ER physicians and public service loan forgiveness?

[illegallysmooth]

Hello,
As ER physicians, does anyone know if you are eligible for public service loan forgiveness? The guidelines are a little unclear. I know that most ER physicians are actually employed by for-profit groups that are contracted by the hospital, and therefore it seems ER docs would NOT qualify. However, I also read that for-profit groups that provide public health services WOULD qualify.

Can anyone help clear this up? Or is it possible to work directly for a university/not-for-profit hospital as an ER physician?

PS: Please don't move this. We've had discussions about it elsewhere and they are utterly futile. It doesn't help anyone to have the blind leading the deaf.

---

Members don't see this ad.

 

[ubuggin]

I'm curious about this as well

 

[Apollyon]

Emergency medicine is not covered. Period. Loan repayment and other programs are divided into three groups - primary care, dental, and psych.

I just looked into this last week (again), and, flatly, if you don't have IM/peds/FM, you ain't gettin' it. You can't get it.

Now, if there was an amendment by Congress, that is a consideration. One of the places where I now work is unique (that word is over-used so much, but this is true) as far as facilities of its type and the docs employed, so I have to petition my Members of Congress to make a correction.

I do not know if working for the Indian Health Service without a prior commitment (like from UHUHS) is eligible for any loan repayment.

 

[EM2BE]

However, some state-run programs do include EM. I know Kansas did (at least 4 years ago, not sure right now).

 

[illegallysmooth]

Are there opportunities to be employed directly by a non-profit hospital as an emergency medicine physician?

I understand ER docs are not eligible for loan repayment programs like NHSC, but under the law for IBR Public Service 10-yr loan forgiveness, positions working for not-for-profits providing public health services should be covered. Specifically, the wording is:
"Public health (including nurses, nurse practitioners, nurses in a clinical setting, and full-time professionals engaged in health care practitioner occupations and health care support occupations)."

If an ER physician is eligible from a financial sense (which in some cases will be true, especially for those with a huge amount of debt), it seems extremely unfair that an ER physician working alongside an (eligible) ER nurse would not be eligible, as long as he/she works for a non-profit hospital.

 

[deleted6669]

However, some state-run programs do include EM. I know Kansas did (at least 4 years ago, not sure right now).

but what is worse? 400k in loans or 4 yrs in kansas....tough pick...I think I would take the loans....

 

[J ROD]

http://forums.studentdoctor.net/showthread.php?t=697439

This is not specifically EM but may help....

 

[Phledge]

Emergency medicine is not covered. Period. Loan repayment and other programs are divided into three groups - primary care, dental, and psych.

I don't know about the rest of y'all, but to me this statement is oxymoronic; I mean, 90% of what I've seen in the ED is exactly those three groups. Sometimes in the same patient.

 

[EM2BE]

but what is worse? 400k in loans or 4 yrs in kansas....tough pick...I think I would take the loans....

haha..I'm guessing other states have similar programs, however, they may have the same appeal to people and that's how they exist. I was already told if I went to rural KS as an attending, they would pay my loans. It wasn't a formal meeting, but it was not a lie. The area was in the middle of nowhere, quite literally I think. Being from KS, you'd think I'd find it appealing, but nope. Not for me either.

 

[RxnMan]

There are state loan repayment programs for docs in underserved areas. The criteria for applying differs by state (~10k/yr). The US has a loan forgiveness program by which your loans are forgiven after working 10 years in a non-profit capacity (see above post).

 

[KYTNOH]

Under the IBR you get the balance loan forgiveness after 10 years if you are employed by a nonprofit organzation. This is for any type of profession, not just medicine. Almost all hospitals are nonprofit, and your 3/4 years in residency will count toward those 10 years. You would need to get 7 years further employment in a nonprofit hospital, but you would have to be an actual employee of that hospital and not of another business. The majority of ER docs work for another "company" that contracts with specific hospitals, so I don't think that would count. For example, even though you would work in a nonprofit hospital TeamHealth might be your employer.

Under the IBR you only get the remaining balance paid off at the end of the 10 year period and then you have to report the paid off balance as income on your income taxes. At an attending's salary after 10 years you're going to still pay a significant amount of money along the way making the benefit smaller.

 

[Apollyon]

I don't know about the rest of y'all, but to me this statement is oxymoronic; I mean, 90% of what I've seen in the ED is exactly those three groups. Sometimes in the same patient.

That's what I said - that I provide large amounts of primary care. The guy on the phone (not to hold it against him - he's just a punch-clock drone) said that it applies to the primary care specialties only. There's no way around it.

