House bill would end PSLF, current to be grandfathered

[tex]

WSJ: House GOP to Propose Sweeping Changes to Higher Education http://archive.is/pTMe7 (to bypass paywall)

Text of bill, more details: https://edworkforce.house.gov/prosper/

 

Also capping amount of student loans. Could make a tough few years to be a med student with high debt, because I don’t see the med school “market” responding by slashing tuition in response to this in the near term.

[jsr52]

Remember, PSLF was created for Public Defenders and Public Educators. Folks who have large student loans with low lifetime future income. Physicians got looped into this because of essentially a gross miscalculation. PSLF is not for people who will essentially be rich, so the clock truly is ticking for physicians to get grandfathered in.

[StarTrekDoc]

May cause an acute deficit in academic fellowships for a year to get into PSLF status as a W2 attending--interesting possible unintended consequences.

Our surge in Academic primary care may be coming to an end with this.  We had a nice healthy crop of recruits in recent years because of the PSLF enticement over the private sector.

[tex]

StarTrekDoc wrote:

–interesting possible unintended consequences.

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Nice take. Anyone else care to forecast the effect of the end of PSLF in their area?

Non-profit neonatology directly competes with megacorp neonatology in many markets, making for very similar job choices to the new indebted attending. So may not make too much difference to me. The ROI for most pediatric sub specialty training is much much lower, however - I imagine an increase in general peds in the near term.

[RogueDadMD]

tex wrote:

Non-profit neonatology directly competes with megacorp neonatology in many markets, making for very similar job choices to the new indebted attending. So may not make too much difference to me. The ROI for most pediatric sub specialty training is much much lower, however – I imagine an increase in general peds in the near term.

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I agree.  For peds emergency medicine, some academic jobs are paying quite well compared to private jobs, but in my particular neck of the woods that is not the case.

In the not too distant past, I think peds heme/onc docs at my place were being paid in the low $100s. That's improving, but that's going to impact a lot.  Salaries will have to go up or people will not take those jobs.  I'm paid much better than that and it's going up, thankfully.

It'll definitely drive people to avoid peds fellowships with academic low paying jobs.  A lot of peds subspecialists in children's hospitals are paid well below market rates.  Neonatology, like all of them, is very market driven.

My older brother is a private practice neonatologist, and the salary discrepancies between his current pay and academic jobs is pretty significant.

 

[Zaphod]

Rogue Dad, M.D. wrote:

tex wrote:

Non-profit neonatology directly competes with megacorp neonatology in many markets, making for very similar job choices to the new indebted attending. So may not make too much difference to me. The ROI for most pediatric sub specialty training is much much lower, however – I imagine an increase in general peds in the near term.

Click to expand…

I agree.  For peds emergency medicine, some academic jobs are paying quite well compared to private jobs, but in my particular neck of the woods that is not the case.

In the not too distant past, I think peds heme/onc docs at my place were being paid in the low $100s. That’s improving, but that’s going to impact a lot.  Salaries will have to go up or people will not take those jobs.  I’m paid much better than that and it’s going up, thankfully.

It’ll definitely drive people to avoid peds fellowships with academic low paying jobs.  A lot of peds subspecialists in children’s hospitals are paid well below market rates.  Neonatology, like all of them, is very market driven.

My older brother is a private practice neonatologist, and the salary discrepancies between his current pay and academic jobs is pretty significant.

 

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Low 100s for ped heme onc? Can that be true? Couldnt do that emotionally, but to be paid so little for such a task...

[RogueDadMD]

Zaphod wrote:

Low 100s for ped heme onc? Can that be true? Couldnt do that emotionally, but to be paid so little for such a task…

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Yes, it's true.  I don't know the # right now, but I know that was the range (at specific academic places) only 5 years ago.  I'm sure it's increased, but I do not believe it's increased to what you would expect.

[MrsIMDoc]

Rogue Dad, M.D. wrote:

Zaphod wrote:

Low 100s for ped heme onc? Can that be true? Couldnt do that emotionally, but to be paid so little for such a task… 

Click to expand…

Yes, it’s true.  I don’t know the # right now, but I know that was the range (at specific academic places) only 5 years ago.  I’m sure it’s increased, but I do not believe it’s increased to what you would expect.

Click to expand...

Yes had a friend who was peds nephrology.  Only making $100,000/year.  The thing is most Peds heme onc or peds nephrology are at academic centers so there is not a large private market.

