Loan Forgiveness (particularly NHSC)

Pre-Med & Medical School
1

Sorry to be asking a million questions, but I got a lot of help on my BS/MD thread, so I thought I’d ask something else I’ve been wondering about!

I have been volunteering and working at a clinic that serves primarily immigrant families for a few years, and will be working there full time in a paid position this summer. I have been able to shadow some of the primary care physicians who work there. My goal is to go to medical school, and become a primary care physician. Doctors who work at the clinic are eligible for NHSC loan forgiveness.

Can you tell me more about NHSC loan forgiveness?

Also, I have some specific questions?

  1. Does it apply to any kind of medical school loan, or only certain kinds?

  2. Does it apply to interest, or only principal?

  3. If I graduate medical school with some debt, and go into a primary care specialty, but then in medical school I fall in love with a specialty. (e.g. I’m training as a pediatrician, but then realize I want to do a fellowship and be a pediatric pulmonologist). Is it ever possible to do residency, work for a few years as a pediatrician and get some loans forgiven, and then apply to a fellowship? Or are fellowships only available immediately after residency?

Yes, I know I’m getting ahead of myself. I just feel as though the more I know about all of this, the better decision I can make next month when I know all my acceptances!

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There are some changes under the current Congress and Administration.

I can’t say whether the clinic you mention would continue to be eligible, or if the NHSC loan forgiveness will be accessible when you would be ready yo be employed.

Here is latest
https://nhsc.hrsa.gov/loan-repayment/nhsc-loan-repayment-program
There is a webinar at the link.

https://www.forbes.com/sites/adamminsky/2026/02/18/trumps-new-student-loan-repayment-plan-could-wipe-out-your-pay-raise/

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Is it too political if I say that I hope that we have a different administration by the time I (God willing) finish my residency? But yes, I know all of this can change. I’m not counting on it, I’m just trying to figure out the landscape of what options might possibly exist.

Thank you for these resources! The comment on the last one (If you don’t understand, that’s not your fault . . . .) made me want to cry and smile at the same time. It’s both sad that things are so complicated, and a little reassuring to know that it’s not my lack of research skills that’s the only issue!

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Even a new administration may not change things or be able to change things. Everything has a cost and budgets are tight. While these changes may not have happened under a different administration, it doesn’t mean things go back after a new one.

Working with immigrants is a tough audience to work with. This was my daughter’s goal - even started a club at school to work with the local resettlement agency to integrate Afghan refugees into society.

But jobs she might have pursued after college have dried up. But she’s found an alternative, for now, through teaching immigrant kids (has a class of many cultures).

So there’s always a path you can find - but one thing you should not count on is others to pay your bills.

So you should factor that into anything that you do.

But hopefully you’ll find a way to “afford” your personal goals - which I’m sure are lovely but may be diminished for generations to come, unfortunately.

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@WayOutWestMom what can you provide for information for this student.

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Can you tell me more about NHSC loan forgiveness?

Also, I have some specific questions?

  1. Does it apply to any kind of medical school loan, or only certain kinds

Only federal student loans that were taken out to pay for medical school. It can’t be applied, for example, to paying off undergrad loans. It can’t be applied to private loans.

To the whole debt, including both interest and principal. But the amount of forgiveness you get with each year of repayment has a ceiling. I think it’s around $40,000/year if you work full time at a FQHC. (But don’t quote me on that.)

To be eligible for NHSC, you must apply for the program no later than the end of your MS2 year. The program is highly competitive. (And has gotten more competitive recently because…..sigh……its funding has been cut in half by the current administration.)

There are no guarantees where you will end up working since you must apply for open FQHC clinics positions and go thru the regular hiring process.

If I graduate medical school with some debt, and go into a primary care specialty, but then in medical school I fall in love with a specialty. (e.g. I’m training as a pediatrician, but then realize I want to do a fellowship and be a pediatric pulmonologist). Is it ever possible to do residency, work for a few years as a pediatrician and get some loans forgiven, and then apply to a fellowship? Or are fellowships only available immediately after residency?

Yes, it’s possible to work in a primary care specialty use NHSC to pay down/ pay off your debt, then go back to residency/fellowship for further training. It’s not easy, but it is possible. Pediatric sub-specialties are not especially competitive outside of ped cardiology or NICU.

