NHSC Loan Repayment

[Sneezing]

Regarding Psychiatrists who are applying for the National Health Services Corps loan repayment program, are any being rejected?
Does anyone know the stats of acceptance/rejections and why people were rejected?
Any personal experiences with the program?

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[F0nzie]

I wanted to apply for this but then it says on the website that the application cycle is closed... Needed to start my job by July 15th...Psh...

 

[wolfvgang22]

Wow, there are a ton of jobs on the NHSC site. So basically, they will pay off up to $60,000 in either federal or private student loans and are mostly in rural areas. Does that mean they will pay less overall? Or do they drive physicians like a used rental car seeing a million patients 1,000 hours a week? Or is it just that most of these positions are in rural areas?

I'd love to hear from anyone who has some experience with NHSC, as I am interested in rural psychiatry.

 

[NYCMS2]

Wow, there are a ton of jobs on the NHSC site. So basically, they will pay off up to $60,000 in either federal or private student loans and are mostly in rural areas. Does that mean they will pay less overall? Or do they drive physicians like a used rental car seeing a million patients 1,000 hours a week? Or is it just that most of these positions are in rural areas?

I'd love to hear from anyone who has some experience with NHSC, as I am interested in rural psychiatry.

I wonder if doing telepsychiatry for the underserved rural population qualifies?

 

[smq123]

Wow, there are a ton of jobs on the NHSC site. So basically, they will pay off up to $60,000 in either federal or private student loans and are mostly in rural areas. Does that mean they will pay less overall? Or do they drive physicians like a used rental car seeing a million patients 1,000 hours a week? Or is it just that most of these positions are in rural areas?

I'd love to hear from anyone who has some experience with NHSC, as I am interested in rural psychiatry.

I'm a Family Medicine attending who received the NHSC scholarship for the last 2 years of medical school. I'm now doing my service payback at an urban site in Florida.

Most of the NHSC sites do pay less than what you could get if you worked in a private practice job in a nearby geographic location. My guess is that the rural sites pay better than the urban sites, but still, less than what you would make in private practice. PM me if you would like to hear my salary numbers.

Part of the problem with the NHSC job sites is that they are crap shoots and you do not know what kind of administrative/medical leadership you will get. I interviewed for a job in Baltimore that required all of their physicians to dispense suboxone, no exceptions. When I said that I didn't feel qualified to take care of suboxone patients as I had had minimal experience as a resident, they said that they would pay for an 8 hour online training course, no worries.

The location can be a bit of an obstacle for some people. The rural locations can be pretty remote, and if you're single, it can be daunting to consider moving to such a small town. If you are from a rural area, you definitely have an advantage.

The NHSC itself is not easy to work with. You have to keep every piece of paper or email that they send you, because it is very likely that they'll forget that they sent it to you, or will tell you something totally contradictory later, etc. If you try to contact them to clarify something, it will frequently take 2-3 weeks to get a response (and even then it's usually a canned response that's not very helpful). The NHSC staff gets turned over frequently, so you often get a noobie staff member who has no. freaking. clue of what to do or how to answer your question. One of my coworkers, who is doing loan repayment, was told that one of the loans she paid off 2 years ago was not "NHSC approved," and so they had retro-actively decided that they wanted that money back. She was told that she owed the NHSC $17,000. It took about 8 weeks to sort out. She was pretty pissed, as you can imagine.

Finally, just because the position is listed does not mean it is real. Many sites do a poor job of updating their job openings and the NHSC does not keep the list updated either.

Hope that helps. PM me with any more questions.

 

[wolfvgang22]

I'm a Family Medicine attending who received the NHSC scholarship for the last 2 years of medical school. I'm now doing my service payback at an urban site in Florida.

Most of the NHSC sites do pay less than what you could get if you worked in a private practice job in a nearby geographic location. My guess is that the rural sites pay better than the urban sites, but still, less than what you would make in private practice. PM me if you would like to hear my salary numbers.

Part of the problem with the NHSC job sites is that they are crap shoots and you do not know what kind of administrative/medical leadership you will get. I interviewed for a job in Baltimore that required all of their physicians to dispense suboxone, no exceptions. When I said that I didn't feel qualified to take care of suboxone patients as I had had minimal experience as a resident, they said that they would pay for an 8 hour online training course, no worries.

The location can be a bit of an obstacle for some people. The rural locations can be pretty remote, and if you're single, it can be daunting to consider moving to such a small town. If you are from a rural area, you definitely have an advantage.