[Craigy]

IMO this is a good thing, both ending PSLF and grandfathering in those currently enrolled.

Even though it's well-intentioned, PSLF creates a huge perverse incentive to go to the most expensive schools possible, get as many degrees as possible, take out as much debt as possible, and then once you finally graduate with doctorates in hand, go and be virtually as unproductive as you can be.  And there are tons of people doing just that as a result.

If they were forgiving debt up to a certain reasonable amount, it could possibly be an efficient, effective system.

But you have to grandfather.  You can't in good conscience pull the rug out from under people who are participating already.

[tex]

Re grandfathering... anyone read the actual bill? (I will not)

I’m imagining the MS4 who has been living high on the debt hog who is about to get burned...

 

[Matt]

Zaphod wrote:

Low 100s for ped heme onc? Can that be true? Couldnt do that emotionally, but to be paid so little for such a task…

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Yup.  I'm Peds Hem/Onc (3 years out of fellowship).  My starting offer at the academic center where I trained was $140K.  I was able to negotiate it up to $160K.  I ended up taking a non-academic position at a private quasi-academic center in the same city for $235K.

[Craigy]

tex wrote:

Re grandfathering… anyone read the actual bill? (I will not)

I’m imagining the MS4 who has been living high on the debt hog who is about to get burned…

 

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I was wondering this too.  The articles I've read suggest those grandfathered are just people who are enrolled and already making qualifying payments.  I don't feel too compelled to read through the text myself.

It seems the fairest way would be to include current students who may have been counting on this, to their detriment... but then obviously that could trickle all the way back to undergrad freshmen who might not graduate from their last degree program and enter the workforce for a decade or more.  The line has to be drawn somewhere.

I have to admit, I don't really feel all that sorry for that MS3 or MS4.

[Zaphod]

MrsIMDoc wrote:

Rogue Dad, M.D. wrote:

Zaphod wrote:

Low 100s for ped heme onc? Can that be true? Couldnt do that emotionally, but to be paid so little for such a task… 

Click to expand…

Yes, it’s true.  I don’t know the # right now, but I know that was the range (at specific academic places) only 5 years ago.  I’m sure it’s increased, but I do not believe it’s increased to what you would expect.

Click to expand…

Yes had a friend who was peds nephrology.  Only making $100,000/year.  The thing is most Peds heme onc or peds nephrology are at academic centers so there is not a large private market.

Click to expand...

This is so vastly different than adult onc/nephro isnt it? What makes the discrepancy so huge? Organizations (insurers/hospitals) just know they can prey upon kids or that their providers are just such good people theyre willing to take a huge cut in pay? Similar issues/treatments should be similarly paid.

A look into this dynamic would be very interesting top to bottom, probably some weird things going on all around.

[ENT Doc]

Zaphod wrote:

MrsIMDoc wrote:

Rogue Dad, M.D. wrote:

Zaphod wrote:

Low 100s for ped heme onc? Can that be true? Couldnt do that emotionally, but to be paid so little for such a task… 

Click to expand…

Yes, it’s true.  I don’t know the # right now, but I know that was the range (at specific academic places) only 5 years ago.  I’m sure it’s increased, but I do not believe it’s increased to what you would expect.

Click to expand…

Yes had a friend who was peds nephrology.  Only making $100,000/year.  The thing is most Peds heme onc or peds nephrology are at academic centers so there is not a large private market.

Click to expand…

This is so vastly different than adult onc/nephro isnt it? What makes the discrepancy so huge? Organizations (insurers/hospitals) just know they can prey upon kids or that their providers are just such good people theyre willing to take a huge cut in pay? Similar issues/treatments should be similarly paid.

A look into this dynamic would be very interesting top to bottom, probably some weird things going on all around.

Click to expand...

Bet the difference is the payer mix and how much of a profit/loss center they are.  I'd bet more kids fall under Medicaid than adults do for the same specialist.  The money-makers get paid and have leverage.  The loss centers don't.  Ultimately you need cross subsidization to have a functioning system, but this limits the salaries for those not making money for the hospital.

[Kamban]

Zaphod wrote:

This is so vastly different than adult onc/nephro isnt it? What makes the discrepancy so huge?

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Most kids who get cancer or ESRD end up on Medicaid. Which does not even cover the cost of the high priced cancer drugs.

So the net income to the academic institution is a small amount or a loss.