 

[WildcatsDoc]

Under the IBR you get the balance loan forgiveness after 10 years if you are employed by a nonprofit organzation. This is for any type of profession, not just medicine. Almost all hospitals are nonprofit, and your 3/4 years in residency will count toward those 10 years. You would need to get 7 years further employment in a nonprofit hospital, but you would have to be an actual employee of that hospital and not of another business. The majority of ER docs work for another "company" that contracts with specific hospitals, so I don't think that would count. For example, even though you would work in a nonprofit hospital TeamHealth might be your employer.

Under the IBR you only get the remaining balance paid off at the end of the 10 year period and then you have to report the paid off balance as income on your income taxes. At an attending's salary after 10 years you're going to still pay a significant amount of money along the way making the benefit smaller.

The bolded is actually not true. The ten year forgiveness, under the PSLF with IBR loan repayments, is not considered taxable income. However, the 25 year loan discharge (under IBR payments) IS considered taxable income.

 

[illegallysmooth]

Under the IBR you get the balance loan forgiveness after 10 years if you are employed by a nonprofit organzation. This is for any type of profession, not just medicine. Almost all hospitals are nonprofit, and your 3/4 years in residency will count toward those 10 years. You would need to get 7 years further employment in a nonprofit hospital, but you would have to be an actual employee of that hospital and not of another business. The majority of ER docs work for another "company" that contracts with specific hospitals, so I don't think that would count. For example, even though you would work in a nonprofit hospital TeamHealth might be your employer.

Under the IBR you only get the remaining balance paid off at the end of the 10 year period and then you have to report the paid off balance as income on your income taxes. At an attending's salary after 10 years you're going to still pay a significant amount of money along the way making the benefit smaller.

That's what I said. Except you don't pay the income tax on public service loan forgiveness.

I guess I wasn't clear enough in my original post. I am familiar with IBR and public service loan forgiveness, and loan repayment programs for primary care in underserved areas. My real question regards employment of EM docs by non-profit hospitals.

No one knows if it's possible to work directly for a hospital as an EM attending?

 

[illegallysmooth]

That's what I said - that I provide large amounts of primary care. The guy on the phone (not to hold it against him - he's just a punch-clock drone) said that it applies to the primary care specialties only. There's no way around it.

You're talking about loan repayment programs, and for that you're correct. The IBR plan and public service loan forgiveness is NOT limited by specialty, but rather by debt to income ratio and employer status as a tax-exempt not-for-profit.

 

[illegallysmooth]

FYI - this is from the AAMC:

Public Service Loan Forgiveness Program
P.L. 110-84 also authorizes a new "public service" loan forgiveness program, effective July 1, 2009. Physicians will be eligible for the program after 10 years of loan repayment while practicing in a "public service" job. The definition of "public service" includes 501(c)(3) non-profit organizations, faculty in "high-needs areas (as determined by the Secretary of Education), and service at private organizations providing "public health" or "emergency management" services. P.L. 110-315 clarifies the definition of public health to include "full-time professionals engaged in health care practitioner occupations and health care support occupations, as such terms are defined by the Bureau of Labor Statistics." Only Direct Loans are eligible for forgiveness, but borrowers may consolidate other federal loans under a single Direct Consolidation Loan. Physicians that participate in the income-based repayment program could save over $75,000 on their total loan repayment.

 

[Laryngophed]

but what is worse? 400k in loans or 4 yrs in kansas....tough pick...I think I would take the loans....

I take the loans every time. I have a moral obligation to avoid the state of kansas.

To the OP: I've wondered about this as well. When I read it (a while ago, admittedly) I got the impression that the non-profit loan forgiveness program applied to any physician working for a 501c.

I've been wrong before though.

 

[J ROD]

check out the link I posted....there is a resident telling how he did it.

 

[illegallysmooth]

Thanks everyone for your input. Here are my main thoughts on the issue:

- Job eligibility - this is the biggest one for me. I NEED to know that my post-residency position will qualify as public service. Hopefully some new guidelines will be published in the next 7 years or so to help students determine if their intended jobs will qualify, instead of being denied 10 yrs down the road. The cloudy part with job eligibility for doctors seems to be the question of whether or not working in a private practice group that provides health sevices for the public AT a public hospital will be considered eligible (i.e. ER physician groups). Unless I'm sure of my job eligibility when I enter repayment, I might just be applying to a good number of VA hospitals 🙂

- Program stability - some are concerned whether this program will still be in place X number of years in the future. I am cautiously optimisitic, given the fact that changes to this program must be written into law, and I can't see that happening easily. Also, the health bill is proposing several positive changes to the program, which I see as a good sign.

