House bill would end PSLF, current to be grandfathered

[jsr52]

Fair enough

[The White Coat Investor]

jsr52 wrote:

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.

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Not sure a pediatrician with $600K in student loans should be considered "essentially rich."

[Sergio Estavillo]

Grandfathering, for PSLF and IDR plans, apply to Direct Loans. This legislation proposes the Federal One Loan Program collapsing the current Unsub and Grad PLUS. The Federal One Loan will have an aggregate limit of $235,500 and annual of $55k for certain health professions. Direct will sunset on June 30, 2024 under this legislation.

[jsr52]

I have to imagine grandfathering will only apply to PSLF and not specific payment plans, so for those cruising along in IBR or Repaye at 10% of income I imagine they would be combined into whatever the new income based payment would be, looks like 15%. Big question is will the new payment plans incorporate spouses income...

[Wings3496]

Literally the only mention of PSLF is on page 84 of the PDF:

"With respect to the public service loan forgiveness program under section 455(m)"

And this is in regards to the US ed sec being required to publish data on the program and how much debt is being forgiven. Given the size if this bill it is frustratingly vague in regards to forgiveness programs other than specifically for teachers. So if the intention is "well if a program isn't in this bill, it will no longer exist" - well okay then, but otherwise it seems difficult to know the future of PSLF, and even of potential 'grandfathering'.

[The White Coat Investor]

FutureDoc wrote:

Really surprised that no one else has really commented on the 150k cap for graduate degree loans.  Lots of students are in more debt than that.

Also, nobody can predict the future, but I put a pretty good wager that if the house bill gets through and ends PSLF we are going to see some major shifts in new graduates coming out in 7 years.

 

 

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That's for federal loans. There's a cap on those now. You can only get so much a year. Above that, it's private. Usually at 7.9%. Could be worse. If you're in the Caribbean, your loans are likely at 8-10% and your match rate is 57%.

[The White Coat Investor]

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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The bill does not have the phrases PSLF or Public Service Loan Forgiveness in it. But it mentions the word forgiveness in ten places. In one of them, it gave me the impression that people already enrolled would be grandfathered in. I think it was page 342.

[FutureDoc]

Really surprised that no one else has really commented on the 150k cap for graduate degree loans.  Lots of students are in more debt than that.

Also, nobody can predict the future, but I put a pretty good wager that if the house bill gets through and ends PSLF we are going to see some major shifts in new graduates coming out in 7 years.

 

 

[ENT Doc]

Hank wrote:

You have a few factors at play for low compensation for pediatric sub-specialists.  First, you’re employed by the local children’s hospital.  How many locations in the country have more than one children’s hospital within a reasonable commuting distance?  Thus, monopsony buying power on the part of the local children’s hospital.

Second, a pediatrician matches into a relatively uncompetitive and poorly paid field, then takes more years of training in a sub-specialty for what sometimes is even lower pay.

A possible third factor may be gender discrimination.  Relatively more women enter pediatrics and peds tends to be underpaid.  This might be correlation, it might be causation, but the “macho”, more prominently male surgical specialties tend to be higher paid and the specialties that have relatively more female docs tend to be less well paid.  (One notable outlier is dermatology, but it may be the exception that proves the rule.)

Finally, we have payer mix, as discussed above.

None of this suggests that the work of pediatric sub-specialists isn’t important or shouldn’t be better compensated, but here we are.

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OB gets paid more and they are mostly female.  Also, it may have nothing to do with discrimination and much to do with negotiations, something females short-change themselves with routinely.

[ENT Doc]

cnceagles wrote:

I’m not a doc (just a lurker, mostly on the Senate tax bill thread and reading the blog generally) but funny enough my son is a Ewing’s sarcoma survivor (doing well, thanks to pediatric oncologists at our local and excellent children’s hospital). And I study/teach a bit of public policy for a living.

Many kids go on Katie Beckett Medicaid, even if a parent has employer-sponsored health insurance. Without Katie Beckett, pediatric cancer cases would blow the risk pools at many small employers.

Also, many cancer/blood disorder centers do a lot of sickle cell cases, which are often Medicaid.

In addition, as noted, the drugs are often (essentially) first generation. Doxorubicin, cyclophosphamide, etc.

But I will say the fellows are fantastic. Underpaid. Lifesaving. Wonderful. Thanks to any and all of y’all who have done that work.

PSLF will affect many, many people – not just MDs, JDs, etc. Peace Corps. Anyone who gets an MPA/MPP to work in the public sector. Other people who could make a lot trading municipal debt, etc. in the private sector. There will be a lot of lobbying on this bill.

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Happy to hear about your son.  And welcome!

[cnceagles]

hightower wrote:

From what I have been hearing, it’s the Senate bill that matters most at this point.  If it’s not in the Senate version of the bill, then it’s unlikely to become law.

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Different law, not a tax bill. This is HEA, which governs all of higher education in the US. This has a real shot at passage.

[cnceagles]

I'm not a doc (just a lurker, mostly on the Senate tax bill thread and reading the blog generally) but funny enough my son is a Ewing's sarcoma survivor (doing well, thanks to pediatric oncologists at our local and excellent children's hospital). And I study/teach a bit of public policy for a living.

Many kids go on Katie Beckett Medicaid, even if a parent has employer-sponsored health insurance. Without Katie Beckett, pediatric cancer cases would blow the risk pools at many small employers.

Also, many cancer/blood disorder centers do a lot of sickle cell cases, which are often Medicaid.

In addition, as noted, the drugs are often (essentially) first generation. Doxorubicin, cyclophosphamide, etc.

But I will say the fellows are fantastic. Underpaid. Lifesaving. Wonderful. Thanks to any and all of y'all who have done that work.

PSLF will affect many, many people - not just MDs, JDs, etc. Peace Corps. Anyone who gets an MPA/MPP to work in the public sector. Other people who could make a lot trading municipal debt, etc. in the private sector. There will be a lot of lobbying on this bill.

[hightower]

From what I have been hearing, it's the Senate bill that matters most at this point.  If it's not in the Senate version of the bill, then it's unlikely to become law.

[Hank]

You have a few factors at play for low compensation for pediatric sub-specialists.  First, you're employed by the local children's hospital.  How many locations in the country have more than one children's hospital within a reasonable commuting distance?  Thus, monopsony buying power on the part of the local children's hospital.

Second, a pediatrician matches into a relatively uncompetitive and poorly paid field, then takes more years of training in a sub-specialty for what sometimes is even lower pay.

A possible third factor may be gender discrimination.  Relatively more women enter pediatrics and peds tends to be underpaid.  This might be correlation, it might be causation, but the "macho", more prominently male surgical specialties tend to be higher paid and the specialties that have relatively more female docs tend to be less well paid.  (One notable outlier is dermatology, but it may be the exception that proves the rule.)

Finally, we have payer mix, as discussed above.

None of this suggests that the work of pediatric sub-specialists isn't important or shouldn't be better compensated, but here we are.

[RogueDadMD]

Matt wrote:

There’s also the inherent underpayment for all Peds services (thanks AAP!).

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Agreed -- I was just thinking about this.  The AAP does a ton to advocate for children, but unlike other professional societies, it doesn't spend a ton of time advocating/lobbying for the pediatricians taking care of them.  They should have been out there demanding when healthcare reform was on the table that pediatric services were reimbursed equally on Medicaid as Medicare is for adults, but I don't recall ever hearing anything about it.

They are really focused on "access" and "the medical home" for good reason, but if you don't pay the doctors/hospitals enough to provide the care, there is still going to be a problem.