The NHSC itself is not easy to work with. You have to keep every piece of paper or email that they send you, because it is very likely that they'll forget that they sent it to you, or will tell you something totally contradictory later, etc. If you try to contact them to clarify something, it will frequently take 2-3 weeks to get a response (and even then it's usually a canned response that's not very helpful). The NHSC staff gets turned over frequently, so you often get a noobie staff member who has no. freaking. clue of what to do or how to answer your question. One of my coworkers, who is doing loan repayment, was told that one of the loans she paid off 2 years ago was not "NHSC approved," and so they had retro-actively decided that they wanted that money back. She was told that she owed the NHSC $17,000. It took about 8 weeks to sort out. She was pretty pissed, as you can imagine.

Finally, just because the position is listed does not mean it is real. Many sites do a poor job of updating their job openings and the NHSC does not keep the list updated either.

Hope that helps. PM me with any more questions.

That is very helpful, thank you.
Do you feel overworked compared to colleagues not doing NHSC? Is the pace something sustainable. I worry that with unreasonable "requirements" at some sites that a physician could end up being "required" to see a patient every 8 minutes. I know family practice doesn't do the longer interviews we do in psychiatry, but are you rushed?

 

[smq123]

That is very helpful, thank you.
Do you feel overworked compared to colleagues not doing NHSC? Is the pace something sustainable. I worry that with unreasonable "requirements" at some sites that a physician could end up being "required" to see a patient every 8 minutes. I know family practice doesn't do the longer interviews we do in psychiatry, but are you rushed?

I am scheduled to see patients every 15 minutes, which is fairly typical for most family medicine offices. Most family medicine doctors see about 20-25 patients a day; I am scheduled for that amount, but usually see less. Because of our patient population, our no-show rate is quite high (couldn't get a bus, my ride didn't come get me on time, I have to wait until my disability check comes in before I can get my car fixed, etc).

I don't feel rushed, but I do feel really tired at the end of the day, sometimes. I think that we sometimes feel more overworked than we really are, and I think that is because each individual patient is so much more work than you would expect. For example, if a patient came in with an ankle sprain, if they had an income and insurance, I would tell them to go to Wal-Mart and buy an over-the-counter ankle brace, no big deal. But with our patients, that leads to a 10 minute long discussion - they don't have the money to buy a brace. They don't have the money to take the bus to Wal-Mart, and they don't have a car. They don't have the money to take the bus to physical therapy, and their crappy Medicaid doesn't cover it anyway. Etc, etc.

I also wish that they would give us more administrative/flex time. But they don't.

That being said, most job sites that I looked at (rural or urban) had decent working hours and schedules. They know that they don't really have a lot of money to keep physicians/NPs/PAs, so they're hoping that if they provide a reasonable work schedule, that will keep people happy. I don't get a ton of vacation, but I get almost every weekend off, all federal holidays off, and I take home call about once every 3 months. I don't admit patients, and I am only scheduled to work 40 hours a week. One job site in Alaska that was recruiting heavily had their FM doctors cover in-patient as well as OB, but they also got, like, 6 weeks of vacation or something along those lines. One of our NPs works every other Saturday, but she only works 3 days during the week.

 

[wolfvgang22]

Thank you, very helpful.

 

[smq123]

I wonder if doing telepsychiatry for the underserved rural population qualifies?

Didn't see this until now....don't know if it's tongue-in-cheek, but no, it does not.

It hasn't been a bad experience. Working with the underserved does definitely force you to stretch your boundaries and expand your comfort zone. I'm doing stuff that I was told in residency that I would "never need to do; refer to a specialist." Well....

 

[Igor4sugry]

Most of the NHSC sites do pay less than what you could get if you worked in a private practice job in a nearby geographic location. My guess is that the rural sites pay better than the urban sites, but still, less than what you would make in private practice. PM me if you would like to hear my salary numbers.

NHSC is not a good way to repay ones loans. The main reasons for this are:

[1] Loss of autonomy of where to live and work
-Location of work sites are crappy. Loss of autonomy is probably the biggest drawback. It will make your girlfriend/boyfriend/wife/husband/kids hate you.

[2] Amount repaid is not great
You get $60k over 2 years if in super underserved area (>14points) and $40k over 2 years if <13points.
That is not that great of repayment. Private jobs will offer that along with a high salary.


[3] Breach of contract rules are VERY harsh
page 26: http://nhsc.hrsa.gov/downloads/lrpapplicationguidance.pdf
Many physicians change their jobs within first 2 years. Now if you sign up for this program you are basically stuck there because getting out will make you much worse off.
If the repayment bellow doesn't scare you I don't know what will.

