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Cracks in the Student Loan Cancellation - $50k

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  • #46
    Out of state tuition for U Penn is a little questionable as well. (Sort of like if a prospective criminal defense attorney says he went to Princeton or Colombia for law school .)

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    • #47
      Originally posted by Hank View Post
      Out of state tuition for U Penn is a little questionable as well. (Sort of like if a prospective criminal defense attorney says he went to Princeton or Colombia for law school .)
      Choose Princeton. Only seven students obtained a law degree before the school closed in 1852. Experience. What could go wrong?

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      • #48
        People act like everyone takes out the max loans since they are in PSLF. You still generally pay more (not all) the more you borrow.

        You pay 10% of your AGI or the 10 year standard repayment rate which ever is lower.

        Most physicians will be under standard payment plan amount while in residency and over while an attending.

        i.e as an attending if you have 200k loans you pay ~2k a month during payoff, while if you have 300k debt you will pay ~3k. (current covid freeze stops this though)


        1. People always talk about how private docs have more tax protected opportunity than w2 employed. Is it possible funneling more doctors into non profit w2 jobs for PSLF qualification has better tax payment returns than these docs going private? (i don't know the answer)
        2. Is it possible that more med students go into primary care since they have PSLF support?

        If medical students listened to the advice on this thread. It would be:

        Go to cheapest best medical school you can find take least amount of loans you can. Go into a specialty that pays well, Not PRIMARY care. Then live in a VLCOL area and pay back your loans fast. I agree with this statement and it's what I did. Though it makes me see why PSLF was created.











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        • #49
          Originally posted by Otolith View Post
          People act like everyone takes out the max loans since they are in PSLF. You still generally pay more (not all) the more you borrow.

          You pay 10% of your AGI or the 10 year standard repayment rate which ever is lower.

          Most physicians will be under standard payment plan amount while in residency and over while an attending.

          i.e as an attending if you have 200k loans you pay ~2k a month during payoff, while if you have 300k debt you will pay ~3k. (current covid freeze stops this though)


          1. People always talk about how private docs have more tax protected opportunity than w2 employed. Is it possible funneling more doctors into non profit w2 jobs for PSLF qualification has better tax payment returns than these docs going private? (i don't know the answer)
          2. Is it possible that more med students go into primary care since they have PSLF support?

          If medical students listened to the advice on this thread. It would be:

          Go to cheapest best medical school you can find take least amount of loans you can. Go into a specialty that pays well, Not PRIMARY care. Then live in a VLCOL area and pay back your loans fast. I agree with this statement and it's what I did. Though it makes me see why PSLF was created.
          Two separate issues:
          • Rural and under served areas for primary medical care.
          • Public Service Loan Forgiveness
          a) Creating medical schools with a target of recruiting students from rural and under served areas to become primary care physicians.
          b) Granting PSLF to those physicians that practice in rural and under served areas.
          The combination of those two objectives would be wonderful incentives. However, the two programs are not linked. Many of the rural and under served do not have medical clinics or practices that qualify. Why? Because it is not economically feasible to provide medical services on a large scale. It is a waste land economically to run a facility or practice. Only scattered private practice. Mutually exclusive goals. The patient population is sufficient to support a PCP but not the non-profit facilities.

          By using a shotgun approach on both objectives, each program will be extremely inefficient. Many students will not be able (by choice or opportunity) to provide PCP to rural and under served areas.

          One example:
          University of Houston: New medical school with state funding focused on objective a). Residencies committed to by HCA. The weakness is that not ONE new clinic or hospital in a rural or under served area. All training in in the current facilities in 3rd largest county and 5th largest metro population area. Extremely few freshly minted attendings will choose to go back to their rural and under served areas because zero new opportunities have been created and they would not be eligible for PSLF.
          The options will simply increase the supply and thus depress the compensation in the urban areas. The target, rural and under served will be missed.

          Over simplification, just an example of a university wanting the "status" of having a medical school without a path to providing PCP to the target.

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          • #50
            https://www.google.com/amp/s/www.cnb...-tax-free.html


            Did anybody else see this provision put in the covid-19 stimulus bill? It added text about any potential student loan forgiveness which occurs in the next 5 years will be tax free. This article is wondering if that is a harbinger of things to come from this New Democratic administration.

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            • #51
              Originally posted by Otolith View Post
              People act like everyone takes out the max loans since they are in PSLF. You still generally pay more (not all) the more you borrow.

              You pay 10% of your AGI or the 10 year standard repayment rate which ever is lower.

              Most physicians will be under standard payment plan amount while in residency and over while an attending.

              i.e as an attending if you have 200k loans you pay ~2k a month during payoff, while if you have 300k debt you will pay ~3k. (current covid freeze stops this though)


              1. People always talk about how private docs have more tax protected opportunity than w2 employed. Is it possible funneling more doctors into non profit w2 jobs for PSLF qualification has better tax payment returns than these docs going private? (i don't know the answer)
              2. Is it possible that more med students go into primary care since they have PSLF support?

