Pediatric Fellowships, finances, loan repayment?

[BigRedBeta]

http://pediatrics.aappublications.org/cgi/reprint/peds.2010-1285v1

New article coming out in this months PEDIATRICS about financial implications of pursuing a peds fellowship. No surprise that Cardiology, Critical Care and Neonatology are the only ones that provide long term financial gain...


What's substantially MORE interesting is that the article mentions (for the first time I've heard about it), the "Investment in Tomorrow's Pediatric Healthcare Work Force" section of the Health Care Reform bill that President Obama signed last spring: Provides $35,000 per year for a total of 3 years for repayment of student loans.

Page 1295 of the HCR Bill is where the program gets discussed: http://www.cbsnews.com/htdocs/pdf/Senate_health_care_bill.pdf?tagcontentMain;contentBody


From my reading of it, it sounds like people entering fellowship starting this year are eligible. Does anyone know about this program? How do I get signed up? With all the legal challenges surrounding the bill, what are my chances of being able to use this when I start fellowship in July 2012?

Seriously, finding this out made my morning...

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[Stitch]

Wow, I hadn't heard anything about this. I'll probably contact my fellowship PD and see if they know the details. At first I thought it was only after you completed training and chose to work in an underserved area, but it specifically talks about those in fellowship training being eligible. That would rock.

 

[WestcoastMedicine]

It was announced a few months ago. You have to google it to read the specifics. The last time I read about it, it was vague as to what would be included. It talked about giving it to peds subspecialists in shortage areas. it did not define shortage. Geographic shortage? Does that only include certain subspecialty areas? They may have defined this now, but not sure. As I understand it you are eligible after one year out of fellowship training and then as it says 35K a year for 3 years. This may also have changed though, not sure.

 

[The Masked Duck]

http://pediatrics.aappublications.org/cgi/reprint/peds.2010-1285v1

New article coming out in this months PEDIATRICS about financial implications of pursuing a peds fellowship. No surprise that Cardiology, Critical Care and Neonatology are the only ones that provide long term financial gain...

From the article:
"Stated differently, a graduating third-year pediatric resident would need to be given a lump sum payment of 870 995 to make the decision to forego a career in general pediatrics and enter fellowship training in infectious disease financially neutral."

Wow, that's sobering. I guess it's not that bad if you spread it out over the life time of the physician career and with the loan repayment program it does help.

 

[oldbearprofessor]

From the article:
"Stated differently, a graduating third-year pediatric resident would need to be given a lump sum payment of 870 995 to make the decision to forego a career in general pediatrics and enter fellowship training in infectious disease financially neutral."

Yes, but the oddest thing is that pedi ID specialists, are, in my experience (and in this case we're talking about knowledge of folks well in more than a handful of places) amongst the most career satisfied doctors I've ever met. Same for pedi rheum. These folks deserve more $$, but seem strangely content with their choices.

 

[The Masked Duck]

Yes, but the oddest thing is that pedi ID specialists, are, in my experience (and in this case we're talking about knowledge of folks well in more than a handful of places) amongst the most career satisfied doctors I've ever met. Same for pedi rheum. These folks deserve more $$, but seem strangely content with their choices.

As cliche as it sounds if you do what you love you never have to work a single day. Even through specialties like geriatrics and pediatrics are among the lowest paid, they are constantly ranked amount highest in terms of career satisfaction. The reason this occurs is that the people who go into these medical specialties do not do so for financial considerations. In the end the financial considerations will only play a small part in what medical specialties I decide to go into. Things like intellectual stimulation and the patient population will play a far bigger role. Still it is important to understand the financial picture not just for future physicians but also to help guide policy and find methods to address the current shortage in pediatric sub-specialist whether it be loan repayment or reducing training to two years.

 

[Mutterkuchen]

What's substantially MORE interesting is that the article mentions (for the first time I've heard about it), the "Investment in Tomorrow's Pediatric Healthcare Work Force" section of the Health Care Reform bill that President Obama signed last spring: Provides $35,000 per year for a total of 3 years for repayment of student loans.

Don't get too excited yet. It is a provision in the Heathcare bill, but I don't believe actual funds have been appropriated to pay for this. Not to be too cynical, but I highly doubt that pediatrics subsubspecialists are a high funding priority for either house of Congress.

 

[RSV]

Take this article with a grain of salt. Most peds. specialties can make a very nice ROI via private practice. Just takes some business IQ, etc. Hope that the pay-back provision stays/gets extended for longer than three years!

 

[MacVA]

How can you get a copy of this article?
My SO is interested in Peds Cardiology.

