SirOliver

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Hi all,

I'm a MS 4 at a UC school, career changer (worked in education for 10 years), with a spouse and 2 young children. I will apply into Psych and plan to complete a Child Psych fellowship. If all goes as planned, I will be in my early 40s upon finishing the fellowship and likely will graduate with around $230k in debt.

NHSC seems appealing to me, as I plan on working with underserved communities anyway. The Students 2 Service program has the added advantage of heading off interest on loans relatively early on, but I'm concerned about what the job availability is for psychiatrists. The job search area on the NHSC website has fewer than 20 jobs available on the entire west coast, and it's unclear if any child specific (with the obvious caveat that the job landscape will change by the time I would be applying). While my family and are open to moving (either for residency or afterwards), we live in a major metropolitan area now and I'm not sure how everyone would adjust to going somewhere rural--particularly my spouse, who is a lawyer for the govt and would have to quit her job. I'm also hesitant to introduce a great deal of transience into my kids' lives--moving for residency, fellowship, NHSC job, etc--but recognize that this may be unavoidable, NHSC or not.

I gather that there are a few different loan repayment options--NHSC, CA state loan repayment, and possibly local/regional incentives (Kaiser, different hospitals, etc.). Seems like a less risky bet, but I have to admit that I'm somewhat taken with the idea of paying down the debt ASAP.

So, my questions:
1) Is there anyone with NHSC and psych job experience that may be able to weigh in on what job prospects are like? Are the opportunities few and far between and mostly rural?
2) To what extent did attempting to maintain stability for your children factor into your job decision making?
3) Did being part of NHSC hamper your salary/benefit negotiations?
4) Are there advantages/disadvantages to the NHSC that I'm missing?

Thanks in advance.
 

vistaril

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Hi all,

I'm a MS 4 at a UC school, career changer (worked in education for 10 years), with a spouse and 2 young children. I will apply into Psych and plan to complete a Child Psych fellowship. If all goes as planned, I will be in my early 40s upon finishing the fellowship and likely will graduate with around $230k in debt.

NHSC seems appealing to me, as I plan on working with underserved communities anyway. The Students 2 Service program has the added advantage of heading off interest on loans relatively early on, but I'm concerned about what the job availability is for psychiatrists. The job search area on the NHSC website has fewer than 20 jobs available on the entire west coast, and it's unclear if any child specific (with the obvious caveat that the job landscape will change by the time I would be applying). While my family and are open to moving (either for residency or afterwards), we live in a major metropolitan area now and I'm not sure how everyone would adjust to going somewhere rural--particularly my spouse, who is a lawyer for the govt and would have to quit her job. I'm also hesitant to introduce a great deal of transience into my kids' lives--moving for residency, fellowship, NHSC job, etc--but recognize that this may be unavoidable, NHSC or not.

I gather that there are a few different loan repayment options--NHSC, CA state loan repayment, and possibly local/regional incentives (Kaiser, different hospitals, etc.). Seems like a less risky bet, but I have to admit that I'm somewhat taken with the idea of paying down the debt ASAP.

So, my questions:
1) Is there anyone with NHSC and psych job experience that may be able to weigh in on what job prospects are like? Are the opportunities few and far between and mostly rural?
2) To what extent did attempting to maintain stability for your children factor into your job decision making?
3) Did being part of NHSC hamper your salary/benefit negotiations?
4) Are there advantages/disadvantages to the NHSC that I'm missing?

Thanks in advance.

Unless that's where you want to be anyways, I wouldn't do NHSC. On a ten year repayment plan 230k would be a monthly payment of Im guessing 2600 or so per month. Is that a lot of money?(especially since it's going to be non-tax ded). Sure. But I don't think it's worth participating in NHSC for. Again, unless you want to work there anyways. You are going to be extremely limited in where you and your family are going to be able to live and what type of work. Do you want that for your family?

