What are the best loan forgiveness offers you have seen for recent FM grads?

[carw1801]

I will be starting medical school in the fall and I don't see my future FM plans changing. Currently, what are some of the best loan forgiveness offers you have seen for new grads?

I have seen $110000 for four years of working at one hospital but I'm looking for offers of total forgiveness. I'd be will to relocate anywhere for 5-10 years.

Our financial aid office gave us a presentation and the PSLF for 10 years makes a lot of sense but I want to know if there are forgiveness options for high balances that can be negotiated in less than 10 years.

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[Ironheme]

I would focus on how you could max your income through incentives/tiers/wRVU rather than necessarily looking for the highest loan forgiveness. I'd recommend looking at the total package. If you're willing to work and your focus is $$, you could clear 300-500k as a family doc, and put a large chunk of that into your loans.

 

[carw1801]

I would focus on how you could max your income through incentives/tiers/wRVU rather than necessarily looking for the highest loan forgiveness. I'd recommend looking at the total package. If you're willing to work and your focus is $$, you could clear 300-500k as a family doc, and put a large chunk of that into your loans.

I keep hearing the 500k figure but I'd like to know what that looks like as far as a contract. I agree, that would make things easier with loans but right now I'm planning for $230K starting or the equivalent 7 years from now.

 

[Ironheme]

I just realized you're a pre-medical student ... come back and talk with us in a couple years... There are so many variables, it doesn't make a lot of sense to number crunch right now. Some states offer fairly decent loan repayment incentives if you work there, etc. The best thing you can do for yourself is do really well in med school to open as many doors as possible, decide on a specialty, and be conservative with your loans (don't waste money). The way I thought of it was for every dollar I borrowed, it was two dollars I'd have to pay back in the future. Put things into perspective of whether I really needed something or not.

 

[carw1801]

I just realized you're a pre-medical student ... come back and talk with us in a couple years... There are so many variables, it doesn't make a lot of sense to number crunch right now. Some states offer fairly decent loan repayment incentives if you work there, etc. The best thing you can do for yourself is do really well in med school to open as many doors as possible, decide on a specialty, and be conservative with your loans (don't waste money). The way I thought of it was for every dollar I borrowed, it was two dollars I'd have to pay back in the future. Put things into perspective of whether I really needed something or not.

I appreciate the advice but I don't see it like that.

I'm not pre-med. I'm an incoming M1 and I'm nontrad if that makes a difference.

I did an SMP at the same medical school so we attended the same M1 financial aid lectures and they said the same things you said regarding spending but they also said that cost of attendance should not stress us out as students.

We all know we have to do "really well" in medical school but I don't think that is going to affect future salaries in FM, which is the only specialty that I am interested in.

The reason for my question is that I keep hearing that, despite lower overall compensation, FM positions offer better debt forgiveness programs depending on geographical location.

I think that's worth looking at today just to see what's out there.

 

[Cranjis McBasketball]

You have no idea what’s gonna happen though. Many people in my med school were “100% set” on a specialty and ended up changing their mind. Theres no reason to draw up hypothetical job offers and hypothetical loan repayment options when you’re 7 years from that. Even if you end in FM there is so much that can change.

But for reference I signed with a place near my wife’s home town. Base 275k, which apparently is actually going up to 300k. $1500 a month in residency stipend, 30k sign on, 25k a year in loan repayment x3 years from the company which is matched by the state because its considered a more rural area.

 

[carw1801]

You have no idea what’s gonna happen though. Many people in my med school were “100% set” on a specialty and ended up changing their mind. Theres no reason to draw up hypothetical job offers and hypothetical loan repayment options when you’re 7 years from that. Even if you end in FM there is so much that can change.

But for reference I signed with a place near my wife’s home town. Base 275k, which apparently is actually going up to 300k. $1500 a month in residency stipend, 30k sign on, 25k a year in loan repayment x3 years from the company which is matched by the state because its considered a more rural area.

I agree anything can happen in the meantime but if you like FM, I highly doubt I will like surgery in third year.

My concern is not really salary. I'm fine with the figures available. What I don't understand is the loan repayment programs that may be available. For reference, I have undergrad private loans, grad school loans, and now med school loans. The thought of it doesn't even make sense to me but my school's financial aid office is assuring people, even in my situation, that we will be "fine."