 

[LIDO]

Take this article with a grain of salt. Most peds. specialties can make a very nice ROI via private practice. Just takes some business IQ, etc. Hope that the pay-back provision stays/gets extended for longer than three years!

ROI could be higher in private practice, but is it not true that most pediatric specialist work in academics due to the patient population?

 

[AI2012]

Has anyone heard any new/more info on this?

As someone entering fellowship this summer, I am eagerly (anxiously?) awaiting more information. Though I don't even know if I'll be eligible (Allergy/Immuno fellow, but in a peds program with the goal of being an academic pediatric allergist...)

I've googled and googled, but can't seem to find anything more concrete than the vague wording in the bill and the AAPs statement of support.

 

[michigangirl]

let's put it this way-- noone is holding their breath. I hadn't heard anything about this until this forum. And I come from a subspecialty heavy institution.

 

[Staphylococcus Aureus]

BUMP

At this point the question is, for someone that didn't get school paid for (+300k debt) does anyone know how to make a peds fellowship financially doable? I'm not aware of any programs that help with loans specifically for peds subspecialties.

 

[NurWollen]

BUMP

At this point the question is, for someone that didn't get school paid for (+300k debt) does anyone know how to make a peds fellowship financially doable? I'm not aware of any programs that help with loans specifically for peds subspecialties.

Do NICU or PICU.

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[WheezyBaby]

BUMP

At this point the question is, for someone that didn't get school paid for (+300k debt) does anyone know how to make a peds fellowship financially doable? I'm not aware of any programs that help with loans specifically for peds subspecialties.

You should verify the numbers below for yourself, but I think it's about right. Below assumes a family of 3, in some random Texas city

If you figure you train for 6 years, your interest will balloon your loan to about 450k give or take a bit based on whatever your payments are. Let's say you make 150k out of training. With repaye, you pay a few hundred a month during residency / fellowship then about 1k a month on that for 25 total years before forgiveness, with forgiven debt about 700k. So after 25 years, your debts "forgiven" with a taxable income that year of 850k, so you're due at that point for about a 300k lump payment. Assuming you don't start saving for that until making attending money, you're putting away, on top of your student loan payments, another 1.3k a month for 19 years in preparation for that lump sum payment. Overall works out to about 2300 a month in student loan payments for 19 years as an attending before you're debt free, or ballpark something like a quarter of your take home. It's financially "doable" but if you compare it to 3 years of training in EM or 4 in anesthesia to be making 300-400k probably working less hours, it's kind of painful. If you're dead set on a peds subspecialty, comparing your income to others isn't going to be the path to happiness though

 

[Staphylococcus Aureus]

You should verify the numbers below for yourself, but I think it's about right. Below assumes a family of 3, in some random Texas city

If you figure you train for 6 years, your interest will balloon your loan to about 450k give or take a bit based on whatever your payments are. Let's say you make 150k out of training. With repaye, you pay a few hundred a month during residency / fellowship then about 1k a month on that for 25 total years before forgiveness, with forgiven debt about 700k. So after 25 years, your debts "forgiven" with a taxable income that year of 850k, so you're due at that point for about a 300k lump payment. Assuming you don't start saving for that until making attending money, you're putting away, on top of your student loan payments, another 1.3k a month for 19 years in preparation for that lump sum payment. Overall works out to about 2300 a month in student loan payments for 19 years as an attending before you're debt free, or ballpark something like a quarter of your take home. It's financially "doable" but if you compare it to 3 years of training in EM or 4 in anesthesia to be making 300-400k probably working less hours, it's kind of painful. If you're dead set on a peds subspecialty, comparing your income to others isn't going to be the path to happiness though

Very sobering. This begs the question, how will we have ANY new peds endocrinologists or peds nephrologists in 10 years, as debt increases with each graduating class.

 

[WheezyBaby]

Very sobering. This begs the question, how will we have ANY new peds endocrinologists or peds nephrologists in 10 years, as debt increases with each graduating class.

 

[thetubes]

Very sobering. This begs the question, how will we have ANY new peds endocrinologists or peds nephrologists in 10 years, as debt increases with each graduating class.

Or if we will have any pediatric pulmonologists to take care of WheezyBaby

 

[SurfingDoctor]

Very sobering. This begs the question, how will we have ANY new peds endocrinologists or peds nephrologists in 10 years, as debt increases with each graduating class.

The NIH has a loan repayment program for debt forgiveness one can apply for. One has to do a research project anyway during fellowship anyway, might as well get the NIH help pay ones debt.

 

[oldbearprofessor]

Just to add a bit of caution about counting on the NIH loan repayment program, here are some of the most recent data about it...

