As the opioid epidemic rages on, officials are turning to a new tool to help curb it — student-loan relief.
The National Health Service Corps, a government program that supports health-care providers working in under-served communities, is now accepting applications for a program that will repay up to $75,000 in student debt for health-care workers combating substance-abuse disorders in under-served communities. (The deadline to apply is Feb. 21, 2019).
The loan-repayment program for people working on substance-use disorders is the latest initiative to use student-loan help as a tool to lure workers with debt-loads into low-paying, but well-meaning fields.
Physicians, registered nurses, licensed clinical social workers and other health care workers are eligible for loan repayment help under the initiative, called the Substance Use Disorder Workforce Loan Repayment Program, as long as they commit to working at an approved site helping under-served communities address substance-use disorder for at least three years.
“As the opioid epidemic expands we want to make sure that we have a mobile and agile health workforce,” said Israil Ali, the director of the division of the National Health Service Corps. The idea behind the loan-repayment initiative is to “create a program that’s going to support the entire care team that’s on the front lines of this epidemic.”
“Everything was pulling me and calling me towards this work and so I didn’t want my financial burden of debt to be the only reason why I wouldn’t do it.”
Sarah Dergins is one of those workers. As a licensed clinical social-work associate, Dergins, 30, spends her days working with pregnant women in a medical assisted treatment program — a type of substance-abuse treatment that combines medication with counseling and behavioral therapy.
Dergins, who works at North Carolina-based Gaston Family Health Services, provides therapy to these women as part of a broader team of health professionals providing integrated care.
“Our goal is to really get these women stable, address any of the psycho-social needs they have — it’s usually a lot of trauma — then stabilize them through pregnancy,” Dergins said. She and the other providers continue working with the women after they give birth. The total time patients spend in the program is between 18 months and two years.
For Dergins, who left graduate school with about $20,000 in student debt and whose husband is now in school, loan-repayment assistance made it possible for her to pursue a job she’s passionate about without giving up a viable financial future.
“I knew coming out of school I wasn’t going to be making a super high level of income,” Dergins said. Gaston, where she works, is committed to serving patients regardless of their ability to pay, which means they don’t have a ton of extra funds to spend on provider salaries. “Knowing that this kind of opportunity existed made it seem a lot more doable,” Dergins said of the loan repayment.
“Everything was pulling me and calling me towards this work and so I didn’t want my financial burden of debt to be the only reason why I wouldn’t do it,” she said.
The $1.5 trillion in student debt affects workers’ career choice
The loan-repayment program for people working on substance-use disorders is the latest initiative to use student-loan help as a tool to lure workers with debt-loads into low-paying, but well-meaning fields. The ubiquity of these programs is an indication of the ways the nation’s $1.5 trillion in student debt is affecting workers’ career choices and the workforce more broadly.
Borrowers with federal student loans who work for the government or some non-profits can have their loans forgiven after at least 10 years of payments through the Public Service Loan Forgiveness program. Many states and localities offer their own loan-relief programs geared towards specific fields or regions.
For decades, the National Health Service Corps has offered loan repayment assistance to health-care providers working in primary care in underserved communities. But the launch of the substance use disorder program is the latest signal of the magnitude of the opioid epidemic, which claimed more than 42,000 lives in 2016 alone.
Congress appropriated $120 million to NHSC for fiscal year 2019 to strengthen the substance use disorder workforce. A significant chunk of those funds will go to the student-loan repayment program. Officials expect to make about 1,100 awards under the program.
For many health-care providers, debt can be a formidable obstacle to working in fields or for organizations where the pay is low, which often overlap with those serving patients with little access to health care. About 76% of doctors graduate with medical school debt and the median balance was $192,000 in 2018, according to the Association of American Medical Colleges.
There’s some research to indicate that medical school debt can influence a doctor’s choice of specialty doctors or where they practice.
“The No. 1 challenge that our clinics have is recruiting and retaining staff. We did a salary survey several years ago, which showed basically that we were competing with Burger King for staff.”
About 78% of students who graduate with a master’s degree in social work leave with school with debt. The average sum is $44,269, according to the Council on Social Work Education. For those interested in providing mental and behavioral health care to patients in underserved communities the salary may not be enough to put a dent in that debt.
“The No. 1 challenge that our clinics have is recruiting and retaining staff,” said Chuck Ingoglia, the senior vice president for public policy and practice improvement at the National Council for Behavioral Health, an association of organizations providing mental health and addiction treatment. “We did a salary survey several years ago, which showed basically that we were competing with Burger King
Many of the clinics that are members of NCBH are publicly funded either through state and federal grants or through Medicaid, the government health insurance program for low-income patients, Ingoglia said. That means they often struggle to offer competitive salaries, he said.
At the Tri-County Community Action Agency Health Center in Rhode Island, officials rely on loan-repayment programs like the substance-use disorder workforce-repayment program to recruit top-notch clinicians, said Matthew Malek, the medical director. Tri-County takes most insurance, including Medicaid and offers the option for patients to pay fees on a sliding scale.
Loan-repayment programs, “provide that extra incentive that we aren’t able to provide,” in salary, he said. “It’s a big factor in terms of making up the gap.”
Malek said the loan-repayment help geared specifically towards providers working with patients on substance-use issues couldn’t come at a better time. He’s seen the demand for providers who can help patients with opioid addiction increase “remarkably” over the past three to five years.
One of the many parts of Malek’s job is to provide primary care to patients and integrate substance use disorder treatment within that. But given that the opioid epidemic is relatively new it’s still rare for primary-care physicians to have training specifically to deal with opioid addiction, Malek said.
Programs like the substance-use disorder loan-repayment assistance program can help encourage future clinicians to get that kind of training, he said. What’s more, the three year commitment period — which is longer than the two years required for the National Health Service Corps’ more general loan repayment program — will help organizations like Tri-County, where Malek works, retain talented providers.
That’s the goal, according to Ali. “We are committed to tackling this public-health crisis,” he said. “We see this as part of the solution.”
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