OP-ED: Should Student Loan Debt be Forgiven for Healthcare Workers?

Recently ABC News published an article about the introduction of a new bill that would forgive debt for COVID-19 health workers. Many healthcare workers are in hundreds of thousands of dollars of debt for their medical or healthcare education. This debt accrues substantial interest making it very challenging to pay off even with a decent medical salary. If a physician wants to enter into a lower-pay specialty or practice then they would need to consider if it is a financial feasibility for them. For this reason, more and more students are deciding to pursue alternate career paths that will require less time, stress and less substantial debt. Yet, for those that valiantly press on in spite of these obstacles, there is no help or guidance in paying off the substantial amount of educational debt they wills start their careers with. This can clearly be seen as the number of doctors choosing primary care are declining steadily leading to a shortage of primary care physicians as soon as 2023. However, for many students, going into primary care is not financially feasible for them. Even while talking with my peers who are in their pre-medical studies, many of them do not even consider primary care to be an option for them after the amount of loans they will need to pay off for undergrad and medical school. For clarification, primary care fields are comprised of Internal Medicine, Family Medicine and Pediatrics. The American Medical Association (AMA) has proposed to Congress that something needs to be done and has endorsed The Student Loan Forgiveness for Frontline Health Workers Act. The bill would affect all employees that are directly interacting with COVID-19 patients including doctors, nurses, aides, residents, interns and technicians. It’s important to recognize that there is also a significant amount of debt that nurses, aids and technicians also carry with them from their educations as well. This a step in the right direction, but I think it also brings up the topic of the ridiculously high cost of pursuing a post-secondary education in the United States today.

“I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said.

https://khn.org/news/american-medical-students-less-likely-to-choose-to-become-primary-care-doctors/

It should come as no surprise, then, that we are predicted to have a massive shortage of physicians of all specialties by 2032. A whopping 122,000 less physicians in the United States than will be required. If the strain placed on healthcare workers during this pandemic is any indication of just how crucial manpower is in the event of a catastrophe, having even less physicians and a growing population is a recipe for disaster in the event of any future pandemics or epidemics. Rural and urban communities have long faced shortages of physicians and is likely that this will exacerbate the issue in many of these communities as well.

Besides having to further specialize or pursue alternate fields in medicine, student loan debt accrued throughout the process is unfathomably high. Not to mention that some private lenders in the US pass this debt along to your family after your death. Thankfully, federal loans usually are discharged after the death. It is unfortunate that this is even a consideration that needs to be made.

“I’m looking at a student loan debt of $318,000,” Dr. Manuel Penton III, age 32, previously told ABC News. “That few extra thousand dollars, while it may make a big difference to some people, for me, most of that money is going to go back into paying off my student loan debt.”

https://abcnews.go.com/US/bill-forgive-medical-school-debt-covid-19-health/story?id=70509644

During internships or residency many students’ loans are placed in forbearance which means payments do not need to immediately be made. However, interest is still very much accruing so it is important to put money towards paying off loans. Yet, the average salary during residency or initial work is much lower than one may assume and is very variable depending on the hospital and post which makes making payments a challenge (especially with starting a family).

Tuition fees are so expensive domestically that many students consider going to institutions outside of the United States to pursue a medical degree with less debt and less time spent in school. I know that when I was applying for a Bachelor’s Degree that it was suggested to me on many occasions to consider moving to Poland or Turkey or Italy for my career. Thankfully, I ended up receiving some scholarships at my institution as well as a part-time job which means that, at least for undergrad, I would not begin racking up substantial debt (which makes staying here in the US a financial possibility). Yet, I know many of my peers and fellow students are not as fortunate in this regard and will, upon matriculation to medical school, carry upwards of $50,000 in student loans already.

It’s important to compare how a path in medicine looks like in other countries. For reference, annual tuition at the Medical University of Warsaw for the English-taught medical program is 11,500 euros a year – roughly $12,300. The program is four years for those who pass the school’s medical entrance exam; the school offers a one- to two-year premed program for international students. That brings the total up to around 6 years of schooling before practicing medicine. 6 years at that cost is 73,800 dollars which is a fractional amount of what it would cost for a medical education in the United States and substantially less time as well. Keep in mind that the United States also requires you to take multiple exams such as the STEPs and USMLE which are costly to take and to prepare for while a lot of medical schools worldwide have preparation incorporated into curriculum and exams offered at a reasonable cost. Should you need to, a lot of schools abroad also qualify for you to take out loans, but the cost is still far lower than attending school in the United States.

For some, they may consider returning to the United States after getting their degrees elsewhere. However, students going to schools abroad and then trying to practice in the United States is often said to be frowned upon. Why is this the case if these are licensed physicians that are very capable in their own rights and we are in the midst of a physician shortage? In fact, only 52% of international medical graduates will match into residency programs in the US while US medical graduates have a 75% placement rate. Partially, it is clearly favorable to accept domestic students for limited residency slots , however, I think that this suggests an issue in the number of residency seats available in the midst of the impending physician shortage. We simply cannot accept more people into medical schools without opening up more residency seats because students will have paid for and gone through medical school without a guaranteed way to pay back the copious loans they’ve taken out. Simply put, the government needs to play a role in investing in the healthcare system to achieve more residency slots in high-demand areas.

“In the medical field, students who attend school abroad have a stigma associated with them: ‘They were not good enough to get into an American medical school,'” said Kristen Moon, a college adviser and founder of Atlanta-based Moon Prep, in an email.

https://www.usnews.com/education/best-graduate-schools/paying/articles/2017-01-19/med-school-in-europe-offers-tradeoffs

Some people may even say that student loan debt for healthcare workers shouldn’t be forgiven if other student loan debts are not forgiven as well. To that I have to say that my personal ideology is that all student loan debts can and should be forgiven. It is not an outlandish idea to suggest that the government can play a larger role in investing in education at all stages of life. There is a definitive reason as to why we administer more and more standardized tests and continue to lag places and places behind other nations in education. However, I understand that there may be some requirements to obtain that forgiveness if it were to be implemented. As many countries around the world have done, there is a way to have student loan debt forgiveness be a more streamlined process.

In the US today, it seems that student-loan forgiveness is a complete disaster of misinformation and fine-print tricks. Take a look at the Public Service Loan Forgiveness (PSLF) program for a peek into what I mean when people have been vastly misled on the ease of loan forgiveness. To date, approximately 1,000 students have had their loans forgiven with more than 100,000 rejected. To reframe this, 99% of applications for forgiveness have been and are denied. Considering that most adults going to college have some amount of student loan debt upon graduation, that number is truly laughable. While it is great for those 1,000 students and their families, the bigger picture is that debt is a huge problem for so many students especially because the new “normal” is to have gone to college and obtained a degree for many fields. It’s not about students being “lazier” than in the past; the fact is tuition has been increasing exponentially over the years with no end in sight.

Healthcare workers, and others as well, should be entitled to at least a clear picture of what their futures mean for them in their chosen career paths. The uncertainty surrounding the financial aspects of all careers is a great cause of stress for many Americans. Healthcare professionals, at times of crisis especially, should only have to focus on their job and not whether or not they’ll be delinquent on loan payments while they risk their lives every day. It’s not a solution to have students fight through numerous phone calls with loan service providers (which are not exactly known for their courteous customer service) and jump through so many hoops just to have a chance at starting a family without a crippling amount of debt looming for the rest of their adult lives.