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Blog » Guest Blog: Protecting Primary Care with PSLF and Grad PLUS

Guest Blog: Protecting Primary Care with PSLF and Grad PLUS

November 9, 2018

By Tiffany Ziegler, MS, OMS-III, Arizona College of Osteopathic Medicine of Midwestern University

I first realized I wanted to become a physician in the last year of my undergraduate studies when I was serendipitously assigned to follow a female pediatric surgeon for a psychology project. As a first-generation college student, it had never occurred to me that becoming a doctor was even a remote possibility for my future, but from my first day following her work I felt an undeniable draw to help others through the practice of medicine.

Returning to school to complete a couple years’ worth of science pre-requisite courses that I had not earned with my bachelor’s degree was no easy task—I had earned a scholarship for my undergraduate education and had to work to fund only my living expenses throughout that time. However, returning to school left the financial burden of both the cost of living expenses and tuition on my shoulders. I worked full-time and went to school at night for three years, finishing all of my science coursework; then, for another year, I earned my master’s degree during the day while working full-time night shifts in the ER to continue funding my education independently.

When the magical moment finally came and I found I had been accepted to medical school, the brutal reality of what that meant financially hit me hard and fast. Seeing for the first time that my education would cost multiple hundreds of thousands of dollars came with the reality check that this was a pursuit that I couldn’t possibly work enough hours to pay for without financial assistance. Students like me—who can’t go into the military or who don’t have families who can help pay for medical school tuition—have only two choices when it comes to becoming a physician: either do so while incurring a spectacular amount of graduate student loan debt, or don’t become a physician.

I decided to take the leap of faith and start medical school with the assistance of Grad PLUS and Federal Stafford Loans—programs without which thousands of students like myself could never have the chance to become a physician. I felt okay making that decision knowing that I wanted to work with underserved communities, and federal programs like Public Service Loan Forgiveness (PSLF) existed to help me pay off my student loans through public service. Without options like PSLF, and often even despite such options, many of us find ourselves having to choose a medical specialty based on pay alone. I’m realizing that at the end of the day I can’t serve others if I can’t afford to pay off my student loans, and unfortunately with the future of loan repayment programs now up for debate in Congress, I’m finding myself having to decide who and where to serve based on pay.

No one tells you going into medical school that your student debt can limit your specialty choice. I certainly had never considered it until I learned more about my interest rate accrual and salary potential during residency and as a new attending physician. Without loan repayment assistance programs like PSLF, the payments I’ll be making in my first few years as a young physician won’t even touch my principal with the high interest rates that began accruing from my very first day of medical school. Like many others in my position, if I don’t choose a higher paying specialty outside of primary care, I may find myself making years of payments only to see my total debt load increase due to the interest structure and my salary-limited payment capability.

This problem certainly doesn’t allow me to go into a lower paying specialty like pediatrics or family practice, even though those would be among my top choices if finances were not a consideration. While this is unfortunate for me and students like me, it is even more so for the populations we will be serving soon; we already have a well-known physician shortage in this country, and, in my opinion, primary care is where we’re hurting the most. However, with rising tuition rates, overwhelming interest, and reduction of loan repayment programs such as PSLF, this problem will only continue to worsen in years to come.

While the financial burden to become a physician is overwhelming, I ask Congress not just to think of the future health care workforce, but the future health of the United States. We can’t afford to continue pushing physicians away from primary care and into higher paying specialties simply because it could be the only option future physicians will be able to afford. For the health of our nation, I urge Congress to #SavePSLF and #SaveGradPLUS during the reauthorization of the Higher Education Act.

The views and opinions expressed are those of the author(s) and do not imply endorsement by AACOM.