Supporting loan repayment programs is key to strengthening the primary care workforce

OPINION:

As a family physician, I’ve seen firsthand what happens when people can’t access the care they need, when they delay seeing a doctor because there’s no clinic nearby or when they wait until symptoms become emergencies. This crisis is especially acute in rural and medically underserved areas. But the solution starts upstream, in our nation’s classrooms and medical schools and it requires policymakers to take urgent action on medical student debt.

The U.S. is facing a critical shortage of primary care physicians. According to the Association of American Medical Colleges (AAMC), we’ll need as many as 40,400 more primary care physicians by 2036. That’s just over a decade away, and we’re already feeling the squeeze. The path to becoming a family doctor is increasingly difficult to walk, especially for those who train and practice in rural and underserved areas.

Medical school debt is a huge part of the problem. The average debt for new physicians now hovers around $250,000. That number alone is enough to steer many interested, passionate, talented students away from primary care and toward higher-paying specialties. It is also more than just a financial burden. For young physicians, it’s a source of crushing stress that often shapes career paths in ways that don’t align with our country’s health care needs.

Recent actions from the White House and legislative activity in Congress could undermine public student loan forgiveness (PSLF). While the ultimate outcome will depend on rulemaking by the Department of Education and votes in this Congress, I urge policymakers not to overlook how essential PSLF Is not just to physicians, but to the patients and communities we serve.

More than 40% of physicians participate in PSLF. That’s tens of thousands of health care workers making a decade-long commitment to public service, often in communities that desperately need them. Family physicians participate in PSLF in large numbers. In a survey sent to AAFP members just last month, over 75% of the respondents who participate in a loan repayment program are enrolled in PSLF. These physicians are choosing to sacrifice higher-paying positions so they can train and practice in areas where their impact will be even more pronounced. The very least we can offer them for this 10-year public service is the opportunity to be debt-free. This financial freedom will also give them greater ability to stay and practice in the rural and underserved communities they have dedicated years of their lives to serving.

PSLF is a crucial program for expanding access to care and supporting physicians who choose to work in areas of greatest need, but it is just one piece of the puzzle. Pieces of legislation such as the Resident Education Deferred Interest (REDI) Act, which allows medical residents to defer their student loans interest-free while they complete their training, and bills that exempt loan repayment programs from taxable income can also help to mitigate federal student debt.

These common-sense and bipartisan measures make family medicine and other lower-paying medical specialties more financially viable. Without them, interest continues to compound while residents earn modest stipends and physicians are subject to large tax bills after successfully completing a loan repayment program.

Further, we need to do more than maintain loan repayment programs such as PSLF we need to expand them. That includes supporting the National Health Service Corps (NHSC), which offers scholarships and loan repayment in exchange for service in high-need areas, supporting rural track training programs and expanding eligibility and funding for all loan repayment programs for physicians who work in underserved communities. The federal government has a critical role to play. By expanding PSLF, passing the REDI Act and increasing investments in scholarship and loan repayment programs like the NHSC, policymakers can help eliminate the debt barrier that keeps too many talented young people from entering medicine or drives them away from primary care.

These aren’t just budgetary decisions. They’re decisions about who gets to become a doctor and who gets to see one. Let’s invest in a health care system that works for everyone by investing in the health of America, today.

• Jen Brull, MD, FAAFP, is a family physician in Fort Collins, Colorado and the president of the American Academy of Family Physicians.