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Revisions to 'College Cost Reduction and Access Act' will create barriers to primary care

(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 nations 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:

  1. they were employed full-time and their federal education debt burden was equal to or greater than 20 percent of their monthly income,
  2. 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 the20/220 pathway, the new law offers borrowers the option of participating in a debt repayment program that caps payments at 15 percent of the borrowers 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.


Contact: David Kinsman
American College of Physicians

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