-----------------------------------
A participant who breaches a commitment to serve in a full-time clinical practice will become liable to the United States for an amount equal to the SUM of the following:
(1) The amount of the loan repayments paid to the participant representing any period of obligated service not completed;
(2) $7,500 multiplied by the number of months of obligated service not completed; AND
(3) Interest on the above amounts at the maximum legal prevailing rate, as determined by the
Treasurer of the United States, from the date of breach.
------------------------------------

[4] Qualifying for repayment is a headache
-Need to maintain records of patients you see, which adds too much paperwork.

[5] Salary is artificially lowered.

-Yes, you will get loan repayment but you will be getting paid probably ~$110k.
So yes, there is money repaid, but its almost a zero-sum game and you loose your autonomy and are stuck in some awful place.
So if you want to work in rural area fine; there are plenty of offers that will give you loan repayment and ~$200k salary.
Not to mention using PSLF.

 

[wolfvgang22]

NHSC is not a good way to repay ones loans. The main reasons for this are:

[1] Loss of autonomy of where to live and work
-Location of work sites are crappy. Loss of autonomy is probably the biggest drawback. It will make your girlfriend/boyfriend/wife/husband/kids hate you.

[2] Amount repaid is not great
You get $60k over 2 years if in super underserved area (>14points) and $40k over 2 years if <13points.
That is not that great of repayment. Private jobs will offer that along with a high salary.


[3] Breach of contract rules are VERY harsh
page 26: http://nhsc.hrsa.gov/downloads/lrpapplicationguidance.pdf
Many physicians change their jobs within first 2 years. Now if you sign up for this program you are basically stuck there because getting out will make you much worse off.
If the repayment bellow doesn't scare you I don't know what will.

-----------------------------------
A participant who breaches a commitment to serve in a full-time clinical practice will become liable to the United States for an amount equal to the SUM of the following:
(1) The amount of the loan repayments paid to the participant representing any period of obligated service not completed;
(2) $7,500 multiplied by the number of months of obligated service not completed; AND
(3) Interest on the above amounts at the maximum legal prevailing rate, as determined by the
Treasurer of the United States, from the date of breach.
------------------------------------

[4] Qualifying for repayment is a headache
-Need to maintain records of patients you see, which adds too much paperwork.

[5] Salary is artificially lowered.

-Yes, you will get loan repayment but you will be getting paid probably ~$110k.
So yes, there is money repaid, but its almost a zero-sum game and you loose your autonomy and are stuck in some awful place.
So if you want to work in rural area fine; there are plenty of offers that will give you loan repayment and ~$200k salary.
Not to mention using PSLF.

I agree with you, thanks for the clear analysis. The other best advice I've seen so far is instead of using the listings on the NHSC website, just look for normal employed jobs. Then if you are really, really convinced you will be at a location for two years consider asking the employer about NHSC at that specific location.

Since you brought up PSLF, I have a question about that. I've been told that residency counts as public service for PSLF purposes. I'm nearly done and haven't signed up for it. If I signed up today, would the past 4 years of residency count, or just this last year of fellowship?
I'm also thinking that payments for IBR might be faily low the first year out of residency, since they use an applicants previous year's adjusted gross income to calculate payments. Is that correct?

 

[freaker]

Regarding Psychiatrists who are applying for the National Health Services Corps loan repayment program, are any being rejected?
Does anyone know the stats of acceptance/rejections and why people were rejected?
Any personal experiences with the program?

I'd be curious to hear about this. I have interviews at several NHSC sites. A fear of mine is that you get all set to work at one of these sites and you don't get approved for loan repayment. The ones that I'm looking at all have scores of 15.

 

[AnnoyedByFreud]

I'd be curious to hear about this. I have interviews at several NHSC sites. A fear of mine is that you get all set to work at one of these sites and you don't get approved for loan repayment. The ones that I'm looking at all have scores of 15.

My university held an info session about NHSC/HRSA (the scholarship and loan repayment). They told us twice as many people apply for loan repayment as there are available spots. However I don't know how that breaks down by specialty (primary care, mental health, dentistry, etc.) They also told us if we're trying to get loan repayment, we should choose sites that have a score of 20 or higher, to avoid being rejected.

 

[smq123]

I'd be curious to hear about this. I have interviews at several NHSC sites. A fear of mine is that you get all set to work at one of these sites and you don't get approved for loan repayment. The ones that I'm looking at all have scores of 15.

I think that Loan Repayment works best if you are set on working on that site anyway, and then just happen to apply for the Loan Repayment as a nice side bonus. Because, otherwise, the chances that you will not find it worthwhile are high - many of these sites have high turnover for a good reason.

