The elimination of the federal Graduate PLUS loan program for future borrowers, as well as a more costly academic landscape, merge to create a difficult pathway for students pursuing a medical or other healthcare degree. Colleges try to make up the gap where and when they can, but they are there primarily to provide an education, not finance one, says Dr. Jeannette South-Paul, executive vice president and provost at Meharry Medical College.
Nashville Ledger: How is the news of Grad PLUS going away hitting med-school campuses, yours in particular?
Dr. South-Paul: “It’s tough when you see these types of legislative changes occur to programs that have existed for decades. That’s problematic, and then there’s not knowing how long these changes will continue. You can wait and see, or do you have to be aggressive in doing something different?
“This is a time of change, and many things are being juggled. We’re trying to figure out where do you put your opportunities? Having our students be able to afford their education is at the top of our priorities. Many students expected to borrow from Grad PLUS.
“The percentage of students who do not borrow is very small; these are not 18-year-olds who are getting some parental help. These are adults who, by the time they get to med school, are in their early to mid-20s. Many have had other careers, done other things, and so are older. So, they know there will be costs involved, but they also need some certainty."
NL: Tuition is mentioned the most, but it’s only part of the costs involved. Can you lay that out more specifically?
DSP: “You pay tuition at the beginning of each semester for school, but the cost of attendance is a different calculus. That factors in living expenses, books and equipment, transportation, all the bills and expenses for the rest of their lives. That’s going to vary for each student depending on their circumstances, so it’s very hard to assign a number to it as you might do with tuition.”
NL: What are the limitations that Meharry, or any institute of higher learning, has around students and how they fund their education?
DSP: “We cannot go to a bank and say, ‘work a deal with us that looks out for our students as a priority.’ And we’re also talking about students who are studying everything from being a physician assistant to a dentist or perhaps a graduate nursing program. There is more than one discipline when it comes to healthcare studies.
“I am a family physician, and I think like one, but I am supported by a whole team who is focused on the health of the community and not their debt.”
NL: What do you think about new programs, from grants to loans, that are attempting to cover some of the financing gaps?
DSP: “I am delighted to hear that our financial colleagues in the community are thinking about this issue. We can say to our students ‘limit expenses as much as you can, but don’t starve,’ and talk with them about being very intentional about what they borrow, but they have to be able to find those sources.
“Here is the challenge: Two-thirds of med students borrow. They are the ones borrowing on those federal, direct unsubsidized loans. Those have a limit of $175,000 and that’s not a lot of money if you’re going to grad school.
“Yes, you can start in community college and maybe pay less for that if you are living at home, but that still adds up. By the time you get to any grad program, you already have education debt.
“With Grad PLUS, you could borrow up to the cost of attendance, so you had that delta to go to, at an unsubsidized rate plus 1%. That’s gone now, so what are students going to do? They’re going to go anywhere they can to get loans.
“And those loans they go and get? They are often at credit-card rates, more than twice what the federal subsidized rate was. They’re borrowing to eat, pay rent, have transportation; it’s much more than tuition and other fees.
“People say, ‘ride the bus,’ but we’re not in Philly or New York. A lot of our kids can’t use public transportation here to get to places they need to go to at the times they need to get there efficiently. So, they have to contend with that, and we don’t want them getting to where they have to decide if paying for an oil change, or making that car payment, is going to affect being able to finish their education.”
NL: A lack of funding might lead to fewer people choosing medicine or another healthcare career that requires postgraduate studies. What’s that going to do to the provider landscape?
DSP: “If they don’t finish school, they do not enter the workforce. If they do not enter the workforce, they are not there to take care of us, our families and our communities.
“It’s not something you can put a green eyeshade on and then cut here and there. Who’s going to care for kids, to provide physical exams, to treat chronic disease? Fewer providers means less access, and that’s already a problem.”
NL: Given the situation, what advice do you provide?
DSP: “We tell them to figure out what their loan limits are and do their best to see if they can complete their program in the shortest amount of time they can. If you have loans, pay them back and do it on time. Apply for grants and other programs as we have discussed.”
NL: You can’t go to banks, but what about donors?
DSP: "A lot of people and organizations are looking for a way to give back, and we do talk to them. That varies by community, especially in rural or underserved areas. But with the decrease in federal funding, those of us in urban areas are truly tapping our philanthropic resources for things that used to be supported by the government.
“People say the federal government shouldn’t be subsidizing various things. OK, but then who is going to do so? Not every community is equally financially secure. Is it OK for some citizens to have access to care, and others not?
“Most federal programs were created to try to provide equity across the nation, so if you grew up in inner-city Philly or Knoxville or wherever, you had access to a practicing clinician.
“I am a big proponent of having state and local resources, absolutely, but we should have federal resources to augment those so that every community has access to the care it needs."
NL: What about students who had access to Grad PLUS, and now face caps but still have some access to funds?
DSP: “Folks are trying to get into programs earlier, use the funds that are already grandfathered in if they are enrolled or have borrowed. That’s not possible in many institutions because they have regimented curriculum, as do most medical and dental schools.
“You can’t just start two months earlier or get money two months earlier. There aren’t a lot of margins, and they can’t take the money they have and put it into stocks, bonds or some other savings mechanism. They have to spend that money on daily activities and school.”
NL: What else are you and your colleagues at Meharry and elsewhere brainstorming?
DSP: “We’re thinking about how to talk to real estate folks in the community, find ways to deal with the increasing cost of housing so we can at least get students some lower living rates. We are so careful about increases in our own fees, and even so we can’t keep them the same because of the cost-of-living increases.
“It’s easy to say the training institutions should bear the brunt of mitigating student expenses, but I respond that much of the cost of attendance rises are not coming from us. It’s coming from the outside.”
NL: When you do get in front of legislators, officials or any stakeholder at any level of government, what’s your message?
DSP: “For us to have the healthcare workforce we need, we as a community need to contribute to lowering the cost of attendance for that workforce. That means rental decrease, support for food and services and living expenses. Educational institutions do not control those expenses.
“We need to provide more scholarships and loan-repayment types of services. I went to medical school on [U.S. Army] scholarships, and in exchange for that tuition assistance I promised to serve, which I did. It was such a supportive environment for advancing my career that I stayed for 22 years.
“There are these programs, but there are not enough of them. States need to step up and offer them. Healthcare organizations need to do so, chambers of commerce, any group that can provide scholarships or loans.
“There are a few programs in Tennessee, but not enough. When you invest in that healthcare workforce you are investing in the community. When you help people with their education and training pathways, they see a place they might want to stay or come back to after they finish training elsewhere.
“Education institutions need more partners so that they can provide the best support to these students.”