Loan Forgiveness Programs Research Articles

Your Tax Dollars at Work: The Effectiveness of the Public Service Loan Forgiveness Program

Your Tax Dollars at Work: The Effectiveness of the Public Service Loan Forgiveness Program

The Value of Student Debt Relief and the Role of Administrative Barriers: Evidence from the Teacher Loan Forgiveness Program

The Value of Student Debt Relief and the Role of Administrative Barriers: Evidence from the Teacher Loan Forgiveness Program

Waivers for the public service loan forgiveness program: Who could benefit from take‐up?

AbstractFor workers employed in the public and nonprofit sectors, the Public Service Loan Forgiveness (PSLF) program offers the potential for full forgiveness of federal student loans for those with 10 years of full‐time work experience. A year‐long waiver issued by the Department of Education in 2021 to address administrative problems in program access provided a new path to PSLF relief for many borrowers. We explore the overall impact and distributional implications of potential full participation in loan forgiveness enabled by the PSLF waiver program using the 2018 Survey of Income and Program Participation (SIPP). Our estimates identify more than $100 billion in loan forgiveness available to as many as 3.45 million borrowers through the PSLF waiver program. Potential beneficiaries of this initiative are disproportionately employed in occupations like teaching and health care. Full take‐up of the PSLF waiver would lead to a narrowing of the racial gap in student debt burden. However, the distributional impact of the PSLF waiver depends critically on the take‐up rate and there is some evidence that those borrowers with relatively high income or advanced degrees have been most likely to access benefits.

Demographic Characteristics and Career Plans of First-Generation Medical Students at a Single Medical School in the United States.

Recruitment of first-generation medical students is essential to improving diversity and inclusion in US medical colleges. First-generation students offer unique experiential insights that foster empathy and cultural competency in the learning environment and improve health outcomes for patients. However, little is known about their demographic characteristics or career goals. It is important to identify these factors to provide insight on ways to better support first-generation students. This exploratory pilot study aimed to describe background, demographic characteristics, and goals of students. We administered a secondary analysis of a quality improvement and health disparities survey to third-year medical students at a large, private medical school in Philadelphia, Pennsylvania. Measures included demographic information, interest in loan forgiveness programs, and other career goal items. We conducted χ2 goodness-of-fit tests to examine differences by first-generation status. Thirteen percent of respondents identified as first-generation medical students (n=26). First-generation medical students were more likely to be male, aged 21-26 years, White, and non-Hispanic/Latino. First-generation students were significantly more likely to report wanting to care for underserved populations during their career and enter loan forgiveness programs, with Department of Education's Public Service Loan Forgiveness program most often cited. This study provides an exploratory profile of characteristics of first-generation medical students and their career intentions. Our results suggests that enrollment of first-generation students may increase the number of physicians who are willing to serve underserved populations. However, first-generation students may also need more financial support through loan forgiveness programs which has important implications for medical education.

Food and Housing Insecurity Among Social Work Students

We know little about social work students’ experience with financial hardship, especially food and housing insecurity, during their academic programs. This knowledge gap is problematic because food and housing insecurity negatively impact student success. In response, we surveyed 125 social work students of a public, Midwestern U.S. university in 2019 to investigate students’ experience with food and housing insecurity, as well as the factors associated with food and housing insecurity. We conducted descriptive and multivariate analyses, finding that 56% of students reported food or housing insecurity. Student financial characteristics, such as filing a FAFSA and taking out loans, were associated with food and housing insecurity. Students who identified as female and nonbinary were more likely to experience housing insecurity. Finally, we found that food and housing insecurity were each associated with lower reported grade point averages. Suggestions for intervention include schools of social work offering paid practica and emergency funds as well as advocating for improved student loan forgiveness programs at the national level.

Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce.

As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.

Perception of Debt During Resident Education-A Systematic Review.