 

[MDPhDgrrrl]

Regarding Psychiatrists who are applying for the National Health Services Corps loan repayment program, are any being rejected?
Does anyone know the stats of acceptance/rejections and why people were rejected?
Any personal experiences with the program?

Oh my goodness.

I am one of the lucky few who have received the loan forgiveness scholarship as a psychiatrist, and I feel that it has been one of the worst mistakes I have ever made in my life.

I was awarded close to $50K about 6 months after I applied, to work at a rural, corrections site in California. Every day I want to quit, but I would be fined around $180K at this time by the NHSC to leave.

Let me tell you what my recent work experience has been: my boss ****ed off for 6 weeks and left me in charge, with no training (I only joined one year ago), then a bunch of other psychiatrists went on vacation, or got sick, or had family crises.
So, for the past 6 weeks, I have been doing the jobs of about 6 or 7 psychiatrists.

I have to answer to administration, because I was volunteered to be Acting Chair when my boss had to leave, and my own work performance on my own job responsibilities has of course gone to **** - so I have to answer to administration some more, and put my license in jeopardy.

Due to the stress and fatigue, in the past one year, I have had what seems like 3 versions of the flu, got clinically depressed, had shingles in my face, passed kidney stones, and have had multiple accidents including falling on my face, and accidentally ripping my toenail out.
My colleagues who work at the same place have had multiple car accidents, cancers, you name it.

This was a big mistake.
I should have just paid off my school loans myself.
My family have had to suffer through this **** as well due to the toll it has taken on my health and happiness.

Please think 20 times before you apply to this program.

 

[Merovinge]

Oh my goodness.

I am one of the lucky few who have received the loan forgiveness scholarship as a psychiatrist, and I feel that it has been one of the worst mistakes I have ever made in my life.

I was awarded close to $50K about 6 months after I applied, to work at a rural, corrections site in California. Every day I want to quit, but I would be fined around $180K at this time by the NHSC to leave.

Let me tell you what my recent work experience has been: my boss ****ed off for 6 weeks and left me in charge, with no training (I only joined one year ago), then a bunch of other psychiatrists went on vacation, or got sick, or had family crises.
So, for the past 6 weeks, I have been doing the jobs of about 6 or 7 psychiatrists.

I have to answer to administration, because I was volunteered to be Acting Chair when my boss had to leave, and my own work performance on my own job responsibilities has of course gone to **** - so I have to answer to administration some more, and put my license in jeopardy.

Due to the stress and fatigue, in the past one year, I have had what seems like 3 versions of the flu, got clinically depressed, had shingles in my face, passed kidney stones, and have had multiple accidents including falling on my face, and accidentally ripping my toenail out.
My colleagues who work at the same place have had multiple car accidents, cancers, you name it.

This was a big mistake.
I should have just paid off my school loans myself.
My family have had to suffer through this **** as well due to the toll it has taken on my health and happiness.

Please think 20 times before you apply to this program.

Really good of you to respond, I'm sure its not particularly easy to reflect on how one made what ended up being such a bad choice.

I will say in psychiatry in particular, there is almost no reason to do this kind of thing. I know of SO many jobs that will just let you see more patients if you want to make more money. If you are willing to work in the areas that qualify for this you should be able make around 300k working 40-50 hours a week (assuming you are able to do inpatient/emergency psych work). That should equal out to at least what NHSC offers even taking into account all the taxes/interest.

 

[smalltownpsych]

As a psychologist, the NHSC has been a nice bonus and way to help pay loans ahead so that I don't have to pay the monthly payments for awhile. I agreed to five years at the place that I am working and will get a little over 100k by the time I am done. So far I have been paid 70k and have a check for 20k coming in a few months. It is nice to pay for loans with untaxed money. The nice part for me is that the site is okay and the pay is above what most psychologists would make so it is all working out pretty well for me. I would not move to a place I don't want to live for a job that I don't like doing or take less income just for the NHSC money though.

 

[Information Underload]

I have had a very good experience with the NHSC, though that will soon come to an end, as they are now demanding that case management services be offered onsight beginning December 2017, and that is not the way we are or will be set-up. It is a shame, as I see this as hurting rural clinics more than urban ones. Right now, I'm working the job I would have wanted to work, anyway, I love my colleagues, and I love the community I am in and being in the middle of nowhere, which for me means having far more entertainment options and access to my hobbies. I am not a fan of urban cities. It's made loan repayment much easier for me. I only had 130k in loans coming out of fellowship, so the NHSC made a lot of sense.

To the poster above, you realize you are allowed to transfer sites, right? It needs to be HPSA score of 14 or above, but there is no resson to stay in a malignant work envieonment like that.