Is loan forgiveness enough to convince students to choose primary care?

in Education | 20 responses

I’ve often said that forgiving medical school loans, often exceeding $140,000, can help more students choose primary care.

Students at Harvard Medical School were the lucky recipients of an offer by an anonymous donor, offering $60,000 to students who entered, and completed, a primary care residency.

Salary is one consideration that students have when choosing a specialty. The other is lifestyle. As they train, they observe primary care role models harried by onerous pre-authorization and paperwork requirements, as well as increasing pressure to deal with many issues in a decreasing amount of time. Generally, primary care doctors in academia are unhappy, and that morale influences a student’s decision.

Will the money help sway some students? Well, let’s say that $60,000 can be made up in about 3 months if a student chooses, say, dermatology over family practice.

So, I can’t say that money will sway many. But it definitely can’t hurt.

Comments

Anonymous
Waste of time. They need to improve rates of pay and the speed and compliance with which both the government and private insurers pay for services. Covering school loans in hopes that someone will choose a practice on a failing business model is stupid and hopeless.
Anonymous
Even if some program like this were well funded enough to sway medical students, the students are years from beginning work.
They need to increase pay in primary care or the current primary care physicians will continue to leave the field. Midlevels are not likely to help much soon because they realize they also make far more for less work in the procedural specialties than in primary care.
Anonymous
how long do you have to stay in primary care before you can go back and fellowship?
The Happy Hospitalist
Don’t forget you have to pay taxes on that $60K. So make it becomes more like $40K or less, depending on your state income tax rate. Not small change, but it is when you compare income potential between procedural based and non procedural based specialties. You can make $30K in a week by owning your own endoscopy suite or being part owner of a specialty hospital.
Anonymous
Who says this often? Primary care physicians? Can’t that be said about lots of jobs? “It’s often said that we’d have more(pick your job) if their loans were forgiven and/or you paid them more money.”
Dr. Mary Johnson
Kevin, I am sorry. I do not understand how you can be online “hocking” these “indentured servitude” programs as a mechanism to funnel newbies into primary care . . . when you KNOW that physicians like me have been professionally robbed, raped and left for dead by them.
Moreover, I’ve been jumping up and down in this blogosphere (signing my name) for YEARS trying to get someone to help me motviate the state of North Carolina and/or the Federal Government to MOVE on criminal charges against the small-town kings who screwd me . . . yet NOTHING . . . ZERO/ZIP/NADA . . . has been done.
These people told my patients and my colleages that “good Pediatricians were a dime a dozen”!?! This is a mindset amongst the businessmen pulling the strings (and again, taking home the big bucks). You are NOT going to change ANYTHING until cases like mine are prosecuted.
I would tell any newbie that loan forgiveness is ABSOLUTELY NOT enough to steer them to primary care. I would tell them to “Run Forest, Run! How can you do this in good conscience?
Anon 7:56 is absolutely right. You have to pay taxes on the money the government is giving you to bring allegedly much-needed medical services to podunk (it makes NO sense whatever) . . . you are generally no more than a warm body to people who want you to work out of a closet and/or sleep in a dorm room (while they collect the phat managerial pay-checks) . . . and, in terms of you place in the medical food chain . . . well, you’re at the bottom.
If you want to lift the veil and reform medicine, you are going to have to start listening to these stories and doing something about them besides pretending these people/situations do not exist.
Which, OBTW, had been DHHS, JCAHO, and the AMA’s tactic to date.
I’d appreciate it if you would not delete the comment.
Anonymous
doesn’t the hippocratic oath have some requirement in it that makes medical education free? what happened?
Anonymous
Mary Johnson:
I have read many of your posts and looked at you website. I get the picture. The current strategy seems not to be effective. Have you hired a lawyer and sued? Hired a PI? Written a book or done a documentary film? There must be other avenues…
Michael Rack, MD
Anon 8:08 am: I agree with you 100%, that is said of many jobs. However, for most jobs right now, we don’t need more people. We don’t need more lawyers, finance personnel/investment bankers, etc right now. With layoffs right now of teachers, we don’t even need more teachers as a whole, though there is a shortage of math and science teachers.
We do need more primary care doctors.
Dr. Mary Johnson
Medical education is not free, Anon 8:49. But if you, as an MD, CONTRACT with the Federal & State governments to spend YEARS of your life providing care to impoverished/under-served areas, they really need to do a better job of (1) protecting you from badness and (2) honoring the terms of their own agreements.
Anon 9:30. First, thank you for reading. In terms of dealing with the hospital directly, my best/only solution can only be found in criminal court . . . prosecuting the over-rated, over-paid executives who destroyed my hometown practice for their perjury, contempt and fraud.
However, I've endured six years of stone-walling on the part of the North Carolina justice system, so I am exploring other options, including (but not limited to) suing the NC Medical Board for failing miserably to protect the duties it requires of physicians. In my case, I was the ONLY one playing by the rules – and I got totally hosed.
That's why I get so furious when the medical establishment tries to pass off these loan-repayment-for-public-service programs as a solution to bringing (1) newbies to primary care and (2) primary care to the masses.
In my case, the government did not give a rat's tail about the Pediatrician who did the right thing – or the community that lost that Pediatrician because she did the right thing. They abandoned ALL of us.
So again, my advice to anyone considering this kind of program is STAY AWAY. STAY FAR, FAR AWAY.
