Mike Hewlett, NHSC Scholar
[Editor's Note: I get lots of emails (40-80 a day) many of which suggest post topics or corrections to the website or book. I often use these opportunities to solicit a good guest post. I figure, “Hey, here's someone who knows more than me on a topic. Let's suck the knowledge out of his brain and share it with 10,000 other people. This post is like that. It comes from Mike Hewlett, who graduates from dental school this year. We have no financial relationship.]
Reading through The White Coat Investor I have been pleased with the advice included in the book. (Pleased because fortunately we’ve already been following most of it up to this point!) My wife and I are finishing dental school this summer and are about to begin practice, so we have been reading it to better prepare ourselves in managing our finances.
Dr. Dahle talks about the National Health Service Corps (NHSC) in chapter four of the book as an option to help pay for medical/dental school (and a few other health care professions), but he doesn't make much distinction between the Loan Repayment program and the Scholarship program. Granted, the NHSC has several programs to help professionals with their school costs, but these two are the ones I’m most familiar with. I'm a recipient of the 4 year NHSC Scholarship and wanted to offer some clarification about the subject.
There is more to be learned about these programs for sure, but I'll give a simple breakdown of the two programs. See the links below for more detailed information.
NHSC Loan Repayment Program
“Licensed health care providers may earn up to $50,000 toward student loans in exchange for a two-year commitment at an NHSC-approved site through the NHSC Loan Repayment Program (NHSC LRP).
Accepted participants may serve as primary care medical, dental, or mental/behavioral health clinicians and can choose to serve longer for additional loan repayment support.
Priority consideration is given to eligible applicants whose NHSC-approved site has a HPSA score of 26 to 14, in descending order. Eligible applicants may receive up to $50,000 in loan repayment for an initial service commitment until funding is exhausted”
- Financial support from the NHSC can be granted in return for working in clinics that meet a certain HPSA score for each year of support received, with a minimum of two years required. (HPSA scores are created by the federal government to identify areas or populations that have some type of access to care issue)
- This repayment is typically applied for near the end of your training or after you’ve gone through medical/dental school and are starting work
- The money is received as a lump sum each year to help pay down your existing loan balance (which has already been accumulating interest)
Overall the Loan Repayment (LRP) is a very crummy deal if only done for the financial aspect. It is money paid toward an already existing balance of school loan debt which accumulates interest from the start of medical/dental school. In most cases it makes little financial sense to select a practice location solely based on their promises of loan repayment. You could think of it as throwing a bucket of water on the raging bonfire that is professional school loans; every bit surely helps, but it won’t make that much difference in the end.
NHSC Scholarship Program
In contrast, the NHSC Scholarship program is very different in the financial impact it can have. The Scholarship program is similar in that you’ll work in the same types of clinics for a similar amount of time (a year for a year agreement as discussed above), but the way the money is paid differs.
Upon receiving the NHSC Scholarship before dental/medical school, all tuition and most fees are paid directly to the school each semester, tax and interest free. They also offer 2 and 3 year scholarships for those who have already started professional school.
“The scholarship pays tuition, fees, other educational costs, and provides a living stipend in return for a commitment to work at least 2 years at an NHSC-approved site in a medically underserved community.
For each year of financial support (up to four years), the student agrees to serve one year (minimum two years) at an NHSC-approved site in a high-need urban, rural, or frontier community across the nation.”
In summary, the payback time for each program is the same, a year commitment for each year of accepted support. However, the Scholarship is much more valuable compared to the Loan Repayment as it is paid in full upfront, thus there is no loan balance to accumulate interest on. I think of the Scholarship program as stopping the student loan bonfire from ever being lit.
- Financial support from the NHSC can be granted in return for working in clinics that meet a certain HPSA score for each year of support received, with a minimum of two years required.
- The Scholarship application can be started in the spring before you matriculate into your professional training program, or can be applied for after you’ve started school. The application cycle is once per year in the spring
- The money for tuition and fees is paid directly to your school, saving you the added cost of accumulating interest at the current rate of 5.84 – 6.84%
My Experience
I'll share my own experience to illustrate how valuable the Scholarship can be.