My advice would be to take a job you like, and if it's NHSC eligible(and it probably won't be) then great. If not, just accept that your salary will be lowered by 2600 take home per month. Does that suck? Sure....but it's not the end of the world.
 

notdeadyet

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I gather that there are a few different loan repayment options--NHSC, CA state loan repayment, and possibly local/regional incentives (Kaiser, different hospitals, etc.). Seems like a less risky bet, but I have to admit that I'm somewhat taken with the idea of paying down the debt ASAP.
If you have any concern about where to move (and with wife and kids, you probably do), avoid NHSC. Options are limited.

You can take one of the benefits you mention above and still live in the metropolitan area you enjoy. I moonlight at a place that one long Saturday shift is enough to cover my loans on a 10 year plan. I'd bet your family would find you gone one Saturday a month to be a lot less hardship on the family dynamic than all of you living just off of an Indian reservation somewhere. Caveat emptor.
 
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So, my questions:
1) Is there anyone with NHSC and psych job experience that may be able to weigh in on what job prospects are like? Are the opportunities few and far between and mostly rural?
2) To what extent did attempting to maintain stability for your children factor into your job decision making?
3) Did being part of NHSC hamper your salary/benefit negotiations?
4) Are there advantages/disadvantages to the NHSC that I'm missing?
I'm an NHSC scholarship recipient with a 3-year commitment but currently still in training. I'm in my first year of child and adolescent fellowship, and have begun the search for an NHSC-approved job I can work at next year. I also have young children; we had 3 kids upon graduation from medical school and added one more during residency. I believe I can certainly empathize with your situation, except that my wife does not work. We, too, have been interested in finding a job in a place we and our kids would enjoy, and if possible I'd rather not move again after my service commitment is fulfilled.

To answer your questions:
1) I haven't yet worked in an NHSC-approved job but I am currently looking for one. The NHSC Jobs Center website gives some ideas, but there are very few child psych jobs posted there. (There is also no way to filter listings according to general vs. child psych; you basically have to click on each one to see what exactly they're looking for.) Recently I learned of a job available in the area where my wife and I would like to raise our kids. I spoke with the employer over the phone, and it sounds like a great job. It's the kind of job I'd probably want to do with or without the NHSC commitment, but the only problem is that it's not yet NHSC-approved. It likely qualifies, but the employer just hasn't applied for approval yet. They are now working on submitting an application, I'm hoping they can get approved soon. If all works out, I might find myself working in my ideal location, at my ideal job, and fulfilling my NHSC commitment at the same time. What I'm saying here is that psychiatry is an underserved specialty, and you may actually be able to find an NHSC job in a place you'd want to live. The NHSC Jobs Center website only shows you which locations have already applied for approval and received it, but there are probably many employers with jobs out there which would qualify but they have not yet applied. If you're interested in a particular area, I'd recommend reaching out to employers early and see if they'd be willing to apply for NHSC approval. By the way, if you haven't already, you can visit the NHSC Jobs Center website and uncheck the box "Only show sites with open positions", and you'll see all of the employers which have received NHSC approval. Be sure to zoom in on the map to see more listings. Some of them might be planning to hire a psychiatrist but haven't updated their status here, so it would be worth asking them.

2) This was a huge factor for us. I have an older child who will be in high school while I'm doing my NHSC service. We want all of our children to attend good schools. We've also moved a lot from going to school, residency, and fellowship, and we're at a point when we'd like to stop moving because it's challenging for our kids to establish new friendships every 2-4 years, and we'd like them to have a sense of stability. There are, of course, several jobs in rural areas which don't interest us. Occasionally there are jobs available in major cities, but they tend to get filled quickly from what I've seen. Fortunately, I'm in a situation where there's a good likelihood of landing a job which I would enjoy, in a city my family would enjoy, and which would be approved by the NHSC. However, to be very honest, until now I had been planning on doing my 3-year service commitment in a tolerable city or town and then move on to someplace else.

3) I'm not able to adequately answer this question, as I've only discussed contracts with one employer so far. With them, they have a standard rate they pay all of their doctors, and it seems good in my opinion. Salary is going to depend on various factors, no matter whether the job is NHSC-approved or not, and the salary offered should not be contingent on whether or not you are with the NHSC. In some cases, you might even find that NHSC jobs pay more than other jobs you'd find elsewhere. For example, there are sometimes strong incentives offered to doctors to work in rural areas.