Applying for sub-speicalty fellowship related to a specialty you have trained in and practiced is usually possible so long as you’ve kept current with developments in your field. This is a situation where networking extensively with fellowship directors will help.

An advisor who used to be active on another site did exactly what you’re asking. They went to med school on NHSC scholarship, did their repayment service of 5-6 years in FM, went back to do residency in different but related specialty then did a highly competitive specialty fellowship. They went into academic medicine, then academic administration and they’re currently a high level medical director of a major hospital system.

The spouse of one of D2’s friends is doing something similar. They were a physician trained in another country, but needed help getting both US clinical experience and USMLE prep. (Since their training didn’t come close to covering all the topics tested on the USMLE.) They went thru a program at UCLA for immigrant doctors which required him to train in FM and serve as a practitioner in state designated health care shortage areas for 6 years. Once they finish their required service, they are planning to apply for a pediatrics residency. (They had been a practicing pediatrician in their home country before meeting their American spouse and moving to the US.) The spouse will just need to wait and see how they fare in the Match. There are no guarantees, but they feel confident they will be able to requalify as a pediatrician.

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Thanks. To be clear, I know this is probably a long shot. I’m just trying to figure out some of the different ways this could go. I didn’t realize you had to apply during medical school, so thank you for that. If you apply in medical school, and get it, can you change your mind or are you locked in?

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There are 2 different NHSC programs. One is a scholarship program that pays for medical school. The other is a loan forgiveness program.

Both lock you in.

You apply to the scholarship program for a 2, 3 or 4 year scholarship. You get a tuition benefit plus a living expense stipend. You can apply as soon as you have a med school acceptance or anytime during MS1 or MS2. You need to repay the scholarship at the rate of 1.5 years of service for each year of scholarship received.

This program locks you in. If you default on your agreement, you have repay all the money you got as a scholarship at punitively high retroactive interest rates. You can’t have the debt forgiven under other programs (PSLF, for example) and you can’t refinance it (except maybe through a private lender).

The loan forgiveness program can be applied for after residency. It has a ceiling on the amount of loans that can be forgiven. The cap is $75K in total over 2 years if you work full time at one of the clinics in the highest need areas. Even if you work longer than 2 years at one these sites, you cannot get any additional loan forgiveness.

Scholarship students are guaranteed a placement and get to apply for jobs at an any openings first. Loan forgiveness applicants can only apply for jobs after all scholarship students have been placed.

If you do enter the loan forgiveness program and don’t complete your 2 year contract, you lose any repayment moneys. So you’re locked in by that program as well.

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9

This is amazingly helpful. Thank you!

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@DCDC

Since you are a District resident, you should know that the DC has its own loan repayment program for physicians and dentists.

The District’s Health Professional Loan Repayment Program (HPLRP) provides loan repayment to eligible health professionals practicing full-time at HPLRP-certified sites in health professional shortage and medically underserved areas (HPSAs and MUAs) in DC. The HPLRP assists certified sites to recruit and retain providers by providing loan repayment up to $151,841.29 over four years for physicians and dentists and $83,510.61 for all other eligible providers.

Of course, there are no guarantees the program will exist 11+ years from now when you’ll become eligible for it.

~~

There are also a couple of other loan repayment & scholarship programs.

The VA HPSP program will pay for medical tuition, plus a living expenses stipend and money for books, labs & exam fees. There is no requirement to become a primary care physician, but your specialty must be one the VA needs (IOW, pediatrics is unlikely to be eligible.) Service payback is 1.5 years for every year of scholarship received. Scholarship is for a minimum 2 years. You must be willing to relocate at your own expense to a site that the VA chooses for you after residency.

The Indian Health Service has a loan repayment program. Primary care fields only or other specialties identified being an area of high need. (Psychiatry and emergency medicine have been accepted specialties in the past.) Up to $50K for a 2 year full time contract at IHS run facility.

Side note: One of D2’s best friends from HS works for IHS as a physician and loves it. D2 did one med school rotation at a IHS facility in AZ and loved her time there. She would have taken a IHS job at another clinic after residency & fellowship but she had a two-body problem. (Meaning she would have had a job, but since IHS clinic was in a remote rural area her husband likely wouldn’t.)