4 years of tuition and fees for dental school where I attend is approximately $70,000 per year (not including living expenses which can tack on another $30,000 per year). Most of my fellow classmates will leave dental school with at least $280,000 in debt (that’s just the initial principal amount, also not including living expenses) at around 6% interest. The interest starts accumulating the moment you sign the loan notes, so they grow quite significantly as you are in school for 4 years. My calculations before receiving the scholarship had us leaving dental school with close to $500,000 in debt including living expenses and interest.
Thanks to the NSHC Scholarship which I received for 4 years, my tuition and fees have been paid each semester as I've attended, and we also receive a small stipend of $1300/month to help with living expenses. With my wife working part time, we'll leave dental school with comparatively little in loans, and owe 4 years in payback working in a qualifying dental clinic.
Each clinic where you can work varies in what they will pay but at least with dentists it’s generally in line with what most dental associates can expect out of school. I've recently been offered a general dentist position at a very good clinic that will pay around $125,000 plus benefits. This is a reasonable salary for a 1st year dental graduate even in private practice. And if you factor in the several thousand dollars in student loans each month for many years we won't have to pay (my calculations had me repaying about $5,000 per month for 10 years), that makes the NHSC Scholarship program much more financially attractive vs the Loan Repayment.
If I did the same deal (4 years of LRP) through the NHSC Loan Repayment, the max value it would have is $120,000 over 4 years to pay toward that approximate $500,000 loan balance I was previously expecting. Given the very large size that my loans would have been, it would be very unlikely for me to be out of debt in only 4 years. But with the NHSC Scholarship program we will be debt free, and should have a good start on building our nest egg.
[Editor's Note: A few comments are in order. There are some similarities with the military HPSP program (similar to the NHSC scholarship) and the military program for attendings (where, if you have no commitment, you are offered a signing bonus and a special payment each year you could put toward loans.) Like NHSC, if you know you're going into the military, the sooner you sign up the better the deal. The rise in medical/dental school tuition makes this difference larger each year because the NHSC/military loan repayment programs simply aren't offering the equivalent of a year's expense in medical/dental school.
However, Mike is leaving a significant point out of his discussion- he gave away a certain aspect of his freedom. He now HAS to work for an NHSC clinic for four years, no matter what other opportunities may come his way. That can be worth a lot of money. Apparently in dentistry, the opportunities are less attractive than in many fields of medicine. Physician scholarship recipients are likely working for a similar wage to what Mike is getting, but might have had the opportunity to sign for $200-300K in private practice. Granted, NHSC service is much less freedom limiting than military service, but there is still a loss of freedom. Also, Mike is still in school. So he's seeing all the benefits but none of the downsides. Most medical students on HPSP are pretty positive about the program too, until they become attendings, when many become much less happy with it. There is often a reason NHSC and the military have to throw money around to get people to take certain jobs.]
What do you think? Have you worked for the NHSC? What was it like? Would you consider it if you were facing a $500K debt in the face? Why or why not? Comment below!
“My wife and I are finishing dental school this summer and are about to begin practice” — This statement early in the post can be interpreted several ways and which can be confusing when you get down to the part where you’re talking numbers and your experience. My first take was that you were both dentists about to graduate. Later on you clarify that your wife works some sort of part time job, so she’s presumably not a dentist. Glad you have a great relationship with your wife, but you and your wife aren’t finishing dental school this summer, you’re finishing dental school.
Thanks for the solid information laying the options out there for others.
Yes, I was confused by this as well. If you are both graduating, and only one had the scholarship, how did this work out? Later the article also says, “we’ll leave dental school with comparatively little in loans, and owe 4 years in payback working in a qualifying dental clinic,” so perhaps both are dentists with the scholarship?
Thanks for clarifying.
It sounds as if this works well for someone going into general dentistry. Would there be more restrictions on someone in medical school, i.e. having to go into primary care?
Lots of people talk about how “they” graduated from medical school or “they” got pregnant. It isn’t technically correct and apparently sometimes can even be confusing. But it’s so common I didn’t think it needed to be edited.
Yes, but lots of couples do go through dental and medical school together, while, typically, only one is actually pregnant. 🙂
Agreed completely! The other twist is that the National Health Service Corps funds seem to be shrinking every year, making it even more pathetic of a deal. Finally, if you turn toward state programs (for example Colorado Health Service Corps), a person can be additionally disappointed by a lack of funds. I worked for a community health center right out of family medicine residency (accepting $30,000/yr less than my co-residents who went to Kaiser), and I applied to Colorado State Health Service Corp twice. Twice I was told my job and I were perfect candidates, but there were NO funds. Loan repayment is a joke, and I think people should not be fooled into waiting for it. Just commit, and do the only deal that makes sense- the scholars program.