4) The obvious advantage to being in the NHSC is the reduced debt you'll have, and it's possible you might get a job which is NHSC-approved and also gives you extra money for paying off your student loans. I can't think of any others, really. Disadvantages include a loss of freedom. You won't be able to work at any job you want for a while. You may be stuck working at a job you don't like in a city your family doesn't like. It's a bit of a gamble. Also, it's the government, so communication can sometimes take a while, and you're obligated to satisfy whatever demands they might have when you start your service. If the HPSA score requirement is 14 when you sign up, but 16 when you begin your service, you are required to take a job that has a score of 16 or higher. In hindsight, I'm not sure if I would have signed up for the NHSC scholarship if I had the chance to do it again. Freedom is a good thing, and it may be worth the extra debt.
 

Doctor Bagel

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These types of work obligation jobs generally work best for people who don't have partners or people with partners without careers. I think your wife being an attorney would create a big negative in that it is possible she will have to make big career sacrifices for you to find a job at an approved location.
 

thoffen

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If you do IBR in residency, I'd estimate $800 / mo, and the REPAYE plan afterward $1100 / mo. 4 years residency counts to public service loan forgiveness. If you stick in academics or community mental health, that'd be 6 more years. That's a total of $117,600 paid before forgiveness. Just rough numbers, and it is depending on no changes in legislation for this, and it would restrict job options post-residency.
 

milesed

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I did the NHSC program for 7 years to pay off all loans after finding a job I liked at a CMHC that happened to be an approved site for NHSC. I like my job and am still working here so it's worked out well for me. Take the advice above. Don't accept a job purely on loan repayment. I'd rec factoring in the yearly amount as salary as you compare job offers (NHSC also pays the IRS directly for the federal taxes you'd pay for the loan repayment amounts each year).
 
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Unless that's where you want to be anyways, I wouldn't do NHSC. On a ten year repayment plan 230k would be a monthly payment of Im guessing 2600 or so per month. Is that a lot of money?(especially since it's going to be non-tax ded). Sure. But I don't think it's worth participating in NHSC for. Again, unless you want to work there anyways. You are going to be extremely limited in where you and your family are going to be able to live and what type of work. Do you want that for your family?

My advice would be to take a job you like, and if it's NHSC eligible(and it probably won't be) then great. If not, just accept that your salary will be lowered by 2600 take home per month. Does that suck? Sure....but it's not the end of the world.
You're confusing the NHSC with the PSLF. The way it works with NHSC is that when you work in a NHSC site, you get 50k tax-free to directly pay down loans (award amount can vary from year to year and depends on site) for a two-year commitment and then 20k for the next year. I have another 20K check coming this summer. :D I would be working here anyway so it's a really nice perk.
 

SirOliver

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This is very helpful. As mentioned above, it's a govt agency, so communication is poor--there's not one psychiatrist (and very few physicians in general) available through their 'Ambassador' program, which is meant to help answer applicant questions. I am appreciative of your efforts to fill in the gaps.
 

Igor4sugry

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Hi all,

I'm a MS 4 at a UC school, career changer (worked in education for 10 years), with a spouse and 2 young children. I will apply into Psych and plan to complete a Child Psych fellowship. If all goes as planned, I will be in my early 40s upon finishing the fellowship and likely will graduate with around $230k in debt.

NHSC seems appealing to me, as I plan on working with underserved communities anyway. The Students 2 Service program has the added advantage of heading off interest on loans relatively early on, but I'm concerned about what the job availability is for psychiatrists. The job search area on the NHSC website has fewer than 20 jobs available on the entire west coast, and it's unclear if any child specific (with the obvious caveat that the job landscape will change by the time I would be applying). While my family and are open to moving (either for residency or afterwards), we live in a major metropolitan area now and I'm not sure how everyone would adjust to going somewhere rural--particularly my spouse, who is a lawyer for the govt and would have to quit her job. I'm also hesitant to introduce a great deal of transience into my kids' lives--moving for residency, fellowship, NHSC job, etc--but recognize that this may be unavoidable, NHSC or not.

