The most important piece of advice we can give about loan repayment?
Loan repayment should not be the only factor job seekers consider when choosing a job (or profession!). Loan repayment can be an important recruitment asset and is a tangible item unique to rural and underserved health care facilities, but it should not be included in any contract language as it is not guaranteed.
Terms you need to know
An employee already has a job with you.The employee is given a set amount of money toward their student loan debt in exchange for service. Example: an employee agrees to work three years for a facility and will receive $40,000 a year for each of those years of service.
An employee may or may not have a job. The employee applies for money toward a medical education they are already accepted to. This may or may not come with a contractual service (or other) obligation.
Health Professional Shortage Areas (HSPAs)
A federal designation of an area (e.g. a county) or facility as having a need or shortage of health professionals.
Primary Care Office (PCO)
The federally designated person/office responsible for many tasks related to improving access to primary care including HPSAs and loan repayment programs. There is one PCO in every state; you can find a full list of PCOs here: http://bhpr.hrsa.gov/shortage/hpsas/primarycareoffices.html
Where can you learn more about repayment programs in your state?
3RNet Member - https://www.3rnet.org/members/organizational-members
Rural Health Information Hub – https://www.ruralhealthinfo.org/funding/types
Primary Care Office - https://bhw.hrsa.gov/shortage-designation/hpsa/primary-care-offices
State Office of Rural Health - http://nosorh.org/nosorh-members/nosorh-members-browse-by-state/
If you’re interested in learning more about a specific program we encourage you to directly contact the program.
Common Loan Repayment Programs
National Health Service Corps (NHSC)
The federal program that supports primary care, dental, and mental health professionals in exchange for service in high need areas. The NHSC has three programs: NHSC Loan Repayment, NHSC Students to Service, and NHSC Scholarship.
You must be designated as an NHSC-approved site to qualify for these programs. Learn more about becoming an NHSC-approved site here: https://nhsc.hrsa.gov/nhsc-sites/index.html
NHSC Loan Repayment
An employee already has a job with your facility and applies to receive ‘x’ amount per year(s) toward their eligible student loan debt. You must be an NHSC-approved site to qualify for this program.
Eligible providers: Medical Primary Care Allopathic and Osteopathic Physicians, Nurse Practitioners, Certified nurse Midwives, Physician Assistants; Dental Primary Care: Doctors of Dental Surgery, Doctors of Medicine in Dentistry, Registered Dental Hygienists; Mental and Behavioral Health Primary Care: Allopathic and Osteopathic Physicians - Psychiatry, Health Service Psychologists, Licensed Clinical Social Workers, Licensed Professional Counselors, Marriage and Family Therapists, Psychiatric Nurse Specialists, Nurse Practitioners - Mental Health, Physician Assistants - Mental Health
NHSC Students to Service
A final-year medical or dental student, already committed to primary care, receives loan repayment during their residency in exchange for a three-year service obligation after completion.
Eligible providers: Medical Primary Care Allopathic and Osteopathic Physicians (Family Medicine, Internal Medicine, Pediatrics, Obstetrics/Gynecology, or Psychiatry) or Dental Students (DDS, DMD) in their final year of school.
NHSC pays for your medical or dental education in exchange for service in an area of highest need for a certain amount of time. A NHSC scholar must commit to this program, and a primary care specialty, during their schooling. NHSC pays for tuition, fees, and reasonable living expenses while attending school. This is the most ‘restrictive’ of the NHSC programs, meaning the penalties for backing out of the commitment are the most severe.
Eligible providers are students accepted to or enrolled in an accredited training program for: Physicians (MD or DO), Dentists, Nurse Practitioners, Certified Nurse-Midwives, Physician Assistants
NURSE Corps Loan Repayment
An employee already has a job as a registered nurse, advanced practice registered nurse, or nursing faculty. They apply for loan repayment and receive payment for a percent of their unpaid nursing student loans in exchange for working in an eligible public or non-profit facility located in a HPSA or in an accredited nursing school.
More information: https://bhw.hrsa.gov/loans-scholarships/nurse-corps/loan-repayment-program
Eligible critical shortage facilities can be found here: https://data.hrsa.gov/tools/shortage-area
NURSE Corps Scholarship
NURSE Corps pays for nursing education (includes tuition and fees) while attending an accredited school of nursing in exchange for service in an area of need for a certain amount of time.
State Loan Repayment Program (SLRP)
SLRP (pronounced ‘slurp’) is partially federally funded but requires a state, employer, or other to match the money given, dollar for dollar. SLRP programs are typically similar to NHSC (e.g. SLRP programs are required to follow the same breach penalty as NHSC), but as the state, employer, or other also contributes money, they may be more flexible in certain aspects (HPSA score needed to apply, etc.) or may impose additional requirements to participate in SLRP. You can see which states participate in the SLRP here: https://nhsc.hrsa.gov/loanrepayment/stateloanrepaymentprogram/contacts.html
There may be other options to consider in your state, such as employer sponsored loan repayment or awards from private foundations.
Independent State Programs
Many states have, through their own legislative processes, created financial incentive programs for health professionals. These programs vary from state to state. Connecting with your 3RNet member or PCO or searching online are good ways to identify independent state programs.
Public Service Loan Forgiveness
Questions and answers for federal student loan borrowers interested in this program can be found here:
Community-Based or Hospital/Health System-Based Programs
Some communities and even hospitals or health systems sponsor their own programs. If you don’t have a program like this in place, consider starting one!
Other Important Things to Know About Loan Repayment Programs
- Know that most programs—including National Health Service Corps—cannot be promised. There is an application process and things (such as HPSA scores) can change.
- Renewals are not guaranteed! For example, if the HPSA score of your facility changes, it will not affect current loan repayment, but could impact an employee’s ability to get a renewal.
- Know the requirements for participation (reporting, etc.) for you AND your employee. What do you have to report? When do you have to report it?
- Federal loan repayment programs are restricted to U.S. citizens, but you may pursue other state, community based or hospital programs that do not have the U.S. citizenship requirement.
- 3RNet members are excellent resources since they are aware of federal, state, and local programs, which is important since regulations for one program may prohibit the use of another.