Does Rural Doctor Loan Forgiveness Really Exist?

TL;DR Loan forgiveness programs may not exist for much longer, but loan repayment programs do. In this blog we take you through federal level programs like the PSLF and NHSC, and top state repayment programs in Iowa, Texas, Delaware and Virginia to give you ideas on how to get started.

Student loans can make you feel like everything around you is moving in slow motion. But in locum tenens we stay moving forward with momentum. Over 70% of the graduating class of 2023 took out loans to pay for their education according to the AMA. Loans for med school are costly and most residents coming out of current programs are leaving with around $200k+ in loan debt, depending on their specialty. Working in a rural area is a great way to do meaningful work for communities while also getting student debt relief that will help you to build your career.

While many loan forgiveness programs that would have forgiven a certain percentage of student debt are no longer available, there are quite a few loan repayment programs that offer a certain dollar amount in loan repayment in exchange for between 2-5 years of public health service. These programs are highly beneficial to both patient and physician, but aren't always advertised in hiring processes.

Let’s take a look at how loan repayment programs work at the national and state level.

• Does Rural Doctor Loan Forgiveness Really Exist?
• National Loan Repayment
• Who is eligible for the NHSC repayment program?
• How competitive is NHSC?
• State Loan Repayment
• Top State Doctor Loan Repayment Programs
• How Do I Find a State-Level Loan Repayment Program?
• Pay Your Loans off Faster with Locum Tenens

Does Rural Doctor Loan Forgiveness Really Exist?

While loan forgiveness options are no longer available, repayment programs at the state and national level exist to support physicians. Loan repayment programs typically require physicians to serve a 2 year term in public service. You’ll want to be aware of the fact that your term of service will be in a Health Professional Shortage Areas (HPSAs) and Maternity Care Target Areas (MCTAs), and that this includes rural and remote locations. These locations are at the top of the list when it comes to the physician shortage and often have many open positions.

National Loan Repayment

At the national level, there are some changes to loan repayment programs you’ll want to be aware of from the get-go. After July 1st, 2026 the primary national level loan repayment assistance plan will be the Public Service Loan Forgiveness (PSLF) eligible repayment plan. As the primary means physicians in public health use to repay student loans, PSLF requires 10 years of service at an eligible nonprofit or governmental organization. But you’ll want to be aware that programs like IBR, pay-as-you-earn and SAVE are ending in 2028.

One of the most important repayment programs for rural locums is the National Health Service Corps (NHSC) Loan Repayment Program. For physicians in eligible disciplines, you can commit to a 2 year term of service at an NHSC-approved site in a rural location (note: onsite only, not telehealth) to help pay down your loans. Applicants who are selected can receive up to $70,000 for a full time primary care provider, $50,000 for all other full time PC providers, and up to $37,500 for a part time primary care provider or $25,000 for all other providers, with a potential bonus of $5k for Spanish speakers if they can pass a proficiency exam.

Who is eligible for the NHSC loan repayment program?

Physicians in eligible disciplines such as primary care providers, nurse practitioners, family medicine physicians, internalists, pediatrics, obstetrics and gynecology, dentistry, or mental health (including substance use disorder). 

How competitive is the NHSC?

Applications for this repayment program are very competitive as the program applies primarily to the largest pool of borrowers with qualifying educational loans. Please note, NHSC does not cover residency, primary care loans or loans related to credit card debt.

State Loan Repayment Programs

The majority of loan repayment assistance programs (LRAPs) exist at the state level and typically require a commitment to public service for a period of at least 2 years. These programs can help borrowers on the path to repayment by paying for a set amount while physicians work in HPSAs.

Top State Doctor Loan Repayment Programs

The top state loan repayment programs are in Iowa, Delaware Texas, Virginia. All of them require public service in an eligible HPSA area and some may have the possibility for renewal for additional repayment coverage.

These loan repayment programs also have specific enrollment periods which you'll want to stay on top of when applying.

Iowa Academy of Family Physicians

The Rural Iowa Primary Loan Program supports rural Iowa communities to gain access to the providers they need while supporting physicians with loan repayment. Physicians need to practice in Iowa for at least 5 years. The maximum award is $200,000 paid out over a 12 month period towards Federal Subsidized Stafford, Unsubsidized Stafford, Graduate PLUS, and Perkins Loans balances. 

The key with this loan program is that it requires medical students to apply while still in school and to stay in Iowa in an HSPA.

Texas Physician Education Loan Repayment Program

In the state of Texas you might qualify for up to $180,000 if you are a physician working in an HSPA. You need to be in one of the approved primary care fields and be open to working for four years with no other obligations such as a scholarship or another student loan repayment program.

Delaware Health Care Provider Loan Repayment Program

Practicing in underserved areas in Delaware for four years allows providers to repay up to $200,000 of medical school debt. At $50,000 per year, this program has the highest repayment for student debt. But as with some of the previously discussed programs, you’ll need to choose between the in-state loan repayment program and federal level repayment programs such as PSLF and NHSC.

Virginia State Loan Repayment Program

The VA SLRP is funded through a mixture of both federal and state funds, meaning that it receives support through the NHSC but is managed by the Virginia Department of Health-Office of Health Equity. Physicians from eligible fields may obtain a maximum award of $140,000 for 4 years of service in an HPSA in the Commonwealth.

How Do I Find a State-Level Loan Repayment Program?

Finding a repayment program is easier than ever, but finding the right one will take some thoughtful planning. Searching in Google or ChatGPT for “physician loan repayment programs in [state name here]” is a good place to start. But you can also go through the Association of American Medical Colleges website to find some super insightful resources. Head to the Students & Resources tab and use their search bar as in this example on the VA SLRP. We recommend this step especially for early career physicians who are doing career and financial planning.

Pay Your Loans off Faster with Locum Tenens

Locum tenens physicians are in a unique position to pay down their student loans faster than ever. With higher pay and better working hours, you’re able to pay more than the minimum on your loans and not burn yourself out while doing it. The trick is finding a placement that aligns with your repayment plans.

You deserve a career where med school debt isn’t weighing you down or holding you back from living your best life. We can help with that. 

Contact us today about finding a placement that fits best with your career and financial plans.