I just don't want to end up paying loans off into my retirement as I am already close to 40.

 

[cj_cregg]

I have not heard of offers more than the one you mentioned in the original post. I'm sure you could negotiate higher numbers, but it will come at the expense of salary. One of my mentors in training once said that negotiating a job offer needs to be thought of like a pie - you can ask to adjust the sizes of the pieces of the pie (signing bonus, stipend prior to starting, salary, loan forgiveness, etc) but you usually can't get a bigger pie. Generally, rural/underserved communities will have better loan forgiveness offers. Look into the NHSC if you're set on primary care - you can either have your tuition paid through that program and have restricted work options, or get loan repayment after you start working if you end up choosing to work at an NHSC-eligible site. But this is limited to about $20k/year I believe. Many states also have primary care loan repayment programs as well.

That said, I agree with posters that unless you are going to start looking for a job today, which I wouldn't recommend for most people, this is not really relevant until you get to the end of your residency and are job hunting. Figuring all this out now won't make a difference.

 

[carw1801]

I have not heard of offers more than the one you mentioned in the original post. I'm sure you could negotiate higher numbers, but it will come at the expense of salary. One of my mentors in training once said that negotiating a job offer needs to be thought of like a pie - you can ask to adjust the sizes of the pieces of the pie (signing bonus, stipend prior to starting, salary, loan forgiveness, etc) but you usually can't get a bigger pie. Generally, rural/underserved communities will have better loan forgiveness offers. Look into the NHSC if you're set on primary care - you can either have your tuition paid through that program and have restricted work options, or get loan repayment after you start working if you end up choosing to work at an NHSC-eligible site. But this is limited to about $20k/year I believe. Many states also have primary care loan repayment programs as well.

That said, I agree with posters that unless you are going to start looking for a job today, which I wouldn't recommend for most people, this is not really relevant until you get to the end of your residency and are job hunting. Figuring all this out now won't make a difference.

My concern at this stage is if FM is a financial dead end or not. If it is not, then I will remain focused on that goal. That's why I want to know what's out there right now. Some people have even said that if you go into very remote areas that you can essentially name your price in FM.

 

[cj_cregg]

My concern at this stage is if FM is a financial dead end or not. If it is not, then I will remain focused on that goal. That's why I want to know what's out there right now. Some people have even said that if you go into very remote areas that you can essentially name your price in FM.

I wouldn't say you can name your price but it is certainly more lucrative. FM is a career that will easily put you in at least the top 5-10% income bracket in the US, I think it's only going to get better reimbursed in the future compared to other specialties, and I certainly would not consider it a financial dead end under any circumstances.

 

[carw1801]

I wouldn't say you can name your price but it is certainly more lucrative. FM is a career that will easily put you in at least the top 5-10% income bracket in the US, I think it's only going to get better reimbursed in the future compared to other specialties, and I certainly would not consider it a financial dead end under any circumstances.

Can you please explain why you think reimbursement will improve in the future? This is what I want to understand at my stage but the Internet is the worst place to get this type of information because so many people, who don't know what they are talking about, sensationalize the outlook. I have heard people say FM won't exist in the future because of midlevels. I just want to know what I am signing up for even though I have a few years to get there so that I can avoid any surprises.

 

[cj_cregg]

Can you please explain why you think reimbursement will improve in the future? This is what I want to understand at my stage but the Internet is the worst place to get this type of information because so many people, who don't know what they are talking about, sensationalize the outlook. I have heard people say FM won't exist in the future because of midlevels. I just want to know what I am signing up for even though I have a few years to get there so that I can avoid any surprises.

I don't think expansion of midlevels will affect FM job prospects. Many midlevels don't want to do primary care and frankly I think it's the hardest specialty for them to do a good job. Plus, there is increasing demand for primary care due to demographic changes and plenty of patients to go around for the foreseeable future.

I think there is a trend towards health policies and reimbursement strategies implemented by insurance companies that recognize the value of high quality primary care and pay accordingly. Recent changes in billing are very primary care friendly for example, and make it very easy for us to increase our RVUs for the same work we were already doing. FM salaries have been rising over the last decade or two.

 

[carw1801]

I don't think expansion of midlevels will affect FM job prospects. Many midlevels don't want to do primary care and frankly I think it's the hardest specialty for them to do a good job. Plus, there is increasing demand for primary care due to demographic changes and plenty of patients to go around for the foreseeable future.