Like the military, they really should get rid of the word “scholarship”. This word, to me at least, implies a financial award without any commitment. It is really servitude, but if that happened I bet no one would sign up
Yes, it’s an exchange of time for money, like any other job. It’s great if you are going to do it anyway, but not necessarily financially wise.
I have a few friends that went this route, and in dental school they loved it. No loans, money in their pocket each month, it was great. I was always a little jealous of the steaks they ate, while I sat with my spaghetti again. But, after school everything changed. They were able to get their jobs, in places they didn’t really want to be, and at a competitive base salary. But, there was no change for bonuses, increased pay etc. In the end those who took the regular loan route were better off, financially and also happiness as they moved to where they wanted and worked where they wanted. I hope the optimism keeps going for the 4 years after dental school…
Also, I know things have changed, but some of them still have their loans, but at 1.8% I can’t blame them.
I have received NHSC loan repayment, and it has been anything but a bum deal for me. I’m living in a small town in what I consider paradise, and my pay hasn’t taken a hit at all. If anything, I am making far more than I would have made in the urban center where I did my training and working for a far more friendly administration. The schools here are better than the urban school where I was at , as well. I have a lot of freedom, though do work longer hours than some places where I might have ended up. You have to know that you want to live in an underserved area if you go this route, as the consequences for not fulfilling your obligation can be severe. I have “only” received 50k tax free for my first two years, but I understand it’s pretty easy to renew and sign up for another year at 20k tax free. When you add in the loan repayment provided by my employer, I’m guessing I’ll have just under 150k in loan debt paid off while forking over not much more than 10k from my paychecks. It’s not been a bad deal for me at all.
My friend and I are graduating from the same primary care specialty and we were both looking for rural positions. I was able to find a great position making $200,000/year with plenty of part time flexibility for when I have children. I will of course make less going to a part time FTE but I have the option to do so. The position also pays $120,000 to my student loans of $200,000.
My friend has the NHSC scholarship and was quite limited in her options, despite also wanting to do rural primary care. The NHSC scholarship requires locations of lower HPSA score (way more rural/need) than the NHSC fellowship. Her position has very little flexibility, requiring 15 minute visits and 36 hours a week. There is not flexibility to go part-time or even 0.8 FTE. The retirement plan is not great either. Altogether she calculated the numbers and knows she would have come out ahead to not do the “scholarship”. I put “scholarship” in quotes because if she does not follow through than the penalties are severe.
Perhaps doing the NHSC makes sense for dentistry where starting salaries for associates are around $80,000 but for physicians it seems like not a great deal. Considering the demand for primary care, there are great positions out there in rural areas that will also help with loan repayment and pay more, compared to NHSC.
The other consideration for physicians is that you have to KNOW you want to do one of the following residencies – family medicine, OB/GYN, pediatrics, internal medicine, or psychiatry. Expecting a first year med student to know that seems unfair to the student.
I don’t know anyone making $80,000 right out of school. In fact, the $125,000 was the lowest I had heard yet. Even working for the big corporations will start you at $125,000, with space for more with bonuses. Granted, I don’t talk to everyone, but I feel bad for anyone who graduated with $300,000 in loans and is making $80,000. That’s a deep hole to get out of.
There are lots of people in that situation; they’re called veterinarians. Could be worse. The attorneys owe $150K and don’t have a job.
SDN forum about NHSC: http://forums.studentdoctor.net/threads/warning-about-joining-the-nhsc.952879/
The biggeset issue is how steep the penalty is for leaving early.
(page-30) https://nhsc.hrsa.gov/loanrepayment/lrpapplicationguidance.pdf
———–
BREACHING THE NHSC LRP CONTRACT
While the NHSC will work with participants to assist them, to the extent possible, participants are
reminded that the failure to complete service for any reason is a breach of the NHSC LRP contract.
Participants should make sure that he/she understands the following monetary damages that are
required by Federal law when an LRP contract is breached.
