By Jonathan Nelson
Last week two TAFP members testified before the House Higher Education Committee, asking for support for House Bill 2261 by Rep. Armando Walle, D-Houston, and Rep. Matt Schaefer, R-Tyler. The bill would increase the maximum payout of the Physician Education Loan Repayment Program from $160,000 to $180,000 for physicians who agree to practice for four years in a federally designated Health Professional Shortage Area. The bill has a companion in the Senate, SB 998 by Sen. Juan “Chuy” Hinojosa, D-McAllen.
In 2009, the Texas Legislature greatly enhanced the existing Physician Education Loan Repayment Program by changing the way smokeless tobacco is taxed and designating part of the difference to physician loan assistance. That allowed physicians to receive up to $160,000 to pay off their educational debt in return for four years of service, and that’s a deal many physicians have been eager to make. In the past five years, the program has enrolled well over 750 physicians who are now caring for patients in rural communities, urban centers, community health centers, and correctional facilities – all places where Texans suffer a lack of access to care.
“For those communities that experience a shortage of physicians, health and wellness is difficult to obtain and maintain,” Rep. Walle said as he introduced the bill to his fellow committee members. “The reality of living in a medical desert is a lack of access to care, a lack of continuity of care and a lack of peace of mind, all caused by a lack of access to physician services.”
Hilary Kieffer, MD, a third-year resident at the Lone Star Family Medicine Residency in Conroe, Texas, testified first, saying the increased maximum level of assistance is needed to maintain the program’s success as student debt levels rise.
“The Physician Education Loan Repayment Program is one of the best tools [Federally Qualified Health Centers] and underserved communities have for physician recruitment,” she said. “This program has resulted in physician access in the most underserved areas of the state that have few if any other resources for recruiting physicians.”
After graduation in June, Kieffer plans to practice at a rural health center in Marble Falls, she told the committee.
Lane Aiena, MD, of Huntsville, testified next, telling the committee the program has played a vital role in helping bring doctors to underserved communities. “Folks, the bottom line is this program works.”
A member of the TAFP Board of Directors, Aiena said physicians who participate often stay in their chosen communities longer than their four-year commitment.
“Once you get established in an area in any job, especially primary care, you get to know the people; you get to establish relationships. It’s one of the joys of our jobs,” he said. “As my partner says, we might not make as much money as specialists but we get more hugs. I think that with the four years, by then you’ve got a practice established, you know the patients, it’s going to be pretty tough to leave.”
Rep. Schaefer addressed the committee last. “This works. This is far less expensive to the tax payer than creating a new medical school,” he said. “These students follow these incentives. These underserved communities benefit from it. It’s what we are trying to accomplish with our public policy. It’s a wonderful thing. ... I think it’s good public policy.”
The committee passed the bill unanimously and it now awaits a hearing on the House floor.
Texas ranks 47th among states in the ratio of primary care physicians to total population. The U.S. Health Resources and Services Administration has designated 123 Texas counties as full Primary Care Health Professional Shortage Areas and 84 as partial HPSAs.
The state’s physician shortage is exacerbated by it’s poor distribution of physicians. Rural counties and many communities in urban centers have much more difficulty accessing care than Texans in more affluent areas. TAFP believes the Physician Education Loan Repayment Program helps solve this problem.
Medical students rack up a lot of debt, and the trend is rising. According to the Association of American Medical Colleges, 76 percent of medical students graduate with debt. In the U.S., the average cost for four years at a public medical school is $243,902. For private medical schools, the cost is $322,767.
As those education costs continue to climb, so does the average debt new physicians carry as they set out to start their careers. In 2011, the average total educational debt for graduating medical students was $173,000. By 2016, it had grown to $190,000.
To be eligible for the PELRP, physicians agree to practice for four years in a HPSA and care for patients enrolled in Medicaid and the Children’s Health Insurance Program. The program pays up to $25,000 in the physician’s first year of service, $35,000 in the second, $45,000 in the third, and $55,000 in the fourth.
The program prioritizes primary care when enrolling physicians, but physicians of all specialties can participate. Any physician with educational debt — not just new physicians — may apply.
For more information, read TAFP’s issue brief, Primary Care Physician Workforce and Loan Repayment.