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Revisions to ‘College Cost Reduction and Access Act’ Will Create Barriers to Careers in Primary Care and Hurt Access to Care in Underserved Areas

American College of Physicians Sites Implications of Rising Cost of Medical Education and Resulting Debt Burden

October 8, 2007

(Washington) –Revisions recently made by Congress to the economic hardship definition in the ‘College Cost Reduction and Access Act’ (H.R. 2669) will deter physicians from pursuing careers in primary care or practicing in underserved areas, said David C. Dale, MD, FACP, president of the American College of Physicians (ACP), in letters to congressional committee leaders involved in the legislation. ACP represents 124,000 internal medicine physicians, residents and medical student members.

“ACP is concerned about the rising cost of medical education and resulting financial debt burden on medical students and physicians-in-training,” Dr. Dale emphasized. “High levels of debt serve as a deterrent to pursuing careers in primary care, working in underserved areas, or entering the medical profession altogether. Further complicating student debt repayment will likely only deter students from pursuing careers in medicine, particularly less remunerative specialties such as internal medicine and family medicine, which are already facing shortages.”

“This new law eliminates the economic hardship deferment qualification criterion that most of the nation’s medical residents rely upon to defer their student loan debts while completing residency training,” Dr. Dale said. Before the passage of the Act, he explained, medical residents could qualify for the economic hardship deferment if:

  • they were employed full-time and their federal education debt burden was equal to or greater than 20 percent of their monthly income,
  • and their income minus the education debt burden was less than 220 percent of the greater of the minimum wage rate or the federal poverty line for a family of two (‘20/220 pathway’).

ACP urged the congressmen to either reinstate the 20/220 hardship deferment eligibility criterion or increase the eligibility threshold for economic hardship deferment.

The elimination of the deferment option forces the majority of medical residents – who would otherwise have been able to defer repayment for a period of time during their residency – to begin repayment immediately after the conclusion of their medical school training. Because the legislation took effect Oct. 1, the College is concerned that medical residents have not had adequate time to arrange for an immediate loan repayment plan.

In place of the’20/220 pathway,’ the new law offers borrowers the option of participating in a debt repayment program that caps payments at 15 percent of the borrower’s income that is above 150 percent of the Federal Poverty Level. However, the repayment program does not go into effect until July 1, 2009, which leaves medical residents with no immediate reprieve for a significant period of time.

Recipients of the letters from the American College of Physicians are:

  • Hon. Edward Kennedy, chairman Senate Health, Education, Labor and Pensions Committee
  • Hon. Michael Enzi, ranking minority member, Senate Health, Education, Labor and Pensions Committee
  • Hon. George Miller, chairman House Education and Labor Committee
  • Hon. Howard McKeon, ranking minority member, House Education and Labor Committee

The American College of Physicians is the nation’s largest medical specialty organization. Membership is composed of 124,000 internal medicine physicians (internists) and medical students. Internists provide the majority of health care to adults in America. Internists are specialists in adult medicine and provide comprehensive care to adult patients.

David Kinsman, (202) 261-4554, dkinsman@acponline.org
Jacquelyn Blaser, JBlaser@acponline.org

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