A participant who breaches a commitment to serve in a full-time clinical practice will become liable to
the United States for an amount equal to the sum of the following:
(1) The amount of the loan repayments paid to the participant representing any period of
obligated service not completed;
(2) $7,500 multiplied by the number of months of obligated service not completed; AND
(3) Interest on the above amounts at the maximum legal prevailing rate, as determined by the
Treasurer of the United States, from the date of breach.
Any amounts the United States is entitled to recover, as set forth above, must be paid within one
year from the date of default. Failure to pay the debt by the due date has the following
consequences:
(1) The debt will be reported as delinquent to credit reporting agencies. During the one-year
repayment period, the debt will be reported to credit reporting agencies as “current.” If the
debt becomes past due (i.e., remains unpaid at the end of the one-year repayment period), it
will be reported as “delinquent.”
Note: The minimum amount the United States is entitled to recover from a participant who
breaches a commitment to serve full-time or half-time will not be less than $31,000.
31
(2) The debt may be referred to a debt collection agency and the Department of Justice. Any
NHSC LRP debt past due for 45 days may be referred to a debt collection agency. If the debt
collection agency is unsuccessful in collecting payment, the debt will be referred to the
Department of Justice for filing of a lawsuit against the defaulter.
(3) Administrative Offset. Federal or State payments due to the participant (e.g., an IRS or state
income tax refund) may be offset by the Department of Treasury to pay a delinquent NHSC
LRP debt. Also, defaulters who are Federal employees may have up to 15% of their takehome
pay garnished to pay a delinquent NHSC LRP debt.
(4) Licensure Sanctions. In some States, health professions licensing boards are allowed to
impose sanctions, including suspension or revocation of a defaulter’s professional license, if
the defaulter fails to satisfactorily address repayment of his/her NHSC LRP debt.
Bankruptcy
The participant should also be aware that it is not easy to discharge an NHSC LRP debt by filing for
bankruptcy. A financial obligation under the NHSC LRP is not dischargeable in bankruptcy for 7 years
after the debt becomes due (i.e., for 7 years from the end of the one-year repayment period). After
the 7-year period of absolute non-dischargeability expires, the debt may be discharged in bankruptcy
only if a bankruptcy court determines that it would be unconscionable not to discharge the debt.
It’s nice you can buy your way out of it for just $7500 a month. The military won’t let you do that!
Repayment when in breech of obligation is $7,500 x the number of months of obligated service not completed; PLUS (3) Interest on the above amounts at the maximum legal prevailing rate, as determined by the Treasurer of the United States, from the date of breach.
Not really doable for many primary care physicians.
As stated, the NHSC program can be a great deal. Also as stated, one must know the details of the deal. If the plan is to go out as an associate dentist for the first several years and work for someone, these types of programs can be fantastic.
Prior to starting dental school, I thought long and hard about joining one of these programs. I was also offered a “scholarship” that would pay for 7 years of school tuition and fees if I committed to getting a PhD in dental research. Again, the I thought long and hard about all these debt-reducing extended employment agreements.
Instead I rolled the dice, took out loans, finished school and joined a group practice where I quickly became a partner. With the same group I have had the opportunity to invest in additional practices as well as get paid to train dentists in those other practices. My business equity is approaching a value of $1m and my salary combined with K1 earnings has me earning more than triple the $125k a new associate can hope to make.
I’ve been out of school 5 years now, and my net worth, salary and future earning potential are far greater than what they would have been had I signed up with one of these “scholarship” programs.
I’m not bragging, although I’m sure my comment can be read as such, just a brag. I’ve read WCI regularly for some time and haven’t really heard anything positive about dentistry on the blog (with mostly good reason too). I’m trying to show that there is a viable alternative in dentistry to achieving financial freedom.
Good for you! I for one am glad to hear about dentists doing better than the corporate starting salaries!
Can you tell me more about how you went about this? I’m currently finishing D1 and this pathway was not something that I am too familiar with.
I am an avid reader of WCI and truly wish I had known about the site while I was a medical student. I am in my 5th year of general pediatric practice and completed my service requirement for the NHSC Scholarship Program last year.
Experiences vary based on specialty, geographic location and site (clinic). As a former Scholar I strongly recommend the LRP to anyone who is deciding between the Scholarship and LRP Program.
