By Christine DeCarlo, AACOM Advocacy and Public Affairs Manager
Katherine D. Kirby, DO, is a recent graduate of the Edward Via College of Osteopathic Medicine in Blacksburg, Virginia (VCOM-Virginia) who is completing her residency training in obstetrics and gynecology at a nonprofit hospital, where she has begun working toward receiving Public Service Loan Forgiveness (PSLF). ED to MED spoke with Dr. Kirby about why PSLF matters to medical students, residents, patients, and communities, and why Congress should continue to support this crucial program.
As a current resident who is now undertaking a ten-year public service commitment through the PSLF Program, what attracted you to the osteopathic profession and a career serving others?
What a great question to start with! It’s helpful to remind ourselves everyday why we’re on this journey. I came to medicine through a non-traditional path. No one in my family is immediately involved in the medical field, and I started my education wanting to pursue music, exercise science, or physical therapy. I didn’t know about osteopathic medicine until a health science class during college taught me about its holistic approach, which appealed to me greatly. I had an a-ha moment, and thought to myself, why isn’t everyone practicing osteopathic medicine?
As physicians, we have so much medical knowledge, but if our patients can’t understand our advice or recommendations, we aren’t helping them. Being able to break things down and explain medical knowledge to patients in ways they can understand and act on brings me so much joy. Going home at night knowing that I helped someone have a better outlook on their future is, I think, what gives so many in medicine their sense of purpose and has been so rewarding for me.
Current data suggest that the PSLF Program helps encourage osteopathic medical school graduates who have high educational debt to specialize in primary care. As a primary care resident who is also currently pursuing PSLF, did the availability of the loan repayment program factor in to your specialty choice?
I was very fortunate to have heard about PSLF early in my medical training. VCOM-Virginia did a great job talking to us about our program options when we were considering our specialty. For the first three-and-a-half years of medical school, that’s all you’re focused on, what kind of physician will I eventually become?
Many students enter medical school with undergraduate loans, and to add medical school loans on top of these can become very daunting and overwhelming. I knew that I wanted to go into primary care, which is an interest shared by a lot of osteopathic medical students. They enjoy and seek the types of patient relationships that primary care allows you to build. Because of the availability of PSLF, I was able to become a generalist OB/GYN without necessarily having to pursue a fellowship to pay off my loans.
Some Republican lawmakers and the President have proposed eliminating the PSLF Program for new borrowers in the reauthorization of the Higher Education Act (HEA). If you were unable to rely on PSLF as a medical student, what impact might that have had on your life and career?
If I didn’t have that option, I don’t know if I would have ultimately changed my decision to go into medicine. I love my field, but it would definitely have been more burdensome. My debt would be something I constantly think about. Without repayment options like PSLF, resident and physician financial burnout would likely lead to students deciding not to go into medicine at all.
You are the Assembly of Osteopathic Graduate Medical Educators’ Residents and Fellows Council Membership and Recruitment Committee Chair, as well as the first resident featured on the ED to MED blog. Why would you encourage other residents to become involved in advocacy, particularly around federal financial aid and loan repayment issues?
While at VCOM, I had the opportunity to advocate for my school at the national level through the Student Osteopathic Medical Association (SOMA). Through SOMA, I was able to attend several advocacy days in Washington, DC to meet with Members of Congress about federal policies and programs that impact health and higher education. The best part about attending advocacy days is getting to experience the overall receptiveness of lawmakers. Even if they don’t agree with your policy requests, they appreciate your story. Such a big part of what Members of Congress do involves talking with constituents. They get into these roles to make a difference, just like physicians. If we’re not willing to spend extra time to help our lawmakers make informed decisions, we should not complain about the decisions that end up being made.
As a resident, I have begun advocating to my health professions colleagues that Congress needs our advice and feedback. As residents and physicians, we need to advocate for our patients to the bridge the gap between patients and Congress.
To benefit from PSLF, borrowers need to be careful to adhere to program requirements. What advice would you give to other residents who are pursuing PSLF to make sure they are on track to obtain loan forgiveness?
This is my second year working toward PSLF, and I’ve been very thankful for VCOM’s guidance with helping me set up my loans initially, and for those at my residency program who have helped me move through the process. I would share four pieces of advice with other residents:
- Start early. Some people believe you can retroactively apply for PSLF after you’ve completed your ten years of service, but it’s much better to approach loan forgiveness as a ten-year process, rather than something you worry about later. I chose a nonprofit hospital for my residency in part because my four years of loan repayment during my training would apply toward PSLF. Planning ahead helped inform my decision.
- Communicate with your loan providers. Make sure they are aware you are working toward PSLF, and make sure you are aware of your loan information. This is very important early on. You may need to move your loans to a different company, which was the case for me.
- Make time for paperwork. Setting aside time to fill everything out correctly when you first begin working toward forgiveness is valuable. At the outset, the requirements seem daunting, but once you get everything in order, keeping yourself on track is much simpler.
- Stay on track. As you’re working toward forgiveness, do your best to stay aware of how your loans are functioning and where they are being maintained. Requirements can change over time, so don’t lose track of your paperwork.
Every year, AACOM hosts COM Day on Capitol Hill to raise awareness of the federal legislative issues impacting health professionals and their patients. This October 17, we are calling on advocates across the health professions community to take action by letting their Members of Congress know why it is crucial that they #SavePSLF as they work to reauthorize the HEA. What message would you share with your lawmakers about why residents and their patients rely on the PSLF Program?
I really appreciate the social media aspect you’ve incorporated into COM Day. Congress consistently uses social media to stay up-to-date on constituent requests, so it’s great that advocates will be able to utilize this avenue of communication if they can’t attend in-person. The message that I would share is that PSLF is vital. It’s so important to primary care physicians and residents. Knowing that we will have financial security later in life helps us make current financial decisions to set ourselves up for success.
Some people get frustrated when they see doctors asking for loan forgiveness, since the perception is that we make a lot of money. When I told my bank officer about the student loans I anticipated having, he said, “Oh, so you’re going to have a house.” I said, “Yes, but a house I can never live in.” My loans aren’t for me, they help me become a better doctor for my patients.
Congress, I would ask you to please continue supporting federal programs like PSLF that help doctors give back to small communities and pursue primary care specialties. Access to primary care continues to be a great need and will become even more vital in the years to come as the physician shortage worsens. Anything we can do to encourage medical students to practice primary care will help set patients up for success and help specialists do their jobs more effectively.