[MHCP med health careers program] AACOM President's Column (Assoc. of American Colleges of Osteopathic Medicine)

Medical & Health Careers Program med-health-careers at lists.ucr.edu
Tue Jul 6 15:08:27 PDT 2010

Dear Students,


If you are interested in a career as a physician, especially in primary
care, the following article is helpful in describing possible efforts to
reduce student indebtedness.  It might also be a prompt to learn more about
careers as a doctor of osteopathic medicine.


Dear Advising Colleagues,

We thought you and your students would find AACOM President, Dr. Shannon's
Inside OME column, "Could New Programs Eliminate Debt for Tomorrow's
Osteopathic Primary Care Physicians?"  of interest.  You may view the column
and more Inside OME content on-line at:

Inside OME logo

June 2010 - Vol. 4, No. 6  

Steven C. ShannonStephen C. Shannon, DO, MPH

Could New Programs Eliminate Debt for Tomorrow's Osteopathic Primary Care

This is the time of year when osteopathic medical school graduates celebrate
the culmination of their undergraduate medical studies and transition to
their residencies. But even as they celebrate, many find that they also are
under considerable financial stress.  On average, today's medical school
graduate is shouldering more than $151,000 in educational debt. And in some
cases, this debt is serving to drive graduates away from primary care career
choices (osteopathic medicine's traditional emphasis) and toward more
lucrative medical specialties.

Nevertheless, osteopathic medical school graduates continue to pursue
primary care fields (internal medicine, family medicine, pediatrics) in
proportions significantly surpassing those of their allopathic colleagues.
Forty percent of those that matched in the 2010 AOA residency match will be
entering osteopathic primary care programs. And of the 1,444 DO graduates
participating in the 2010 ACGME match
<http://www.nrmp.org/data/resultsanddata2010.pdf> , 55 percent will be
entering primary care programs. In contrast, just 34 percent of U.S. MD
graduates matched into primary care training. More telling is family
medicine. This year (and in recent years), only 7 - 8 percent of U.S. MD
graduates have matched into that specialty, whereas around 20 percent of DO
graduates select family medicine programs, whether choosing AOA or ACGME (or
combined) programs.

However, the trend among osteopathic medical graduates has been away from
primary care (56 percent of U.S. DOs are primary care physicians; 41 percent
are family practitioners). What makes this important? Why is there concern
about primary care specialty selection? What is the impact of educational

Today, about 32 percent of the U.S. physician workforce consists of primary
care physicians, and most health policy experts suggest that in a
well-functioning health care system, that percentage should be 40 - 50
percent. If current trends continue, rather than growing the number and
proportion of primary care physicians necessary for our health care
infrastructure, there is a real chance that the current numbers will in fact
shrink over the next two decades. Similar trends away from primary care
practice among physician assistants and nurse practitioners challenge the
notion that the contribution of these two professions will offset primary
care physician shortages.

Although the issue is more complicated than debt alone, we should explore
what might happen if the prospect of significant debt were removed from the
primary care choice picture. Would new DOs surge in greater numbers to the
primary care fields? Could the nation meet its increasing needs in this
critical area if it were to provide enough help that an entire cadre of
primary care physicians had their student loans repaid in full? Although
much remains to be done in this regard, myriad new efforts nationwide
provide incentives for medical students to pursue careers in primary care.

In addition to provisions that provide bonus payments and other incentives
for primary care physicians in the recently enacted health reform law, the
Patient Protection and Affordable Care Act, a variety of scholarship and
loan repayment programs have been greatly enhanced. 

Funding provided by the American Recovery and Reinvestment Act of 2009
(ARRA) allowed the National Health Service Corps (NHSC)
<http://nhsc.hrsa.gov/>  to expand its already extensive programs. The NHSC
recruits health care professionals to practice in underserved communities
through scholarships and loan repayments. Through ARRA, the NHSC received
$200 million in addition to regularly appropriated funds, permitting the
doubling of its field strength. Primary care clinicians who currently work
in or are interested in working in underserved communities may be eligible
to receive up to $50,000 in medical education loan repayments each year.
And, if the Congress appropriates above the FY 2008 level, the health reform
law mandates $1.5 billion over five years (FY 2011 to FY 2015) for the NHSC
to provide service-based debt relief to encourage more physicians to go into
primary care and work in areas experiencing physician shortages. In
addition, new provisions that allow graduates to receive loan repayments for
half-time NHSC service provide flexibility to those seeking nontraditional
positions while they attend to family needs or other clinical work.

Many other federal and organizational loan repayment programs also have been
established or expanded. And, in an effort to shore up the primary care
workforce in their underserved areas, many states have enacted legislation
that provides loan repayment to medical school graduates who commit to
in-state primary care practice for a number of years. For available student
loan repayment programs, see our online
Programs.pdf>  list (compiled by the Edward Via College of Osteopathic
Medicine), which provides links to program details.

The health reform law also addressed federally supported student loans for
students willing to commit to primary care service. To increase the appeal
of the Primary Care Loan Program <http://bhpr.hrsa.gov/dsa/pcl.htm> , the
act eased current criteria for schools and students to qualify for loans and
shortened the length of the primary care practice requirement. It also
lowered the additional interest rate that students failing to comply with
their loan agreements must pay from 18 percent to 2 percent.

And, the establishment and funding of teaching health centers (THCs) and
community health centers will bolster opportunities for new primary care
physicians. The health reform law authorized a grant program in which THCs
may receive three-year grants for up to $500,000 to establish or expand
primary care residency programs. The funds may be used to cover costs for
curriculum development; recruitment, training and retention of residents and
faculty; accreditation; and faculty salaries during the development phase.
The law authorized $25 million for fiscal year (FY) 2010, $50 million for
FYs 2011 and 2012, and such sums as are necessary for each subsequent FY.
Importantly, the law also authorized and appropriated funding in the amount
of up to $230 million over five years (FY 2011 to FY 2015) for payments to
qualified THCs for direct and indirect costs of training residents.  If
these programs develop as hoped, they will be training a cadre of primary
care physicians specifically oriented to practice within community health
centers and other locations serving underserved populations and qualifying
for NHSC or other loan repayment designation. 

Both ARRA and the health reform law allocated significant funding to beef up
the nation's community health centers, providing both expanded opportunities
for new primary care physicians and greater access to primary care services
for those most in need. Nine months after receiving $2 billion in ARRA
funding, health centers had served an additional 1.8 million patients,
representing the largest annual growth in the history of the Health
<http://bphc.hrsa.gov/>  Center Program. As with the NHSC, if the Congress
appropriates above the FY 2008 level, the health reform law mandates $11
billion over five years (FY 2011 to FY 2015) for community health centers.

Of course, all of these programs are aimed at expanding access to primary
care and mitigating the nation's primary care physician workforce shortage,
which is expected to reach critical proportions over the next decade.
Nevertheless, they represent a potential win-win for the nation and
osteopathic medical students who may find a pathway to primary care

Recently, I heard one health policy expert say he believes that if every one
of the many opportunities these programs collectively present were taken
advantage of by medical students, an entire generation of primary care
physicians would face no debt at all. I am not sure that is yet the case.
However, working toward such a goal, training the physicians we need (which
osteopathic medical education does so well), providing them an opportunity
for service in exchange for debt forgiveness or loan repayment, and
improving reimbursement and the overall atmosphere for primary care practice
could go a long way toward helping to solve this long-term and complex






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2011 Osteopathic Medical College Information Book Now Available
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