As a Scholar you must commit to practice primary care and work in an underserved area for the number of yeras you received scholarship support. The site options are few and far between for most specialties. The majority of positions are for FPs. In addition, if you have a strong desire or need to work in a specific geographic region options are limited. If you sign on the dotted line and commit to work at a site that turns out to be Nightmare on Elm Street and nothing short of a horror movie you are stuck. The NHSC is not obligated to assist you and will not assist you with finding another position. In addition, to being committed to the NHSC you may or may not be in breech of your contract with your employer if you opt to resign to seek another position. You must be approved by the NHSC prior to submitting a resignation and must be approved by the NHSC prior to accepting a position at another approved site. It is also imperative to check Labor Laws for the state in which you are employed as many states are at will and the employer has the right to terminate any employee without/with cause. If you lose your job or the site closes you may or may not be held in default by the NHSC and be considered in breech of your obligation.
Based on my conversations with close friends in the LRP Program there is more flexibility with regards to site selection. There is also an option to finding a site, private practive, hospital, clinic or FQHC within a geographic area that is considered underserved and reaching out to HRSA/NHSC to have the site approved prior to you starting your employment with said site. The LRP Program is also more flexible in that you can work at a site for a while to see if it meets your needs and is a good fit prior to applying to the LRP Program.
For every student/resident it is imperative that you list the pros and cons of each option and discuss them with your significant other/spouse/partner. Free money is never free and making the decision solely based on the funds and amount of interest you will pay over time on your student loans is not wise.
While I am glad to have less educational debt than my colleagues who chose not to participate in NHSC the emotional cost was not worth it in my experience. I worked at an awful site (which has since closed) for 14 months prior to being wrongfully terminated. Thankfully I was able to secure employment at a wonderful site 4 weeks after I was terminated and based on the extensive documentation I provided to NHSC was not held in default. I completed my service requirement last spring and am not very happily employed at a large multi specialty physician owned group with phenomenal benefits and a wonderful reputation.
Choose wisely. All that glitters is not gold. Nothing is ever as it seems and free money is never completely free!
should say NOW happily employed
As a recent dental graduate and current NHSC LRP participant I find this post to be a mixed bag. It is true that from a strictly financial view the NHSC Scholarship program is superior to LRP. However it is not true that “Overall the Loan Repayment (LRP) is a very crummy deal if only done for the financial aspect.”
When I graduated dental school a few years ago I had $240K in debt and three employment options in my area:
1) $120K salary with corporate dental company, poor benefits, no loan help, minimal bonus potential.
Total annual value = $140K
2) 35% of collections for the work I did as an associate in private practice. Estimate was for ~$130K , no benefits, no loan help, no bonus
Total annual value = Who knows? Could be $80K or $150K, hard to say because of the compensation model.
3) $125K salary with an FGHC, $25K in benefits, 403b match, up to $15K in bonus, and $60K tax free in NHSC LRP for a two year commitment. That is $30K/year tax free. At the 35% marginal tax rate I am at (federal + state) I would have to earn $47K in earned income to get $30K to pay on my loans.
The FQHC is not in a major metro area but there is an airport, major arts/cultural hub, shopping, good schools, etc… Definitely not a “small town” but not a urban center either.
Total annual value = $212K (125 salary + 25 benefits + 15 bonus + 47 of earned income to be able to pay 30 on loans)
These options are typical for a new dental graduate who does not have their dad’s practice to take over. I would say option 3 is far from a crummy financial deal. Which is why I still work their 4 years later where I have continued to receive $20K/year tax free after my original two year agreement ended. So far I have received $100K in loan repayment money which would have required $155K in earned income to generate the same $100K to pay to my loans. I have also received a raise every year, refinanced a portion of my loans per WCI advice, lived like a resident, and will be student debt free in 30 days (less than 4 years out of school, a position my classmates in private practice making $200K/year are profoundly jealous of)
Could I have been an NHSC scholar instead? Maybe. But what was not pointed out in this post is how difficult that scholarship is to get. There are TONS of people applying and very limited spots. Most of those spots are given to students who are either from minority backgrounds, underserved areas, have demonstrated service/volunteer time in public health dentistry, etc. It is not common for a white upper class male from urban America to receive these 4 year scholarships (and I think that is a good thing).