 

[J ROD]

I know the hospital I work at hires EM docs as hospital employees and it is state funded....

I hope to return there and work one day.

 

[thorg12]

I am very interested in this also. Arent most academic em dept employed by the hospital and arent most hospitals resgistered as 501c3? If this is true and your residency is a 501c3 doesnt it make sense to at least do IBR during residency if you can afford it and see if the job you take as an attending qualifies also? thanks

 

[illegallysmooth]

I am very interested in this also. Arent most academic em dept employed by the hospital and arent most hospitals resgistered as 501c3? If this is true and your residency is a 501c3 doesnt it make sense to at least do IBR during residency if you can afford it and see if the job you take as an attending qualifies also? thanks

I don't know about most academic EM depts. Most people with a qualifying amount of debt do IBR for residency. If you have a lot of debt and relatively low income as an attending (i.e. family practice) , it may suit you to do IBR then too. Google IBR and read up on it.

 

[doctorFred]

Program stability - some are concerned whether this program will still be in place X number of years in the future. I am cautiously optimisitic, given the fact that changes to this program must be written into law, and I can't see that happening easily. Also, the health bill is proposing several positive changes to the program, which I see as a good sign.

i wrestled with this bit in particular, and in the end, i've come to the conclusion that the program will be a nice benefit for someone who already plans to be in an academic setting 10 years from now, but it's a bit more risky to plan around it.

also, it is my understanding that in the types of settings that will qualify you for IBR forgiveness, you'll be earning ~40k (give or take) less per year than your community counterparts. at 7 years of attending salary, that's almost 300k, which exceeds the majority of graduate indebtedness.

Quote:
Originally Posted by Apollyon
Emergency medicine is not covered. Period. Loan repayment and other programs are divided into three groups - primary care, dental, and psych.
I don't know about the rest of y'all, but to me this statement is oxymoronic; I mean, 90% of what I've seen in the ED is exactly those three groups. Sometimes in the same patient.

 

[J ROD]

also, it is my understanding that in the types of settings that will qualify you for IBR forgiveness, you'll be earning ~40k (give or take) less per year than your community counterparts. at 7 years of attending salary, that's almost 300k, which exceeds the majority of graduate indebtedness.

good point....personally, I want to get state and federal retirement so I plan to work for them both when I am done...with maybe PT at a small community ER/Urgent Care.

so it would be great for me.

 

[SFO-IST]

FYI - this is from the AAMC:

Public Service Loan Forgiveness Program
P.L. 110-84 also authorizes a new "public service" loan forgiveness program, effective July 1, 2009. Physicians will be eligible for the program after 10 years of loan repayment while practicing in a "public service" job. The definition of "public service" includes 501(c)(3) non-profit organizations, faculty in "high-needs areas (as determined by the Secretary of Education), and service at private organizations providing "public health" or "emergency management" services. P.L. 110-315 clarifies the definition of public health to include "full-time professionals engaged in health care practitioner occupations and health care support occupations, as such terms are defined by the Bureau of Labor Statistics." Only Direct Loans are eligible for forgiveness, but borrowers may consolidate other federal loans under a single Direct Consolidation Loan. Physicians that participate in the income-based repayment program could save over $75,000 on their total loan repayment.

So this quote would seem to include physicians working at a 501c hospital even if they are privately employed by "TeamHealth" as a previous poster eluded to. If I were to plan my education (new med student here) around this program, doesn't this program just create an incentive for me to borrow as much as I can, live a more "lavish" lifestyle on my loans, and just work 3-7 years post residency at a 501c hospital before having all my loans forgiven tax free?

 

[Tornadoman84]

So this quote would seem to include physicians working at a 501c hospital even if they are privately employed by "TeamHealth" as a previous poster eluded to. If I were to plan my education (new med student here) around this program, doesn't this program just create an incentive for me to borrow as much as I can, live a more "lavish" lifestyle on my loans, and just work 3-7 years post residency at a 501c hospital before having all my loans forgiven tax free?

With our national debt and the current political leaning towards tightening the budget, there is always the risk that the government amends/closes this in the future and doesn't include a grandfather clause. Just like social security, don't plan on it, but hope for it 😉.

 

[AzEMMD]

With most EM residencies being 3 years long, I don't think PSLF makes much sense. I imagine you could probably pay off your loans before the 10 years is up with a community attending salary. As mentioned in previous posts, taking a job at an academic center would probably cost you more in the long run (even with PSLF) since your salary will be substantially less.