who work in New York HSPAs for 2 years. However, IR is not an explicitly eligible specialty for repayment.
Among survey respondents, the most commonly mentioned form of debt relief is the Public Service Loan Forgiveness Program (PSLF). Those enrolled in the PSLF must work at an eligible nonprofit or government organization to have the remainder of their federal loans forgiven after 10 years of repayment. While PSLF does not specifically target rural or underserved communities, many community health centers and hospitals operate as nonprofits, thus providing viable opportunities to clear educational debt beyond higher-paying, metropolitan-area jobs.
Another key benefit of the PSLF program is that some physicians can begin accruing years of service while still in training.
“Because all of my loan debt is from federal loans, I am only applying to residencies in which residents are employees of a qualified PSLF employer (e.g., a nonprofit hospital or the VA system),” said Piers Klein, a medical student at Boston University.
The rural relief solution Despite graduating residents’ willingness to go to rural areas, they were clear: with limited options for funding available, they were more likely to go where they could ensure income.
“My student loans, in combination with loans taken to pay for childcare during residency, feel insurmountable. The paycheck will likely dictate my career choices,” said one survey respondent, a PGY-6 resident who wished to not be identified.
After years of practice, mid-career and later career IR physicians can celebrate the settlement of their onerous debt issues, Dr. Ignacio said—but the challenge of student loans resurfaces from the practice side as physician groups attempt to recruit and retain IR physicians, particularly in small, rural and underserved areas.
According to Dr. Ignacio, novel approaches are emerging where local IR practices may offer direct stipends to a trainee in medical school and residency if that individual is willing to commit to their specific practice locale. This financial support during training can defray the final loan debt. Some groups also offer
22 IRQ | FALL 2024
idea that has the potential to make a major impact across the country.”
Looking for loan relief options?
If passed, this bill would direct the HRSA to provide up to $250,000 to specialty medicine physicians who practice in a rural community with specialty medicine shortages. The SPARC Act is unique in its relief for specialists, while also providing substantial reimbursement opportunities to entice physicians into rural communities.
SIR identified the SPARC Act as one of its legislative priorities during the 2023 Washington Fly-In event.
Many states have medical school loan relief programs that are IR eligible. The Association of American Medical Colleges has compiled a list of all state relief
programs. Check out your state to see what you may be eligible for.
signing bonuses, benefit options and job sharing to young IR doctors, which translates to debt management as well as expansion of IR services in the periphery of their community.
Another answer to both the rural workforce shortage and mounting student debt may lie in targeted relief programs that are relevant to IR.
There is a precedent for this kind of program. The Child Neurology Society led the effort to enact legislation to create the Pediatric Specialty Loan Repayment Program, which provides $100,000 to pediatric subspecialists who work for 3 years at sites that treat underserved communities or are in a shortage area.
One possibility may be the Specialty Physicians Advancing Rural Care (SPARC) Act, which was introduced into the Senate in 2023.
“The United States is facing a historic nationwide physician shortage, which has hit rural communities in Mississippi especially hard,” said a press release by Sen. Roger Wicker, R-Miss., one of the bill sponsors. “The SPARC Act is designed to attract specialty providers to rural areas by offering incentives to medical professionals who choose to work in underserved areas. It is a simple
Conclusion For many reasons, the cost of postgraduate education has significantly risen over the last 20 years, leaving the future of IR facing huge debt. Debt management options for physicians-in- training, such as practice stipends and loan forgiveness programs, can certainly improve financial positions, as well as support and cultivate IR services in small, rural or underserved areas.
“A diminished debt burden benefits the young IR physician, and the town or community sees more access to essential IR services for patients,” said Dr. Ignacio. “I’m excited that sustainable initiatives like these are moving forward for interventional radiology.”
References
1. Association of American Medical Colleges. Press release: AAMC Report Reinforces Mounting Physician Shortage. June 2021.
aamc.org/ news/press-releases/aamc-report-reinforces- mounting-physician-shortage
2. National Health Service Corps. The NHSC Students to Service Loan Repayment Program.
nhsc.hrsa.gov/loan-repayment/nhsc-students- to-service-loan-repayment-program#eligibility
3. Indian Health Service. Indian Health Service (HIS) Loan Repayment Program.
ihs.gov/ loanrepayment/eligiblehealthprofessions.
4. New York State Education Department. The Regents Physician Loan Forgiveness Program.
nysed.gov/postsecondary-services/ regents-physician-loan-forgiveness-program-lf
5. Federal Student Aid. Public Service Loan Forgiveness Program (PSLF). studentaid. gov/manage-loans/forgiveness-cancellation/ public-service
6. Roger Wicker. Press release: Wicker fights against rural physician shortage. March 2023.
wicker.senate.gov/2023/3/ wicker-fights-against-rural-physician-shortage
7. Association of American Medical Colleges. Loan Repayment/Forgiveness/Scholarship and Other Programs.
systems.aamc.org/fed_loan_pub/ index.cfm?fuseaction=public.welcome
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