But what is the cost for being a scholar? Less flexibility in which FQHC you work for, more rural locations, no option to leave after 2 years. The NHSC scholarship program is awesome but the author is simply too early in his career to appreciate the gravity of those tradeoffs and as demonstrated the LRP can be very financially beneficial if planned and executed correctly.
Congratulations! It sounds like it has been a pretty good deal for you. I am a current D3, but am trying to come up with my best financial plan post graduation. Are you still able to qualify for the NHSC LRP if you refinance your government loans using SOFI or something similar?
I believe you are able since they are still student loans, just like a private student loan you may have taken out in dental or medical school.
I was an NHSC LRP participant as well and had a very good experience. I took a job in a clinic in an underserved urban area and was in the program for four years, during which time my entire balance of just over $100k was paid. It was a job I was likely to choose regardless of the program, so I didn’t feel like it impacted my decision too much. I didn’t sign up for the scholarship program when starting school since at that point I didn’t know what to expect and didn’t want to limit my options. I couldn’t be happier about how things worked out. Underserved areas can use programs like LRP to recruit doctors, but they also have a major interest in retaining those doctors after the service time is complete. My organization doesn’t have the funds to give huge raises, but I have found it is relatively easy to negotiate improved hours and vacation. I am now in the office only six hours a day rather than eight, and have a couple extra weeks of vacation each year. I plan to stay here indefinitely, which is one of the main goals that NHSC has for the program.
Do not do the NHSC! I just got out and got my default letter because I wasn’t able to procure a job at a qualifying site. They gave me $30,000 and expect me to pay $293,000 in fines by next year.
Tell us more. What kept you from getting a job for instance and how $30K grew into $293K?
I am in the exact same position. I signed on while working for an approved site for the PT commitment and the approved hospital had a hiring freeze. 4 years and many locums jobs later (I worked locums while forever trying to find an open site) after a great career working in Children’s Hospitals, while trying desperately to find any approved site available for PT work,I am practically bankrupt as a Pediatrician. The site lists jobs available but they are often not updated and in fact not related to reality. While I have had to tunr down great jobs and I’ve moved cross country for this 4 times and tried to get sites approved and worked at sites that never gave credit. The NHSC is a great idea but it is not an organized or safe program. I urge people to consider alternative ways to work for those that are underserved without risking their careers and finances. This has been devastating. Maria.
I am in the exact same position-$166,000 owed now. I signed on while working for an approved site for the PT commitment and the approved hospital had a hiring freeze. 4 years and many locums jobs later (I worked locums while forever trying to find an open site) after a great career working in Children’s Hospitals, while trying desperately to find any approved site available for PT work,I am practically bankrupt as a Pediatrician. The site lists jobs available but they are often not updated and in fact not related to reality. While I have had to tunr down great jobs and I’ve moved cross country for this 4 times and tried to get sites approved and worked at sites that never gave credit. The NHSC is a great idea but it is not an organized or safe program. I urge people to consider alternative ways to work for those that are underserved without risking their careers and finances. This has been devastating. Maria.
Thanks for sharing your experience. I’m sorry it hasn’t been what you expected. I know the feeling as my military service turned out a bit differently than I had imagined it.
The good news is your loan burden at this point is not that high. $166K is likely no worse than 1X your income as a pediatrician. You should be able to pay that off in 2-5 years by living frugally even without any sort of NHSC or PSLF program.
Can you please describe more? I’ve been offered a loan 2 service repayment for primary care in medicine and would really like advice
hey, seems this is not updated. As far as I know, now NHSC is increased the scholarship terms. They pay a whole tuition (medschool, where im) and 1.360 $ monthly stiped + coverage of reasonable expenses (imo; board exam fee, away rotation expenses, etc)
Can someone give a recent experience? How looks like working at NHSC approved site?
What?! Not every one of the 1200 posts on this blog is always updated instantaneously? Tell me it isn’t so.
For sure, unless there is a note on a post detailing an update, assume it was last up to date on the date it was published.
Thanks for sharing your information. That’ll help someone else.
Hi James,
I am a long-time WCI lurker and podcast follower. I also just read your book, and I wanted to come on the website to comment on the NHSC program.
The information on NHSC you have in the book is incomplete, as this poster notes. There are other additional points that have been left out of discussions on the WCI website. I can frame some of these points using my wife’s experience.
