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BEHIND THE CURTAIN OF MEDICAL SCHOOL DEBT
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State Physician Loan Repayment Program (LRP) Comparison*
State
Pennsylvania
New York
New Jersey
Delaware
Ohio
11111

Service length requirement
2 years
3 years
4 years
2 years
2 year minimum
Additional 2 years

Maximum Award
$100,000
$120,000
$120,000
$100,000
$25,000/year
$35,000/year

State physician LRPs are designed to increase access to medical care
for underserved populations. The number of positions is limited and
applicants must meet eligibility criteria. The Pennsylvania program in
effect until the 2014-2015 fiscal year was significantly less generous
than those of other nearby states, requiring 3 years of service for total
repayment help of $64,000.
*Award amounts and service requirements are subject to change.
**Award amounts may be less, depending on the characteristics of the service site.

That anxiety can be paralyzing.
- Consider P.A. school.
- Mid-level practitioners might be an option.
- Live at home if possible. Take out only as much as you need.
Cut back on unnecessary costs such as eating out/shopping if
possible. For parents: start bonds that mature when child is
20-25. My parents did $100 bonds which matured to $10,000
in 20 years. That helped significantly. Also make sure parents'
taxes don't affect the amount of loans that you get.
T.J. H.: These questionnaires certainly gave me a lot to think
about. I had never considered the amount of financial anxiety felt
by some aspiring physicians. As someone who never had to stand
the rigors of medical school, I can only imagine the added stress
on a student of knowing that if they fail to graduate, not only
would they not achieve a career objective, but they would also be
burdened with a debt load their alternate career earnings might
not support.
So I have to ask, after reviewing the magnitude of the debt
load my son could be carrying in 2035, and reading about some
of the struggles facing our current young physicians, as a parent
(and patient) I have to calmly and objectively ask........WHO
IS GONNA BE ABLE TO AFFORD BEING A DOCTOR ...
AND IN TWENTY YEARS HOW MANY DOCTORS WILL
BE LEFT?
T.J.H. and L.J.C.: As the responses to our residents'
questionnaire illustrate, student debt already plays a prominent
role in a young physician's life. It is time to take a hard look at
the meaning of such debt for both the individuals signing all
those promissory notes and for the future of the profession.
While there is no reason to think that the cost of a medical
education is causing the applicant pool to shrink (in fact, the
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number of applicants has increased to record levels), the debt so
many successful applicants amass could still affect access to care.
Specifically, the need to repay these loans could play a role in choice
of practice location and type of practice, and even in choice of
specialty since incomes vary widely.
According to the 2015 AAMC Physician Workforce Profile,
Pennsylvania had 39,176 active physicians, making us 8th in the
country in physicians per 100,000 residents. We were also in the
top ten in active patient care physicians, with 12,693 in practice. In
terms of "physician supply" our state ranks near the top 20 in all 9
of the AAMC's listed categories. However, as is the case across the
U.S., the geographic distribution of Pennsylvania's physicians leaves
certain areas and certain patient populations underserved. Data
from HRSA Data Warehouse: Designated Health Professional Shortage
Areas Statistics, as of January 1, 2017 indicates there are presently
159 Primary Care HPSAs in Pennsylvania, and that an additional
88 primary care physicians serving these areas would be needed in
order the for designations to be lifted. Some of these HPSAs are
facilities (mainly correctional facilities), but the majority are lowincome areas. Shortages also exist in a number of non-primary-care
specialties and in the fields of dentistry and mental health.
Pennsylvania is 4th in the United States in numbers of
M.D. and D.O. students, with 8,114 enrolled in Pennsylvania
institutions in 2015. In addition, 7,881 Residents and Fellows
are also training in our state, putting us fifth in the nation in that
category. Considering the number of outstanding medical schools
in Pennsylvania, these numbers are not surprising (2 D.O. schools
and 7 M.D. schools). It would appear, therefore, that Pennsylvania
should be in a good position to attract newly-trained doctors to
serve the needs of the state's population.
However, Pennsylvania is losing grounds in terms of retaining
our young physicians. In the same AAMC Profile, we are ranked
in the bottom third of states for physician retention. There are
a number of factors contributing to this state of affairs, but
considerations involving income potential and opportunities to
enter loan forgiveness programs probably influence graduates
carrying a heavy debt load.
According to the Merritt Hawkins 2016 Review of Physician
and Advanced Practitioner Recruiting Incentives, the region of the
U.S. that includes Pennsylvania (Northeast) was associated with the
lowest average salaries offered to both Family Medicine and Internal
Medicine physicians. Pennsylvania does have a Physician Loan
Repayment Program (LRP), which offers help with loan repayment
in exchange for a term of service in a Health Professional Shortage
Area in the state, but up until two years ago it was much less
generous than LRPs offered in nearby states (Sidebar No. 2). On
the national level, successful applicants to the National Health
Service Corps program can receive up to $50,000 in exchange for a
two-year commitment to work in a high-need, underserved area.
The assistance available through loan repayment programs is
constrained by competition for a limited number of positions and
because the actual amount received may be less than the maximum,
depending on the exact characteristics of the service site. According
to the AAMC (Sidebar No. 1), 44% of indebted medical students
say they plan to enter loan forgiveness/repayment programs.
Although the state and federal programs mentioned above are not
the only such programs, not all students hoping to lighten their
debt burden in this way will meet with success.

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