I am actually doing a series on my blog right now that tells the story straight from my legal file. I am going to finish that project before I do anything "official".
And, yes, I do plan to write a book as well.
Anonymous
does hospitalist count?
Anonymous
I finished my residecny in family practice 11 years ago, and have been practicing ever since. It took me along time to finally admit that my choice of specialty was a mistake, but it finally happened.
The problems with primary care are at every level. A carrot and stick approach, like a little loan forgiveness, is meaningless. Why in the world would someone choose 150,000 per year over 400,000 per year, while at the same time garnering minimal respect from the government, insurance companies, other doctors, and last but not least, patients?
A family practitioner
Anonymous
Dr. Rack,
You say we need more pcps. How many more? If we don’t know how many we need how do we know how to incentivize them? And where do we need them as well?
You should be careful in claiming that as well lest the impression be given that a certAin number of them are a “right”.
Kipper
I don’t think loan repayment will do the trick.
There’s a chicken and egg problem in that I really do think that the key to making primary care appealing is to have role models who enjoy it and do it well. Which is not what we have right now; for every excellent and engaged primary care physician like my current doctor, there’s a handful of dead-eyed HMO docs who never would’ve gotten into medicine if they knew they’d spend their days as assembly-line prescription-writers.
I have noticed that the really good primary doctors I’ve known generally got into it because they had a mission, generally wanting to improve care for some population or perhaps wanting to improve the practice of primary care itself. Outreach to foster that sense of mission could probably help, but what happens after a couple of generations of students take the bait and end up that HMO prescription machine? Not good for credibility.
Another concern that I wonder about now is whether new doctors going into primary care can even bank on being able to practice in that field for their entire career (if desired), or if they’re in danger of being forced out long term. I would certainly be concerned about that in their place.
Michael Rack, MD
Anon 12:48,
I don’t know how many more PCP’s we need. I am not advocating incentivizing primary care. I am a specialist, any incentive for primary care won’t help me. Docs who advocate for the fixing broken healthcare system are accused of being greedy or of abandoning patients (depending on if they advocate for increasing medicare/medicaid payments or if they favor concierge models)- even if they are specialists commenting on primary care. I was just making an offhand comment previously, I am not advocating for anything. I can live with the way things are.
Sharon
I agree… loan forgiveness will help, but in my opinion the more important reforms will be in making the job more enjoyable (less paper work, less hoops to jump through, more time with patients, more ancillary services to help us take the best care possible of our patients) and improving the way PMDs are respected within the medical profession (just because I didn’t go into dermatology doesn’t mean I didn’t have the grades to do so, although that seems to be what many specialists think). But as you state, the loan forgiveness can’t hurt, and will help PMDs feel a little less screwed. I really don’t mind making less than others, but it hurts more when I send in my $1500 check every month.
Med Student
Retainer medicine is enough to bait me into primary care.
Anonymous
Two problems with loan forgiveness:
1. If it draws people into primary care who otherwise wouldn’t go, it will just mean higher levels of unhappiness in the field when they find out it does nothing to correct the problems with the field.
2. The government will then think it owns you and you will be fully subject to the whim of the mob. Note what is going on with the AIG execs. Take the King’s Schilling and you must salute and march to the King’s colors.
I don’t think it is salary, I think it is work/business conditions. I make the same as primary care in psychiatry, left one of the most lucrative fields for it, and am reasonably happy with it–at least less unhappy than the PCP’s that I know. While I sometimes have greed fits and regret not staying with the 400,000 a year field, I usually come to my senses on that point–but I wouldn’t trade with PCP’s for love or money. My compensation is reasonable for what I do but I would not find it reasonable for what they do.
Anonymous
If they buy you, they own you.
Anonymous
Loan forgiveness is really only a short-term incentive. Compared to the costs of operating an outpatient practice, with rent, staff salaries and benefits and other continuing and escalating operating costs, the student loan cost is not usually the biggest concern. That isn’t to say it’s unimportant, but eliminating loan payments is not going to solve the access problems we now have, nor will it relieve the likely worse problems we will develop.
Third-party payers and patients both drop costs onto small practices that did not exist for these practices a generation ago. Even the smallest practices have to have a business staff to file, follow and chase payments from insurers and Medicare, activities that can cost even the smallest practices many tens of thousands of dollars to do, something the earlier payment at the time of service model never had to bear.
Unless more money goes to providers, offsetting the effective cuts from rising operations costs, there isn’t going to be an “answer” to the primary care access problem. Fewer doctors will accept Medicare patients, more will choose cash-based practices and see those who are able to pay for what they want.
Expecting the generalist medical community to provide costly and valuable service without payment, something that third-party payer failure to keep pace with practice costs is inherently doing, is not a reasonable or sustainable working condition. Ultimately a system that indulges itself in this kind of behavior will fail. When it does fail, we will see even worse problems than what we presently have. Under-insured lack of access will dwarf our present problems of uninsured lack of access.

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