My wife has had an NHSC scholarship since the beginning of medical school. She had no undergrad debt. She is now completing her Ob-Gyn residency this June. (Ob-Gyn is considered “primary care” by the NHSC.) The NHSC gave her a stipend of ~$1300 per month all through medical school. She was able to live on this and a very small loan that she paid off during her first year of residency. She is frugal and a saver; she is now emerging from residency debt free with about ~$70k in personal savings (including some retirement savings she funded when doing jobs during and after college).
She is currently in the process of interviewing for jobs in HPSA-eligible locations. As posters have noted, the NHSC is a poorly run and disorganized program, which makes it difficult to get good guidance. Additionally, the HSPA eligibility score for sites has been increasing over the recent years (i.e., more restrictive), which makes employment choices increasingly narrow. The score for the NHSC scholarship repayment program is now 18 or greater; this is a significant jump from 14 just in 2014.
As an example of the restriction of choices, my wife is completing residency in a metropolitan area in the midwest, but there are effectively no HPSA-eligible sites listed within at least 100 miles of our home. However, there are often many more opportunities in other states. For example, I am also a physician and starting a fellowship this year in a new state, and my wife is currently interviewing with 2 sites that are about 30-45 minutes drive from my new hospital.
The geographic restriction is extremely serious. and people considering NHSC programs need to think about this deeply before committing to the program.
One obvious question is the salary differential (if any) between an NHSC vs. non-NHSC qualifying job. I am also curious about this, but I don’t have these data yet and cannot comment.
As the spouse of an NHSC scholar, my biggest complaint is that the program doesn’t run smoothly. It’s hard to get good advice. The website always seems to have something wrong or out-of-date. There’s not really good mentorship from prior scholars. While there is awesome potential for a thriving online community of current and past scholars, none really exists. So you kind of feel alone in the woods.
It’s important to remember tha priorities shift a lot from the time you start medical school until you get out of residency. When my wife was accepted into NHSC scholarship program, she was (1) 99% certain she wanted to be a family doctor and (2) enrolling at a state medical school that would give her ~$200-250 in debt. Both of these assumptions changed: she decided to pursue Ob-Gyn (more highly paid than family medicine), and she also was awarded a scholarship at a more prestigious private medical school that would have shrunk her anticipated debt to perhaps $100-150k.
In the last paragraph, my point is just that when deciding on service commitment, in the financial calculus, you have to make comparisons and choices in the moment. But personal priorities and financial assumptions change. At the time of her NHSC enrollment, I think it was a very astute financial and personal decision to enter the program. In retrospect, given her switch into a much higher-compensated discipline and her scholarship, the NHSC was not a financial “no-brainer.”
In our case, my wife entered medicine to carry out very underserved care, and she is still excited to be part of the program and fulfill her NHSC pledge. So we are still really happy with things.
My bottom-line:
Overall, I agree with the general WCI sentiment I see on the blog: If caring for populations in such underserved sites is personally fulfilling and rewarding, then the NHSC scholarship might be for you.
But doing it solely for the financial reasons will be risky given (1) changes in underlying financial assumptions, (2) changes in personal priorities, and (3) significant and non-negotiable restrictions on future geographic and employment freedom.
Thanks for sharing your experience!
A few years ago the NHSC site where I worked in a under-served part of a big city had a huge budget cut, and they terminated the positions of about four providers. I was one of them. During the year after that job loss the NHSC representative that I was working with was pointing me in the direction of other job sites, but all required relocating hundreds, if not thousands of miles away. Within two months after losing my job I developed my own serious health issues that kept me from being able to walk, and this is after only one year into fulfilling my two-year commitment to NHSC. I informed NHSC of my situation and I think I may have filed a waiver because of my health problems. So they stopped contacting me for many months. My health was so bad that I had no choice but to move to another state in order for my family to care for me. I never heard from NHSC again, most likely because I had moved to another state and no longer used the same email address from that previous job. I thought they just dropped the issue because of my health problems. When I moved to the other state to get physical help, I finally had surgery, but the health problems continued. I tried for temporary disability and was denied twice (as most people are). After another year without the ability to work or walk without assistance, I had a second major surgery, and since then, I have gradually, with rehabilitation, been able to walk again. So now, I began thinking that I might be able to complete my 2-year commitment. But in the last few months I found out that NHSC has charged me the outrageous fees without even informing me, and to my surprise, I owe over $200,000 in charges to them. They also kept my tax refund this month(!), and I didn’t even know any of this was happening at all. I am afraid to call them because I think they may try to track me down and put liens on my assets, too, and then revoke my professional license, or worse!