              If medical students listened to the advice on this thread. It would be:

              Go to cheapest best medical school you can find take least amount of loans you can. Go into a specialty that pays well, Not PRIMARY care. Then live in a VLCOL area and pay back your loans fast. I agree with this statement and it's what I did. Though it makes me see why PSLF was created.











              I don't really get #2. Primary care specialties have a 96% match rate - are we saying that the extra 4% who could possibly fill it are going to solve our "primary care shortage"? It's all musical chairs. All I can see is that family medicine would get more competitive and you would have more US MDs filling the spots? I'm not sure that really matters... although for different reasons I would like to see the lower paying specialties get paid more.

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              • #52
                Originally posted by Turf Doc View Post


                I don't really get #2. Primary care specialties have a 96% match rate - are we saying that the extra 4% who could possibly fill it are going to solve our "primary care shortage"? It's all musical chairs. All I can see is that family medicine would get more competitive and you would have more US MDs filling the spots? I'm not sure that really matters... although for different reasons I would like to see the lower paying specialties get paid more.
                The problem is most want a nice comfortable Primary Care in a nice suburb and Loan forgiveness. Drives employment to the non-profit employed clinics in the suburbs without addressing the rural and under served locations. Nice zip code and loan forgiveness. Not characterizing, this is way too much of a generalization.
                PLSF is not actually targeted to rural and under served. Most employment is in urban healthcare institutions. They get the same break, leads to lower compensation in already over crowded markets.
                If 90% go to urban, the benefit yield is very small. Just a contrarian point of view of PSLF using a shotgun and missing the target. Targeted approach true public service locations would be much more accurate and much less participation. 90% yield would be nice, the 10% would be those that just couldn't hack the practice in rural and under served areas. No data, just a different take on the program.

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                • #53
                  Originally posted by Tim View Post

                  The problem is most want a nice comfortable Primary Care in a nice suburb and Loan forgiveness. Drives employment to the non-profit employed clinics in the suburbs without addressing the rural and under served locations. Nice zip code and loan forgiveness. Not characterizing, this is way too much of a generalization.
                  PLSF is not actually targeted to rural and under served. Most employment is in urban healthcare institutions. They get the same break, leads to lower compensation in already over crowded markets.
                  If 90% go to urban, the benefit yield is very small. Just a contrarian point of view of PSLF using a shotgun and missing the target. Targeted approach true public service locations would be much more accurate and much less participation. 90% yield would be nice, the 10% would be those that just couldn't hack the practice in rural and under served areas. No data, just a different take on the program.
                  I totally agree with everything you've said here - just saying that I don't think PSLF necessarily does anything to get more primary care docs into the workforce. I often here that from people (not necessarily you) but that fails to account for the pretty high match rate.

                  Comment


                  • #54
                    Originally posted by Turf Doc View Post


                    I don't really get #2. Primary care specialties have a 96% match rate - are we saying that the extra 4% who could possibly fill it are going to solve our "primary care shortage"? It's all musical chairs. All I can see is that family medicine would get more competitive and you would have more US MDs filling the spots? I'm not sure that really matters... although for different reasons I would like to see the lower paying specialties get paid more.
                    Yes good point and I don't disagree. Though, most internal medicine graduates do not go do primary care. Thus there is another selection pressure of how many decide not to pursue a fellowship and stay in primary care. Those graduating IM residency with 300k debt have an incentive to pursue fellowship or higher paying opportunities than primary care. I would propose that knowing they can work at any non profit doing what they want to do and be ok takes away the pressure of feeling like they need to pursue fellowship for financial reasons.

                    I'm not saying it's going to work, i'm just saying its logical.

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                    • #55
                      Originally posted by Otolith View Post
                      I'm not saying it's going to work, i'm just saying its logical.
                      There are many points about student loans and PSLF that are logical but do not work together as intended.
                      Targeted program from training, residency and loan forgiveness. If the candidate doesn’t find their own, they will be assigned. Tour of duty in under served or rural location. Wherever the Primary Care Corps assigns you.

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                      • #56
                        Originally posted by Otolith View Post

                        Yes good point and I don't disagree. Though, most internal medicine graduates do not go do primary care. Thus there is another selection pressure of how many decide not to pursue a fellowship and stay in primary care. Those graduating IM residency with 300k debt have an incentive to pursue fellowship or higher paying opportunities than primary care. I would propose that knowing they can work at any non profit doing what they want to do and be ok takes away the pressure of feeling like they need to pursue fellowship for financial reasons.

                        I'm not saying it's going to work, i'm just saying its logical.
                        This is a great point i never thought of - what percentage of those who match "primary care" end up actually practicing primary care instead of pursuing some sort of niche fellowship or tailoring their practice to something else? I know if I matched into FM I'd probably try that. Definitely need to pay actual primary care more to keep the incentives right.

                        Again imo the surest way to get people practicing in rural underserved programs is to accept people in the first place through special programs where their license will only be valid in designated areas

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