I gather that there are a few different loan repayment options--NHSC, CA state loan repayment, and possibly local/regional incentives (Kaiser, different hospitals, etc.). Seems like a less risky bet, but I have to admit that I'm somewhat taken with the idea of paying down the debt ASAP.

So, my questions:
1) Is there anyone with NHSC and psych job experience that may be able to weigh in on what job prospects are like? Are the opportunities few and far between and mostly rural?
2) To what extent did attempting to maintain stability for your children factor into your job decision making?
3) Did being part of NHSC hamper your salary/benefit negotiations?
4) Are there advantages/disadvantages to the NHSC that I'm missing?

Thanks in advance.

I would advise to NOT do NHSC. It is something that will make it more restrictive for you going forward. I would say do IBR/PAYE while in residency and make sure your loans are PSLF elligible.
You won't have any difficulty finding work once you graduate. There are plenty of jobs that have loan repayment or are eligible for PSLF and NHSC loan repayment. Particularly the VA offers loan repayment (up to $120k).

I would also recommend leaving California for residency and not coming back, particularly as you have a family of 4. You will struggle on resident salary for those 4 years in high cost of living areas.
 

milesed

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I would advise to NOT do NHSC. It is something that will make it more restrictive for you going forward. I would say do IBR/PAYE while in residency and make sure your loans are PSLF elligible.
You won't have any difficulty finding work once you graduate. There are plenty of jobs that have loan repayment or are eligible for PSLF and NHSC loan repayment. Particularly the VA offers loan repayment (up to $120k).

I would also recommend leaving California for residency and not coming back, particularly as you have a family of 4. You will struggle on resident salary for those 4 years in high cost of living areas.

Can you elaborate what you mean by "It is something that will make it more restrictive for you going forward." ?
 

Igor4sugry

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You will be stuck looking for jobs that need to qualify for NHSC. Psychiatry is in demand, many jobs are in underserved areas and come with signon bonuses or qualify for loan repayment programs (such as NHSC loan program ($50k over 2 years)
Don't get stuck in this NHSC scholarship program, its too restrictive for what they are giving you.
 
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You will be stuck looking for jobs that need to qualify for NHSC. Psychiatry is in demand, many jobs are in underserved areas and come with signon bonuses or qualify for loan repayment programs (such as NHSC loan program ($50k over 2 years)
Don't get stuck in this NHSC scholarship program, its too restrictive for what they are giving you.
Ah. I was confusing the NHSC LRP which is what I am in and a scholarship program which I don't know much about but if it means you are restricted to certain sites that could be a problem in early career. I got the job first, the NHSC LRP was a plus.
 

alina_s

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I did the NHSC scholarship program and regretted it. No regrets around specialty- I got in starting 3rd year and knew that I would do psychiatry already- but lots of regrets around committing to NHSC site placement, and I was single. I would've been happier with it if the site selection rules when we signed up were what we were committing to serving, but that wasn't the case. When I signed on, there were lots of IHS sites and residents were being allowed an extra year for child psychiatry, but in the following years, they awarded so few scholarships that psychiatry sites were nearly all with the bureau of prisons and they explicitly forbade child psychiatry. I completely agree with Igor that it's too restrictive to be worth it. It was a relief to not take out more loans, but the program support was terrible and the site options were bad. Truly, I wasted hours in my last year+ of residency trying to talk to whoever my placement support staff person was, and when I got to talk to humans, I was probably referred to a dozen different people. When I did get connected, he was completely useless. The people running placement (private, for-profit company with no background in medical staffing) didn't know that psychiatrists are physicians and couldn't answer the most basic questions, just focused on crossing t's, dotting i's, and pressuring me to sign a contract ASAP. The NHSC contracted with different companies while I was with them, which made it even more efficient. They were so effective that I flew out to an approved site for an interview before discovering that the position they were hiring for didn't really qualify for the service obligation. Some of the sites weren't just underserved populations but also incredibly poorly run. I lost sleep over the work load and also worried about whether the billing was ok or whether I'd get in trouble with Medicare or Medicaid and what badness in the agency I might be held responsible for in court. And I don't think mine was one of the worse sites.
 
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