All I really want to know is if the NHSC will allow me to go back into the program to complete my commitment and take off those exorbitant fees, now that I can walk and work again. I’d be willing to move to wherever the site is, too.
Does anyone know?
This is so sad. The NHSC is not well run nor organized. They have a great mission but use penalties and treat their physicians poorly-not giving credit for work done, requiring tons of paperwork over and over again-that undermine the purpose of that mission. I have been talking with so many people with stories like yours. I feel for myself that it is more dangerous financially to try to finish my commitment. I am negotiating through an attorney a settlement given that the majority of sites on their website are not actual active jobs and that I cannot possibly move a 5th time for them. Please be very careful in negotiating with them and signing any documents. They will not help you to become employed despite that being in their contract and will levy your bank account and wages for that penalty. I am happy to help in any way possible with information from my experience. There are journalists expressing an interest in learning about these issues right now. Maria.
I’d guess so. Might be worth finding a health care attorney in your state though.
As a first year medical student staring in a few weeks, I’ve looked into ways to minimize my debt. I’m a saver and like to live frugal. Thus, the HPSP was one option but I felt this was not the right fit for me. Then I looked into NHSC programs and Indian Health. I really would like to care for the underserved so I’m hoping I can find a program that works.
This is an old thread, but I wanted to give my two cents. I am a pharmacist who just got approved for NHSC LRP, but for me, this was just a bonus on top of a job that already has some pretty nice perks. Compared with traditional retail pharmacy, FQHC pharmacies tend to be pretty great places to work, with 8-5 hours, Monday-Friday. We are closed holidays, and my particular FQHC is owned/run by my city, so we have government health and pension benefits.
Pharmacists are not covered through the NHSC scholarship program or the regular primary care NHSC LRP program, but are now covered through the NHSC SUD program focusing on substance use treatment. Practically speaking, my health center still focuses mainly on primary care, but because we do offer access to SUD treatment and counseling, we are eligible for the SUD funding. I had already worked for my FQHC for nearly 4 years when I applied for the new SUD funding to help pay off my student loans. The award for qualifying providers is up to $75,000 for 3 years of service. As this is a job I will continue to stay in, it felt like a no-brainer. Yes, there are now restrictions on my ability to leave my position penalty-free for 3 years, but I really wouldn’t have anyway barring a layoff situation. My salary is pretty on par with pharmacists at a similar level of experience, and I have more job security and less stress. Probably the one difference is in ability to earn bonuses with companies like Walgreen’s or CVS, but the positive aspects of FQHC pharmacies as a practice environment far outweigh bonuses, in my opinion.
We do have newer MDs and NPs who filter in and out of our health centers with various levels of satisfaction with the job experience. It can be draining given the level of need of our patients and the expectations placed on these providers. I don’t think there is particular dissatisfaction with compensation, but our providers do a lot of their own resulting, charting, and prescription responses, which can burn them out. That’s not to say we don’t have long-time providers, just that newer providers do have more turnover. Our dental team seems to be more steady than our medical team, with many of our dentists staying with our FQHC for the bulk of their careers. They may have earned more in a private practice environment, but again, still had good salaries, excellent benefits, and generous sick, vacation, and parental leave policies that make for an attractive work environment.
For me, I was comfortable with signing the NHSC contract because I had already worked for my employer 4 years before becoming eligible for NHSC loan funding. I had ample time to truly evaluate my employer and whether this was a place I wanted to stay for my career. If you are thinking of taking a job with an NHSC-eligible employer with intent to apply for LRP money, it might not be a bad idea to postpone to the next application cycle if you haven’t had enough time to decide if this is a place you can or, better yet, want to hang out for a few years. If your sole purpose in taking a job is the NHSC money, and you really haven’t considered the other factors that make you happy in a job, then you might well be in for a miserable couple of years or a pretty steep default penalty.
Thanks for sharing your valuable experience.