses will likely be covered. The requirement that expenses must be for attendance at an "eligible education institution" may be more helpful for borrowers. Eligible institutions are defined as institutions that are eligible to participate in a Title IV program.Title IV refers to the title of the HEA that governs federal financial assistance programs. Most, but not all schools, are eligible to participate in these programs. For example, numerous unaccredited schools have gone in and out of business in recent years. These unaccredited schools are not eligible to participate in the Title IV programs. Other scam programs such as "diploma mills" are also not eligible to participate in Title IV programs. Borrowers with student loans from these schools should be able to discharge the loanswithout having to prove hardship. I only bring this up because many US citizens and foreigners go to Carribean or other schools that are not Title IV "Eligible institutions". These loans may be discharged if you seek a competant lawyer. Even those Pesky TERI(Currently in a bankruptcy of their own) and Xpress Student Loans(Currently Closed). Most lawyers don't have a clue what the current law is regarding student loans. All US schools and many foreign schools are Title IV. Association with a Nonprofit Institution 11 USC 523(a)(8)(A)(i) excepts from discharge any education loan "made under any program funded in whole or in part" by a nonprofit institution. This exception is limited to loans funded by the nonprofit institution. Loans guaranteed by a nonprofit institution are not excepted from discharge by virtue of the nonprofit nature of the institution (but might be excepted from discharge as a qualified education loan under 11 USC 523(a)(8)(B)). This becomes clear when one examines the full context of the language in 11 USC 523(a)(8)(A)(i), which has two clauses: an educational benefit overpayment or loan made, insured, or guaranteed by a or made under any program funded in whole or in part by a governmental unit or nonprofit institution. The first clause excepts from discharge any loan made, insured or guaranteed by a government unit (including the federal government and state agencies), regardless of the source of funds. The second clause does not include parallel language for "insured or guaranteed", but rather just language concerning the funding of the loans. This is a clear indication that Congress did not intend to except from discharge loans that were guaranteed by a nonprofit institution, but rather just those funded by a nonprofit institution. Thus a private student loan that is funded by a nonprofit institution is excepted from discharge, but not a private student loan that is guaranteed or insured by a nonprofit institution. A recent bankruptcy case in Massachusetts, Taratuska v. TERI (Chapter 7 Case 01-10361-RS, Adversary Proceeding 05-1653, August 16, 2007) used similar reasoning to find that a private student loan guaranteed by TERI was not excepted from discharge. The judge's decision involved several nuances. 1. Although the statute requires the program to be funded by the nonprofit institution and not the loan, the judge concluded that funding a program means "advancing funds for a loan or loans under that program". The judge rejected the contention that guaranteeing a loan constitutes funding the program, in part because a guarantee does not mean advancing funding but rather only payment upon a possible future default. 2. The judge made the same argument regarding the terminology used in the two clauses, finding "Notably, the statute employs both terms, plainly indicating that they have different meanings; otherwise, one or the other would be unnecessary." 3. Marketing of a loan program by a nonprofit institution does not constitute funding that program or making of loans under that program. 4. Commingling of nonprofit and commercial student loans in a single program appellation without regard for the different attributes of the loans does not constitute a program funded by a nonprofit institution because it unfairly "converts dischargeable commercial student loans into non-dischargeable commercial student loans" solely as a consequence of the classification system and "for reasons having little to do with the loan itself". The judge's decision would require separate discrete classifications for nonprofit and commercial student loans. (This is the weakest aspect of the judge's decision. One could argue that lumping together multiple distinct loan types into a single loan program is consistent with the statutory language that focuses on funding of a loan program as opposed to funding of a loan. However, a loan program should exhibit a degree of cohesiveness as is exhibited by the Stafford Loan Program or the PLUS Loan Program It is worth noting that this clause was most likely intended to except Perkins Loans (formerly, National Direct Student Loan Program) from discharge and not private student loans.) Collection Agencies-Know your rights-Get a very good lawyer Most offer to consolidate the loans. Data from 2003, for example, show that the Department of Education reported about 16% of its collections from consolidations. Guaranty agencies, in contrast, reported nearly 57% of total recoveries from consolidations. Reporting a consolidation in the "recovery" category is misleading because it is really just a matter of paying off one loan through consolidation and originating a new loan. This is more like shuffling debt around. Regardless of whether funds were recovered through consolidation, there have been significant costs to the aggressive and nearly limitless collection efforts. To compound the problem, even borrowers that wish to repay or exercise other rights are often shut out because of problems with overly aggressive and often abusive collection agencies. Private collectors have in some cases deliberately deceived consumers by misrepresenting themselves as the Department of Education. They have overcharged consumers for collection fees, used misleading tactics to track borrowers, browbeaten borrowers into unaffordable payment plans, threatened them with actions that they cannot legally take, and pressured consumers to borrow from relatives. Some of these abuses have arisen because of the fact that a federal government program is involved. Student loan borrowers have many important rights. Yet many private collectors do not have enough knowledge about these rights. As a result, consumers are deprived of important options to which they are legally entitled. Even worse, some collectors misrepresent these rights or steer consumers into options more profitable for the collector. Legislation being introduced to try and strike down BAPCA Senator Clinton's Student Borrower Bill of Rights Act of 2007 (S.511) includes a provision which would restore the pre-1998 language. Sen. Durbin's bill, S.1561, not only rolls back BAPCPA, but also strikes the prior language which extends an exception to discharge to loans "made under any program funded in whole or in part by a … nonprofit institution".