I think there is a trend towards health policies and reimbursement strategies implemented by insurance companies that recognize the value of high quality primary care and pay accordingly. Recent changes in billing are very primary care friendly for example, and make it very easy for us to increase our RVUs for the same work we were already doing. FM salaries have been rising over the last decade or two.

This is great to hear. Based on my observations over the last decade, I am seeing urgent care centers popping up everywhere and my understanding is that they hire FM not IM. If I were to take a guess, I would say that urgent care centers will evolve into "primary care" centers where people will go for routine care.

Is there a publication that is accessible to med students that I can read over the next few years? A journal perhaps?

 

[cj_cregg]

This is great to hear. Based on my observations over the last decade, I am seeing urgent care centers popping up everywhere and my understanding is that they hire FM not IM. If I were to take a guess, I would say that urgent care centers will evolve into "primary care" centers where people will go for routine care.

Is there a publication that is accessible to med students that I can read over the next few years? A journal perhaps?

I doubt it re: urgent care centers - they are really not set up to do true primary care well. They are (appropriately) focused on acute visits/management and have plenty of volume with that alone.

What are you hoping to learn about with your reading?

 

[carw1801]

I doubt it re: urgent care centers - they are really not set up to do true primary care well. They are (appropriately) focused on acute visits/management and have plenty of volume with that alone.

What are you hoping to learn about with your reading?

I want to keep on top of any trends in FM so that I know what to expect in third year and then interviews.

 

[cj_cregg]

I want to keep on top of any trends in FM so that I know what to expect in third year and then interviews.

Join your family medicine interest group and get student memberships to AAFP and your state academy of family physicians. Both should have student-oriented conferences you can attend during medical school. AAFP has two journals, American Family Physician and Family Practice Management, that are both generally much more granular/clinical than you'll need at this point but will occasionally have articles and op ed type things on larger trends within the specialty.

 

[avatarftw]

I wouldn't say you can name your price but it is certainly more lucrative. FM is a career that will easily put you in at least the top 5-10% income bracket in the US, I think it's only going to get better reimbursed in the future compared to other specialties, and I certainly would not consider it a financial dead end under any circumstances.

FM is top 2-3 percentile income for individuals. The gap from 1 to 2 to 3 percentile is fairly large, however.

Income Percentile Calculator for the United States

The income percentile calculator for individual US income in 2022. See average, median, and top 1%. What percentage of earners were you?

dqydj.com

295k in 2022 was top 2 percentile income for an individual

It's not a very high paid specialty but it's only 3 yrs and if you have a good RVU based system, you can easily make 300-350k seeing 2 pts/hr.

 

[avatarftw]

25-30k a yr *gross* for student loan repayment is standard but there are indeed programs that give 30-60k NET a yr.

 

[carw1801]

FM is top 2-3 percentile income for individuals. The gap from 1 to 2 to 3 percentile is fairly large, however.

It's not a very high paid specialty but it's only 3 yrs and if you have a good RVU based system, you can easily make 300-350k seeing 2 pts/hr.

That's good enough for me.

 

[carw1801]

25-30k a yr for student loan repayment is standard but there are indeed programs that give 30-60k NET a yr.

I'm liking what you just wrote!

 

[cj_cregg]

FM is top 2-3 percentile income for individuals. The gap from 1 to 2 to 3 percentile is fairly large, however.

Income Percentile Calculator for the United States

The income percentile calculator for individual US income in 2022. See average, median, and top 1%. What percentage of earners were you?

dqydj.com

295k in 2022 was top 2 percentile income for an individual

It's not a very high paid specialty but it's only 3 yrs and if you have a good RVU based system, you can easily make 300-350k seeing 2 pts/hr.

Yes, I was being conservative.

 

[InternistDO]

In terms of financial benefit I think it's pretty hard to beat PSLF for primary care, since many loan programs aren't going to pay 50k a year for the 8-10 years it would take to cover most of your loan payments.

In addition, you can end up golden handcuffed to a job you don't like since loan repayment that generous is fairly uncommon, they way NHSC scholars get stuck at FQHCs in rural Oklahoma seeing 30 patients/day.