Debt is a common issue among medical residents in the United States. This review attempts 1) to evaluate the level of debt among residents, 2) to assess perceptions toward debt among residents, 3) to determine debt-management options pursued, and 4) to gauge whether levels of debt affect resident career choices. A systematic literature search of articles published between January 2012 and January 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed. The combination of search terms of (financial literacy OR debt) AND (residency OR graduate medical education) were utilized. Primary outcome measures assessed were the levels of debt and perceptions toward the debt. Secondary outcome measures were debt-management options pursued and whether debt affected career choices for residents. Twenty-one studies evaluating a total of 15,585 residents were included in this systematic review. Levels of debt greater than $200,000 were not uncommon across residents and debt burdens are increasing. Greater levels of debt are associated with increased stress and anxiety. Residents reported multiple debt-management options pursued, including loan forbearance, moonlighting, income-based repayment models, military financial support, and loan forgiveness programs. Those with increased levels of debt were less likely to pursue subspecialty training and academic employment positions. The findings conclude that residents carry a substantial amount of debt, and it is a common source of stress and anxiety. Although there are many different avenues that are pursued for debt repayment, levels of debt appear to affect decisions to pursue subspecialty training and to pursue academic positions. Strategies or programs aimed at reducing the debt burden felt by residents could be of great value.

Medical student intentions to practice internal medicine in underserved areas associated with debt, identity and extracurricular participation

BackgroundCurrently, Internal Medicine (IM) physicians do not reflect the ethno-racial diversity of the US population. Moreover, there is a shortage of IM physicians in Medically Underserved Areas (MUAs) in the US. The purpose of this study was to determine factors that influence medical students’ intent to practice IM in MUAs. We hypothesized students with intentions to pursue a career in IM and work in MUAs were more likely than their peers to identify as underrepresented in medicine (URiM), report greater student debt loads, and report medical school experiences in cultural competencies.MethodsWe analyzed de-identified data of 67,050 graduating allopathic medical students who completed the Association of American Medical Colleges’ (AAMC) Medical School annual Graduation Questionnaire (GQ) between 2012–2017 by multivariate logistic regression models, examining intent to practice IM in MUAs based on respondent characteristics.ResultsOf 8,363 students indicating an intent to pursue IM, 1,969 (23.54%) students also expressed an intent to practice in MUAs. Students awarded scholarships, (aOR: 1.23, [1.03–1.46]), with debt greater than $300,000 (aOR: 1.54, [1.21–1.95], and self-identified non-Hispanic Black/African American (aOR: 3.79 [2.95–4.87]) or Hispanic (aOR: 2.53, [2.05–3.11]) students were more likely than non-Hispanic White students to indicate intent to practice in MUAs. This pattern also existed for students who participated in a community-based research project (aOR: 1.55, [1.19–2.01]), had experiences related to health disparities (aOR: 2.13, [1.44–3.15]), or had experiences related to global health (aOR: 1.75, [1.34–2.28]).ConclusionsWe identified experiences and characteristics that associate with intention to practice IM in MUAs, which can aid future curricular redesign by medical schools to expand and deepen comprehension of health disparities, access to community-based research, and global health experiences. Loan forgiveness programs and other initiatives to increase recruitment and retention of future physicians should also be developed.

Lifetime Earning Potential and Workforce Distribution in Developmental and Behavioral Pediatrics.

Compare lifetime earning potential (LEP) for developmental and behavioral pediatrics (DBP) to general pediatrics and other pediatric subspecialties. Evaluate association between LEP for DBP and measures of workforce distribution. Using compensation and debt data from 2018 to 2019 and a net present value analysis, we estimated LEP for DBP compared to general pediatrics and other pediatric subspecialties. We evaluated potential effects of eliminating educational debt, shortening length of fellowship training, and implementing loan repayment or forgiveness programs for pediatric subspecialists. We evaluated the association between LEP for DBP and measures of workforce distribution, including distance to subspecialists, percentage of hospital referral regions (HRRs) with a subspecialist, ratio of subspecialists to regional child population, and fellowship fill rates. LEP was lower for DBP than for general private practice pediatrics ($1.9 million less), general academic pediatrics ($1.1 million less), and all other pediatric subspecialties. LEP of DBP could be improved by shortening fellowship training or implementing loan repayment or forgiveness programs. LEP for subspecialists, including DBP, was associated with distance to subspecialists (-0.5 miles/$100,000 increase in LEP, 95% confidence interval [CI] -0.98 to -0.08), percentage of HRRs with a subspecialist (+1.1%/$100,000 increase in LEP, 95% CI 0.37-1.83), ratio of subspecialists to regional child population (+0.1 subspecialists/100,000 children/$100,000 increase in LEP, 95% CI 0.04-0.17), and average 2014 to 2018 fellowship fill rates (+1% spots filled/$100,000 increase in LEP, 95% CI 0.25-1.65). DBP has the lowest LEP of all pediatric fields and this is associated with DBP workforce shortages. Interventions to improve LEP may promote workforce growth.

