Educational Debt in Healthcare, Public Service Loan ...

Educational Debt in Healthcare, Public Service Loan Forgiveness: Financial implications and political outlook

Ben George and Justin Grischkan

UR Public Health Grand Rounds

September 15, 2017

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Outline

-- Why is debt important to the healthcare workforce? -- What is happening to debt trends over the past few decades? -- What is Public Service Loan Forgiveness? Considerations? -- What are the financial implications of Public Service Loan Forgiveness (PSLF)? -- Why is Public Service Loan Forgiveness (PSLF) different for doctors? What are the costs? -- Updates on proposed legislation to change Public Service Loan Forgiveness...

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Debt has the potential to impact career choices...

According to a 2008 survey of college undergraduates: ?One-third said that student loans impacted their decision to choose a career ?47 percent said their career pursuits were influenced by loan payments ?40 percent took a job that provided higher pay, but less satisfaction, to pay off loans

In the medical literature: ?Primary care and work for the rural/underserved have lower return on investment compared to (sub)specialty work and work in urban/well-served areas ?High educational debt deters some medical school graduates from choosing a career in primary care

Source: Kahneman, Proceedings of the National Academy of Sciences, 2010;

Weeks, eCt aol,n2f0id02e,nAtciaadl cMoepd;yPhilips, Fam Med, 2010; Phillips Ann Fam Med, 2014

Debt also impacts lifestyle...

?Higher rates of burnout have been found among internal medicine residents with greater debt ?38% of final year medical residents report that educational loan forgiveness/ repayment are a "major concern" (2014) ?Increased financial concern is associated with poor health

Source: West, et al, JAMA, 2011; Turunan, et al, 2014, BMC Public Health, Merritt Hawkins Survey 2014

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Mean cost of attendance and educational debt is rising for medical students...

US $, Adjusted to 2013 dollarsa

350,000

300,000

Private Cost of Attendanceb

250,000 200,000 150,000

Public Cost of Attendance Private Educational Debt Public Educational Debt

100,000

50,000

0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

Source: AACMoCnTfiuditeionntaiandl cFoeepsySurvey, AAMC Databook

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