loans picked up by State


I’ve approached several states with the following:

You pick up my bill and I work under certain conditions as a PCP.

Two states have responded very favorably. It looks like they will probably pick up the entire cost of my studies as long as I work in state for 10 years and for a nominal fee of $ 40. No dealing with insurance. Everybody who walk in, insured or not, pays $ 40.

I will post which two states are agreeing to this as soon as they tell me I can.

But suddenly I’m kind of scared. It’s nice to finish with no debt, but am I going to make it financially as a PCP in a private practice if I make 40 bucks per patient. As one of the bureaucrats mentioned, I won’t have to hire any front desk staff to deal with insurance. Still, when I think about malpractice insurance and everything, is this a good deal?

Did they tell you how many patients they expect you to see in a day/week/month/year? Can you start to figure out what sort of overhead you would need to pay for? (phones, electricity, some staff members perhaps, an electronic medical records system, etc.) PCPs who have a conventional office practice (i.e. take insurance) must spend 60-70% of what they take in on their overhead. You would certainly be able to do it for considerably less if you run a cash-basis practice, but you do still have to figure some overhead.

You also need to figure out: are you your own boss? who decides when you can go on vacation? Or attend continuing medical education? Who pays for your malpractice insurance? If you are self-employed, you pay twice as much in social security tax (FICA) as someone who’s an employee. Where will your own health care benefits come from? If you have employees, will you get them health insurance? Will YOU have insurance?

Fifteen patients a day, five days a week, is $3000 per week. To be honest that doesn’t sound like enough to keep up with all the expenses involved in running a medical practice, even one that doesn’t deal with insurance. OK thirty patients a day would double your take but I am telling you that it would halve your satisfaction.

So my gut, without doing the research at all, is that this seems risky. Remember, the state is offering you a deal that’s good for THEM, not you.


TWO general rules of thumb immediately come to mind here:

#1: if it appears to be too good to be true, then it probably is

#2: in virtually ALL business dealings, esp with gov’t (ESP in context of their perpetual ultra-severe low-balling of reimbursement figures for docs over many many years), the lead bid is gonna be a massive effort to underbid and try to pick up a “victim” that aides them far than it does you.

All in all, I would talk to a lot of folks, A LOT OF FOLKS IN THE KNOW, and have at least 1 lawyer to review any & all proposals. Signing on the dotted line with the gov’t has a nasty ring of PERMANENCE that you just do not not want to much with nor make mistakes. They tend to be an unforgiving lot.

OTOH, after you do your homework and are assured that the details are not going to drown you OR you negotiate and have come to mutually satisfactory terms, then striking a relationship like this with a state or the Fed can be sweeet. I had more than one med school classmate who attended school and had not just book stipends; but also living expense stipends who had formal commitments to some state to return to do primary care, usually rural or inner-city. I am only still in touch with one of them - she went back home to Topeka, KS and loves it - no regrets. So, it can be done in a way all parties are content. But, I would be damned careful with initial offers, ESP those that mandate 10 years. That is a long time and, potentially, a lot of lost income for you.

NO offense but it sounds like a TOTAL rip off!

I am a NP and while I was in school was working as a RN and had a loan repayment from the government which paid $24k or ~60% of my BSN loans for a 2 year commitment. I could choose where I worked as long as it was an under-served non-profit (which the majority of hospitals are). I could have extended another year for another 12k but I didn’t want to be “owned” by the government any longer, so I’m paying the rest myself.

If you want to work with the underserved you would be MUCH better off checking out these loan repayment programs.

They will pay 50k per 2 years of service. Which is much better time commitment in case you need to move, etc.

I see many jobs advertised for NP/PA at 100k+ with the loan repayment for family practice. So for a MD/DO it would be higher. Often they are with Large sign on and moving expenses like 5-10k because they are desperate and can’t get anybody to go to the rural areas to work.

Here is the government website. Most healthcare providers including DO/MD/NP are eligible. And you get paid a regular salary AND the loan repayment.

Here is a website you can search different states for different jobs that qualify for repayment usually over 2-3 years.

This thread is months old, but I want to put in my 2.0 m$.

Is the $40 per patient the total of what you would receive? If so, then without doubt this is a very bad deal. If you would also receive other gov’t payments, and/or if the state would provide all your office expenses (equipment, staff, etc.), then this is possibly a decent deal.

Assume you can see 20 patients per day. If your actual working time is eight hours per day (not including administrative tasks or lunch break, which makes it more like a ten-hour work day), you can allocate (8 h) / (20 patients) = 24 minutes per patient. This includes reviewing the chart, talking with and examining the patient, making a diagnosis and doing any follow-up.

That assembly-line procedure will gross you $800 per day. In a 250-day work year, this is $200,000 per year. If that is your gross takehome pay, that’s an outstanding paycheck, esp. for a new family doctor working only 50 hours a week. Even allowing for taxes and malpractice insurance, that’s a comfortable salary. But if you’re paying your staff, rent, utilities, etc. out of that gross amount, then no way. Can’t be done.

Full disclosure: I am not a doctor, nor do I play one on the internet. But I can do math…

wanted to add my 2 cents as well, even though the thread is old. 40.00 per patient, welcome to my world of chiropractic…can it be done, yes. is it fun, happy, comfortable…no. can it be done at 20 people per day…no, unless 1. you own the building you work out of and preferably you have somebody else in a different part paying you to be there are the only game in town. If people have a 20 dollar copay, the will go to the urgent care and save the 20 bucks. I run 50/50 with cash (35.00) and insurance payments. and its close to not being profitable. There are differences with dc/md i know, but here are some of the things you will need: someone out front, handling calls and making appointments,( you just can’t be up every five minutes to answer the phone in the middle of an exam) plus some kind of health insurance for that person. You will not really ever be able to take longer than a three day vacation.(absolutely trust me on this one!!!) you need a working spouse to carry your own health insurance, then you have rent, malpractice, supplies, an x-ray suite, unless you are farming out your film needs, computers to handle the accounts (just because you are cash, doesn’t mean you can’t track accounts. People and lawyers want statements all the time.) Plus you need at least 20-50,00 grand for start up if you have to buy all the equipment, office supplies, phone system, etc… You will probably also have to incorporate and pay business tax…trust me, that one is a killer, employee payroll tax (and with you as an employee of the business that tax is a rough one)uneployment tax for when you have to let a front desk girl go due to hard times…and on and on. Overhead can be trimmed down but almost always runs around 50% unless you own the building. Is it any wonder then why you see people in my profession seeing 30-50 people a day. Although, i do realize that our reimbursement schedule is far below the md’s. Since it sounds like you would not be using insurance, you will NOT survive at 40.00 per person at 20 people a day… Basically if you are telling me that you would have to do this for ten years, i would like to sell you a moderately used bridge that i happened to pick up on craigslist…