The Value of Student Debt Relief and the Role of Administrative Barriers: Evidence from the Teacher Loan Forgiveness Program

The Value of Student Debt Relief and the Role of Administrative Barriers: Evidence from the Teacher Loan Forgiveness Program

The Value of Student Debt Relief and the Role of Administrative Barriers: Evidence from the Teacher Loan Forgiveness Program

The Value of Student Debt Relief and the Role of Administrative Barriers: Evidence from the Teacher Loan Forgiveness Program

Advancements in Education Policy

NCTE Executive Director Emily Kirkpatrick and Senator Ben Ray Luján meet to discuss expansion of the Teacher Loan Forgiveness Program.

Influence of demographic and socio-economic factors in choosing hospitalist careers among US medical students

BackgroundThe subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students.MethodsWe analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020.ResultsWe analyzed 46,614 questionnaires. 19.3% of respondents (N = 8,977) intended to work as a Hospital Medicine [HM] (unchanged from 2018 to 2020), mostly combined with specialties in Internal medicine (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, sexual orientation minorities (Lesbian/Gay or Bisexual), Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher median total debt ($170,000 vs. $155,000). Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM.ConclusionAbout one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of debt, planning to enter a loan forgiveness program, or are interested in doing a fellowship.

Outcomes of States' Loan Repayment and Forgiveness Programs From the Perspective of Safety Net Practice Administrators.

Nearly every state offers loan repayment (LRP) and some offer loan forgiveness to clinicians who commit to work in safety net practices. The effectiveness of these programs from the perspective of safety net practices is largely unknown. OBJECTIVES: To assess safety net practice administrators' assessments of key outcomes for the 3 principal types of state service programs: LRPs funded by states, LRPs funded jointly by states and National Health Service Corps, and loan forgiveness programs. SUBJECTS: Administrators of safety net sites where primary care, behavioral health and dental health clinicians began serving in 26 state service programs in 14 states from 2011 to 2018. Survey responses were received from 455 administrators reporting on 754 of 1380 clinicians (54.6%). OUTCOME MEASURES: Administrators' ratings of their sites' difficulty recruiting clinicians; relative ease, quickness and cost of recruiting the participating (index) clinician with the service program; program expected effects on participants' retention; participants' job performance. RESULTS: Most administrators (66.1%) reported that recruiting clinicians of the index clinician's discipline is generally difficult but made easier (81.7%) and quicker (65.4%) with the service program, but only sometimes less expensive (34.8%). 78.8% of administrators anticipate that the clinicians will remain longer because of program participation. Participants are perceived to practice good quality care (96.9%) and be positive contributors (92.4%). Administrators' assessments are generally similar for the 3 types of programs. CONCLUSIONS: Administrators of safety net practices generally perceive states' loan repayment and loan forgiveness programs succeed in helping them recruit and retain good clinicians.

New York MH professionals receive boost with $1M donation towards student loan forgiveness

New York City Mayor Eric Adams and NYC Health + Hospitals announced on July 24 the launch of a new student loan forgiveness program for behavioral health providers, funded by a $1 million contribution from an anonymous donor, New York City news outlets have reported. The new program is designed to help attract and retain doctors, nurse practitioners, and other clinicians who care for New Yorkers with mental health or substance use needs as the U.S. faces a national shortage of mental health professionals.mental health professionals. NYC Health + Hospitals will offer psychiatrists, psychiatric nurse practitioners, psychologists, and licensed clinical social workers between $30,000 and $50,000 of student loan debt relief in exchange for a three‐year commitment to serve the public health system. The news was welcomed by New York State Office of Mental Health Commissioner Dr. Ann Marie T. Sullivan. “The nationwide shortage of health care workers has impacted facilities and providers all across the country, at a time when the stress of the COVID‐19 pandemic has increased the need for services,” she said.

Salary and student loan debt for oncology social workers: Findings from the oncology social work competencies, opportunities, roles and expertise (CORE) survey

Purpose To better understand the current salaries and student loan debt levels among oncology social workers (OSWs). Design Cross-sectional study using online survey. Sample OSWs across a variety of cancer care settings in the U.S. (n = 1055). Methods Salary and debt were collected via single ordinal variables. Crosstabs and chi-square tests were used to examine whether salary and debt differ by demographic and work-related characteristics. Findings Median OSW salaries ranged from $60,001 to $70,000. Three-fourths of OSWs reported having student loan debt. Younger and recently graduated OSWs and OSWs of color were more likely to have greater student loan debt than their counterparts. Conclusions Relative low salary and debt burden have important implications for securing a current and future OSW workforce. Implications for Psychosocial Policy Adequate reimbursement and loan repayment opportunities for frontline OSWs will better secure this workforce. Advocacy efforts to identify OSWs qualified for loan forgiveness programs are warranted.

