Incorrect. Lenders (all federal, most private) are
required to grant mandatory deferrals during school and mandatory forbearances during residency. There are also deferrals for economic hardship. No, you can't get one just by asking for one, there's paperwork which is sometimes overwhelming, but generally there is no assumption by lenders that there is income during med school or that income during residency is sufficient to make payments. And of course you should be looking at repayment plans like REPAYE instead of deferral/forbearance whenever you have nontrivial income, because your monthly payment can be very very tiny if you have dependents or whatnot.
Deferment and Forbearance
Incorrect. The word "underserved" means
it's hard to get providers to practice in an area. If you're willing to work in an underserved area you'll be recruited half to death and you'll have multiple forgiveness/assistance options to choose from. Also there are abundant locums opportunities in underserved areas to get extra $ on weekends or to take a 1 day/wk gig. (Is it worth working in an underserved area for the money? Totally up to you and where you're willing to work. Possibly the same thing as the military decision - universally understood that you don't do it for the money.)
Specialists are recruited to work in underserved areas, under a variety of incentives, just like primary care docs. Pick a rural area & google a hospital. Wiki the bed count. If there are more than about 24 beds, there's an OR. If there's an OR, there are obgyns, surgeons, anes, rads & most likely specialists. If you're way out in a rural part of the WWAMI region, 27% of the US land mass, 3% of the people, then you can assume you'll get choppered to a hospital to get to a specialist for a non-acute problem. Otherwise in many rural areas you "just" have to wait for the "urologist day" in your local hospital.
Correct. I lost count about 4 years ago, but the number of HPSP free ride scholarships is around 250. For the whole country. Similarly there are around 200 NHSC scholarships. Note those scholarships are not specific to MD/DO but include dentists, PTs etc. Even if I'm off by a factor of 10 with these numbers there are still only a tiny number of these scholarships.
Incorrect. PSLF is not specific to specialty. HPSP is not specific to specialty but it does add constraints to matching odds. NHSC is specific to primary care (FM/IM/Peds, sometimes psych).
Local/state incentives are not necessarily specific to specialty, and frequently target obgyn, gen surg, anes, rads etc. One of the obgyn attendings I work with just got a $100,000 scholarship from the state to work in a safety net hospital.
Correct but if you're thinking you'll have trouble matching into the least competitive specialties, many of which are in primary care, then you very simply should not go to med school.
In other words, if you're sneaking in a low-GPA back door to med school without being academically ready, such as taking any acceptance you can get in the Carib or in a new/religious/for-profit med school, you're probably getting yourself into massive debt without a stable plan (ie matching into a residency) for getting out of that debt.
In other words, the debt loads vs. Carib match rates absolutely should be reducing the enrollment in the Carib but
now that we're a country that embraces higher ed fraud what even matters anymore.
Not necessarily. As above, incentives of all kinds are available and vary dramatically across the country. Here's a 2 second national job search on physician jobs of all specialties including "repayment", see for yourself if the base salary is what you're expecting regardless of incentives.
Physician Jobs | Physician Jobs | PracticeLink.com
(No, there are no really great physician job search sites; PracticeLink is currently the one I think of as least sucky.)
Completely incorrect for PSLF: only required to have a non-profit employer. Completely incorrect for PAYE and REPAYE: only required to make your payments for X years.
The primary care constraints for FM/IM/Peds are in NHSC and state primary care programs. Sometimes psych, sometimes obgyn, sometimes even gen surg.
Generally no, although you can always find hospitals willing to pay a BC/BE IM doc $60k and make them work their fannies off for a year of ED time and call it a fellowship. EM is a 4 year residency and to get BC/BE in EM you have to complete that residency, regardless of whether you completed IM or whatever already. If you do FM you arguably have more EM fellowship opportunities but don't confuse that with being EM BC/BE. FM with an EM fellowship means you're slightly more employable on staff in a small ED, such as you take call while you're mostly in clinic. Yes of course there are FM docs serving as ED chief in some places. (BC/BE means you're employable in your specialty. BC: board certified, means you passed the boards. BE: board eligible, means you're done with residency, haven't taken/passed boards. EM: a discipline. ED: a facility. ER: a TV show.)
In summary:
1. ridiculous student debt loads of $350k+ are the new normal for non-trust-fund kids. Given there are 45,000+ US med students per year, I think it's fair to be thinking at
least 10,000 new MD/DO grads per year are in $350k debt. Point being: you're not alone and you have a decent federal lobbyist arm in the AMA.
2. currently, there are still abundant options to manage a ridiculous level of student debt during med school, residency and practice
3. loan forgiveness is a component of many debt management programs including federal repayment (PSLF, REPAYE, PAYE), underserved practice, military, state/local, hospital group etc.
4. deferral and forbearance for standard income hardships are mandatory for all student lenders, public or private (enrollment in school, internship/residency, economic hardship, national guard service, natural disasters, peace corps etc)