"In Fiscal Year (FY) 2015, 2,736 individuals applied to the five Extramural Loan Repayment Programs (LRPs): Clinical Research, Pediatric Research, Health Disparities Research, Clinical Research for Individuals from Disadvantaged Backgrounds, and Contraception and Infertility Research. Of those applicants, 1,351 received either new or renewal awards totaling $69,368,686. The combined (new and renewal award applicants) success rate for the Extramural LRPs was 49 percent. The Clinical Research LRP received nearly 56 percent (1,529) of all Extramural LRP applications. New award applicants (those not previously funded by the LRP) constituted 60 percent (1,641) of all applications while renewal award applicants (those previously funded by the LRP) comprised 40 percent (1,095) of all applications. Success rates for new and renewal award applications were 39 and 65 percent, respectively." (Reports and Statistics). A lot more info about the program can be found at Data & Reports | NIH: Division of Loan Repayment

In other words only about 40% of new applications were accepted in the 2015 cycle. I don't know about more recently, but I doubt that is going up. Certainly cutbacks to the NIH or even an even budget would not be a good sign for this program. This program has increasingly also been attracting junior faculty who are not physicians and has become tougher for fellows to get money from - many applicants are academic early career faculty which is fine, but might not be ideal for those with large debt loans.

As far as how we will ever get more pediatric subspecialists in the lower paying specialties, that is a good question. Certainly not everyone heads into fellowship with a debt load > 250K, especially many of those from places like Texas with lower tuition for the vast majority of students. For those with very high debt, it is a real challenge to go into these fields.

 

[SurfingDoctor]

I didn't mean to susgest it was a slam dunk, but a 40% chance of getting it, especially considering ones has to do a research project anyway... there's no risk in trying. However there is a 0% chance of getting a NIH LRP if one doesn't try.

 

[wellchild]

If I recall, NIH loan repayment programs also require a percentage of protected time for research. While this might be feasible in the research years for less-clinical subspecialties, fellows in PICU/NICU/etc may not have that sort of protection even in the last two years. Additionally, you need a pretty good mentor and support letters for extramural awards. My PICU fellowship was at a research-heavy highly-funded institution, and it was rare to see fellows develop strong research projects early in fellowship when you'd need to apply for LRP--largely because of the clinical responsibilities in the first year. Still SurfingDoctor's point is well taken: you never know until you try. And if you have the time to put together an application for LRP, you probably have the time to put together a pretty decent research project.

Another big issue is the decline of academic jobs available in the "high paying" peds subspecialties. Job prospects are fine if you're looking for a clinical career, but for the honor of working in academics the jobs are scarce these days and the pay is low. I know many friends from residency making much more in private practice gen peds from day one than anyone starting out in critical care. No one goes into peds for the money, but as the academic job market tightens and loan burdens go up, this is clearly not sustainable.

The predominant method right now is to go into peds fellowship knowing you'll need to live on the cheap when you're done and cross your fingers that PSLF will stick around long enough for you to benefit.

 

[SurfingDoctor]

If I recall, NIH loan repayment programs also require a percentage of protected time for research. While this might be feasible in the research years for less-clinical subspecialties, fellows in PICU/NICU/etc may not have that sort of protection even in the last two years. Additionally, you need a pretty good mentor and support letters for extramural awards. My PICU fellowship was at a research-heavy highly-funded institution, and it was rare to see fellows develop strong research projects early in fellowship when you'd need to apply for LRP--largely because of the clinical responsibilities in the first year. Still SurfingDoctor's point is well taken: you never know until you try. And if you have the time to put together an application for LRP, you probably have the time to put together a pretty decent research project.

Another big issue is the decline of academic jobs available in the "high paying" peds subspecialties. Job prospects are fine if you're looking for a clinical career, but for the honor of working in academics the jobs are scarce these days and the pay is low. I know many friends from residency making much more in private practice gen peds from day one than anyone starting out in critical care. No one goes into peds for the money, but as the academic job market tightens and loan burdens go up, this is clearly not sustainable.

The predominant method right now is to go into peds fellowship knowing you'll need to live on the cheap when you're done and cross your fingers that PSLF will stick around long enough for you to benefit.

As to your first point, I was a PICU fellow when I was on the LRP.

As for a reduction in academic positions. Yes and no. There are academic jobs, they are just more selective than they used to be. But there are plenty of private reactive jobs that typically pay more. Depends on what ones well-defined career goals are on what the opportunities are.

Of course, none of this addresses the issues with the cost of higher education which is completely ridiculous and not sustainable in the long term. Also this issue of school debt is not unique to pediatrics or medicine, but is a national issue

 

[michigangirl]

FWIW, I was also a PICU fellow when on the LRP.