Associations between career choice and educational debt for fourth-year students of US veterinary schools and colleges, 2001-2021.

To determine whether career choice and starting salary of new DVM graduates in the US were associated with their educational debt accrued during veterinary school. Up to 48,527 fourth-year students at US veterinary schools who responded to the AVMA Senior Survey in 2001 through 2021 and accepted a full-time position or advanced education opportunity. To determine whether career choice was associated with educational debt, multiple linear regression was performed, controlling for graduation year, gender, age, marital status, having children, tuition level, and school location. The correlation between educational debt and starting salary was also determined. On average, mean educational debt increased by $6,110 each successive year. A mean of 60.5% of respondents accepted positions in private practice (public practice, 3.3%; advanced education, 36.2%). Respondents choosing public practice had a mean of $24,913 less debt than those choosing advanced education, controlling for other factors. Respondents choosing public practice also had less debt than those choosing private practice, but debt did not differ significantly between private practice and advanced education. The correlation between educational debt and starting salary was significant but low (r = 0.177). Findings suggested that the amount of debt incurred during veterinary school was associated with new veterinarians' career paths. Notably, graduates with higher debt levels appeared to seek higher paying jobs or clinical training that might lead to higher paying jobs, leaving public practice-a field in which critical needs have been identified-underrepresented despite the availability of loan forgiveness programs and other incentives.

Money Talks: Pilot Financial Wellness Programs to Promote Positive Financial Planning Behaviors Among Residents.

Graduate medical education programs and national organizations are becoming more involved in promoting trainee financial wellness. Current literature reports residents have poor financial knowledge, high debt levels, low concern about their finances, and deficits in financial preparedness, but there has been little published on best practices for implementing financial wellness programs for residents or measuring meaningful outcomes of such programs. From June 2017 to 2019, the authors invited 277 internal medicine residents from the Stony Brook University Hospital, Montefiore Medical Center, and Johns Hopkins Bayview Medical Center residency programs to participate in financial wellness programs. Each institution held at least one 90-minute financial planning session; Stony Brook also had biannual financial wellness check-ins. Participants were invited to complete a presession, an immediate postsession, and a year-end survey to assess changes in financial planning behaviors. Survey response rates were 49% (135/277) for the presession survey, 47% (130/277) for the immediate postsession survey, and 22% (61/277) for the year-end survey. Ninety-six percent (125/130) found the sessions helpful and 98% (120/123) recommended continuing the program in the future. At year-end, the most frequent completed financial planning actions prompted by the session included saving emergency funds, creating a monthly budget, consolidating loans via the Public Service Loan Forgiveness program, contributing to retirement savings, and participating in an employer's retirement plan. Residents liked that some sessions were during intern orientation before the selection of retirement plans. Postgraduate year (PGY) 1 residents were more likely to complete positive financial planning actions and to agree or strongly agree that the session prompted them to take financial planning actions than PGY-2 and PGY-3 residents. While financial wellness programs are well received by internal medicine residents, more robust evidence is needed on curricular delivery methods and program features that promote positive financial planning behaviors.

Waivers for the Public Service Loan Forgiveness Program: Who Would Benefit from Takeup?

Waivers for the Public Service Loan Forgiveness Program: Who Would Benefit from Takeup?

The magic and misdirection of public service loan forgiveness in the United States

AbstractIn recent years, the Public Service Loan Forgiveness program has garnered more attention among student loan borrowers in the United States as a potential source of loan relief. However—at least prior to the PSLF Program Overhaul introduced in October 2021—arduous eligibility criteria, opaque communication on the part of the U.S. Department of Education and contracted loan servicers, and ongoing threats to the continuation of the program made for a skittish and frustrated group of enrollees. This article leverages a mixed methods study to explore the meaning borrowers ascribe to prospective loan forgiveness and interrogates how magical thinking contributes to enrollees' perspectives on prospective loan forgiveness. With several of these sources of meaning standing in conflict with each other and with confidence in personal prospects of loan forgiveness fairly low, we argue that magical thinking overlays the meaning of potential loan forgiveness among some borrowers.