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Wow, that DC program looks amazing.

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RE; DC program.

Before you get too excited—

Remember you are 12 years (or more) away from being eligible for it. It may not exist by the time you’re eligible for it. IOW, don’t bet your future on it.

The program is relatively new and is chronically underfunded. Legislation to establish program was passed in 2016, but program did not begin operating until 2020 (because there was no money allocated for it) and the amount of funding available annually is subject to the District’s budget allocation. No individual is guaranteed to receive the maximum amount allowable under the terms of the program. Also funds for loan repayment are given to the clinical site, not to a specific individual. It is the site’s director who decides which eligible providers gets loan repayment money and how much.

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As a DC resident, I live in a community that is vulnerable to the whims of each administration. I know not to count on anything. I can still find it exciting that something is available to people now, even if it doesn’t end up benefiting me.

I feel as though, the more things I identify that might be possible solutions to the problem of how to pay for undergrad and med school, the better. Will all of them work? No, but the more solutions I can identify the greater the chance that I can find a combination that will work for my specific situation. Also knowing that there are a range of possible partial solutions now, gives me hope that even if the solutions are different when I get to that stage of the journey, there will probably be some solutions that I can at least try for.

I feel like each time I ask about a possible partial solution, whether it’s a comment that I might apply to be a Resident Assistant, or get a job during undergrad, or apply to a school close to home so I can save money by living with my parents, or pick a state school so I can use DCTAG, or look into loan forgiveness . . . people point out that that thing might not work. I really do know that.

I’m sorry to vent, but I know the future is uncertain. I will need to make what seems like a huge decision in a couple months. So, having information, even if it’s not clear the information will apply to me in 4 or 8 or 12 years, seems helpful.

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In the end, you can go to undergrad, stat dependent, for $20k plus per year saving big time on the front end. Many fine schools have huge merit. Many have pre med living learning communities too for enrichment. And a school like Alabama has the McCullough pre Medical Scholars so you can be out for $100k all in for undergrad.

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Taking a high merit offer, not specifically Alabama because I didn’t apply there, but one of the ones I’ve been offered at other schools is definitely on the list of partial strategies.

I say partial, because I assume that the total amount (undergrad + med school) will require multiple solutions.

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Hopefully you have some that you might consider rock bottom prices and if not, you still have time.

Clearly you are well researched, prepared.

Good luck.

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Take a breath, let it out slowly. Then take another breath.

Although it feels like you are deciding the rest of your life right now in choosing a college, you are not.

Remember, there is no decision that cannot be changed or undone.

Remember, that in the long view, it really doesn’t matter all that much where you go to college. Your success depends on you, not the name of the school on your diploma.

Remember, there are many, many paths to medical school and that every individual’s path is different and unique. If medicine is your destiny and your calling, you will get there eventually even if it’s by a path you cannot envision right now.

Resilience and adaptability are among the 17 basic competencies expected of all medical students.

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I’m not freaking out, I’m excited about some of the acceptances I have, and impatient to know all my options. I’m also really curious about people who have done this before me, and the paths they took.

One piece I am a little worried about is the money, even though I know that there are people in far worse positions financially who become doctors. So, I’m curious about how they did it, even if I may not do it the same way.

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I put the link below.

I’m not sure this is possible anymore - given the $200K limit. And I think that has people concerned. I’ll let others weigh in though - I might be misinterpreting the $200K limit - which I believe includes undergrad.

  • 74% of currently practicing physicians hold student debt. Nearly ⅓ of physician borrowers still owe over $250K in student loans.

Average Physician Student Loan Debt | Highway Benefits

Why doctors go broke—and how to avoid it | MDLinx

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This limit is just for federal educational loans, not private loans. Because this newish federal limit has opened up a whole new market of people needing private loans, there will likely be some innovation in this area. More banks and financial companies are entering the market with differing types of loans and/or payback options, including no co-signer loans, income driven repayment plans, and income share agreements.

More colleges are also starting to offer student financing/loans.

I’m not recommending people take more than the federal limit in loans but some people who attend professional programs like med school, DO school, etc won’t be able to avoid it.