PSLF is easy, transferable, and most PCPs will pay something like 150k over the 10 year period--and sometimes you can loan other loan repayment options to cover some of that.

 

[carw1801]

In terms of financial benefit I think it's pretty hard to beat PSLF for primary care, since many loan programs aren't going to pay 50k a year for the 8-10 years it would take to cover most of your loan payments.

In addition, you can end up golden handcuffed to a job you don't like since loan repayment that generous is fairly uncommon, they way NHSC scholars get stuck at FQHCs in rural Oklahoma seeing 30 patients/day.

PSLF is easy, transferable, and most PCPs will pay something like 150k over the 10 year period--and sometimes you can loan other loan repayment options to cover some of that.

Does IBR also apply to PSLF with an FM salary over the 10 years? Wouldn't the total over 10 years theoretically be lower than 150K?

 

[InternistDO]

Does IBR also apply to PSLF with an FM salary over the 10 years? Wouldn't the total over 10 years theoretically be lower than 150K?

IBR does, so if you're doing something like SAVE it probably works out to 1500-2500/month depending on your income (and if your spouse works and you file together or not), but for 3 of those years it'll be close to 0 (residency) and your first attending year it won't be too high either.

 

[Marcus Brody]

They are a scam imo, all of them. Designed to lock you into the corporation and prevent you from leaving. It makes no sense to me why "loan forgiveness" couldn't simply consist of a higher base salary. The reason is that doesn't allow them to control you.

 

[Cranjis McBasketball]

They are a scam imo, all of them. Designed to lock you into the corporation and prevent you from leaving. It makes no sense to me why "loan forgiveness" couldn't simply consist of a higher base salary. The reason is that doesn't allow them to control you.

Because if you flip to production based payment then that higher base salary literally means nothing.. just read the contract on what the loan forgiveness has tied to it

 

[retroflex]

You have no idea what’s gonna happen though. Many people in my med school were “100% set” on a specialty and ended up changing their mind. Theres no reason to draw up hypothetical job offers and hypothetical loan repayment options when you’re 7 years from that. Even if you end in FM there is so much that can change.

But for reference I signed with a place near my wife’s home town. Base 275k, which apparently is actually going up to 300k. $1500 a month in residency stipend, 30k sign on, 25k a year in loan repayment x3 years from the company which is matched by the state because its considered a more rural area.

At what point in your training did you sign? I’m an M4 getting interviews and offers already. Trying to figure out if the incentives during residency are worth closing the door on potential opportunities over the next three years.

 

[Keona]

At what point in your training did you sign? I’m an M4 getting interviews and offers already. Trying to figure out if the incentives during residency are worth closing the door on potential opportunities over the next three years.

Do you know 100% where you want to live? Do you have a significant other? I wouldn’t plan to sign things until 2nd year, that’s when most of my classmates signed agreements or started negotiating as we figured out exactly where we wanted to live and what type of family medicine we wanted to practice.

 

[Cranjis McBasketball]

At what point in your training did you sign? I’m an M4 getting interviews and offers already. Trying to figure out if the incentives during residency are worth closing the door on potential opportunities over the next three years.

No way man. I wouldnt sign before 2nd year of training. There are so many life circumstances that can change. You may even get into residency and realize you like inpatient more than outpatient and wanna be a hospitalist (happened to a few co-residents). The deals arent going anywhere. No need to rush to sign. In fact base salaries just keep increasing

 

[retroflex]

@Keona @Cranjis McBasketball I hear you both. My wife and I want to be in a specific rural area of our midwestern state between our families who are about 2.5 hours away from each other. I feel we have our location nailed down pretty good so we’re not too worried about that changing. But you’re right, my ideal scope of practice could change in residency.

 

[dial1010usa]

I'm a 2nd year rural FM resident and my loans are piled up. I have no clue where I'm gonna go. I hope I'm going where loan forgiveness offered as part of my offer. I'm in CA.

 

[BocephusTim]

I'm a 2nd year rural FM resident and my loans are piled up. I have no clue where I'm gonna go. I hope I'm going where loan forgiveness offered as part of my offer. I'm in CA.

PSLF is probably your best option if your loan total is astronomical -- and you have the freedom to bounce around jobs if you things get sour at one particular workplace, which is a very nice perk compared to other places that lock you in for 5 years on loan repayment offers