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Lightening the Load

Creative ways to pay off student loan debt

If you're one of the 60% of people who borrow money to help cover higher education costs, you are likely feeling weighed down by debt.1 U.S. student loan debt is nearing $1 trillion. Roughly $864 billion is outstanding federal student loan debt, while the remaining $150 billion is in private student loans.2

The average student loan balance for all age groups is $24,301. About 25% of borrowers owe more than $28,000; 10% of borrowers owe more than $54,000; 3% owe more than $100,000; and less than 1% owe more than $200,000.3

Making student loan payments the traditional way can take years. Due to the demand for nurse practitioners, some creative options allow you to pay back loans more quickly.

Health Service Corps
Nurse practitioners who want to work in communities with limited access to healthcare can reduce their educational debt through the National Health Service Corps (NHSC) Scholarship and NHSC Loan Repayment programs. More than 88% of NHSC nurses are nurse practitioners.

NHSC is a federal program that provides scholarships and loan repayment in exchange for a 2-year service commitment in an underserved community in the United States or its territories. NHSC clinicians provide primary care services to communities located in a health professional shortage area (HPSA). An HPSA is a geographic area, population group, public or nonprofit private medical facility or other public facility that the Department of Health and Human Services determines to have a shortage of primary healthcare professionals. HPSAs are located in rural, urban and frontier areas.

Specific needs vary by community. Specialties include, but are not limited to, family practitioner, general internal medicine, general pediatrics, obstetrics and gynecology, general psychiatry, internal medicine, dentistry and nurse midwifery.

The 2015 application cycles for the NHSC Loan Repayment and NHSC Scholarship Programs are expected to open in winter 2015 and spring 2015, respectively.

These programs support nurse practitioners who are dedicated to working in healthcare facilities with a critical shortage of nurses. NPs may be eligible to apply to both programs but are only permitted to accept loan repayment from one. Applicants must be employed or have accepted an offer of employment at an NHSC-approved site.

In order to apply, applicants must: be licensed to practice in an NHSC-eligible discipline; have a job at an NHSC-approved site; and have unpaid, qualifying educational loans.

More than 30 states also offer grants, and the number and amount of awards varies by state and by year. Interested NPs should contact their state loan repayment program for information about eligibility and requirements, not the NHSC.

Another service and repayment option is the Indian Health Service (IHS), whose mission is to meet the physical, mental, social and spiritual health needs of American Indians and Alaska Natives.

The IHS Loan Repayment Program was created to support this mission by providing health professionals the financial freedom to fulfill career goals. The program awards up to $40,000 toward the repayment of qualified student loans in exchange for an initial 2-year service commitment to practice full time at an IHS site.

Serving in the IHS allows providers to work in some of the most beautiful areas of the country and in communities with deep traditions, said Jackie Santiago, chief of the IHS Loan Repayment Program. IHS providers enjoy flexible work schedules and work within an integrated, interdisciplinary team environment.

While nurse practitioners work throughout the IHS system, the greatest current needs are in the Navajo Area (New Mexico and Arizona), Bemidji Area (Minnesota and Wisconsin) and Alaska, Santiago said. The IHS has the greatest need for family nurse practitioners.

Applications are accepted year-round beginning Oct. 1 through the Friday of the second full week of August. Applications are evaluated monthly beginning in January, or as soon as funds become available.

"The community benefits by receiving access to comprehensive healthcare with a provider fulfilling critical roles in clinic, hospital and public health outreach programs that are vital to the health of the population and the mission of the IHS. The provider benefits by serving a critical role on the healthcare team while being able to repay student loan debt," Santiago said.

SEE ALSO: Will Work for Student Loan Forgiveness

U.S. Military
The U.S. Army seeks NPs to meet full-time (active duty) and part-time (reserve) needs, explained Capt. Ebony A. Peterman, RN/BSN, CMSRN, an Army healthcare recruiter in Fort Hamilton, N.Y.

Consisting of more than 11,000 men and women, the Army Nurse Corps is dedicated to providing high-tech, quality health care for military personnel, their families and military retirees all over the world. Nurse practitioners have the opportunity to work at one of eight Army Medical Centers or more than 100 Army Community Hospitals and clinics worldwide.

The Army has positions available in many specialties, including obstetrics and gynecology, critical care, anesthesia, community health, psychiatric/mental health and perioperative nursing. Many Army nurses have the opportunity to gain education and experience in advanced practice nursing roles.

Army nurses, regardless of specialty, care for a diverse patient population in collaboration with Army physicians, pharmacists, dietitians, therapists and other healthcare professionals. Details about active and reserve assignments are described below.

Active Military Duty
As an active duty officer, responsibilities and privileges expand as leadership and clinical skills develop, Peterman said. Army nurses have the opportunity to work in a wide range of healthcare environments, whether in a modern hospital or supervising paraprofessionals in a medical field unit.

Specialties for active duty include: family nurse practitioner, psychiatric/mental health nurse practitioner, certified nurse midwife and certified registered nurse anesthetist. Incentives and bonuses are available to qualifying active duty nurses in certain specialties.

Active Duty Health Professions Loan Repayment provides up to $120,000 (amount changes each fiscal year) for the repayment of qualified educational loans. The annual repayment of $40,000 is contributed over a maximum of 3 years. Qualifying loans for repayment may include tuition, principal, interest, related expenses and related living expenses, Peterman said.

Active duty eligibility requirements include:

• U.S. citizen or permanent resident

• 21 to 42 years of age (age waiver may be available)

• minimum BSN degree from an accredited school

• current, valid, unrestricted license to practice as a registered nurse

• must meet the Army's physical and moral standards.

The active duty commitment consists of attending the 11-week Army Medical Department Officer Basic Leaders Course and serving on active duty for a minimum of 3 years.

Reserve Military Duty
NPs interested in an alternative to active duty service may consider the Army Reserve. In addition to entering the Army Nurse Corps as a commissioned officer, NPs are able to earn a second income and have the opportunity to pursue educational and career goals. Reserve nurses serve one weekend each month and are required to participate in annual training for at least 2 weeks each year.

Specialties needed for the Army Reserve include: family nurse practitioner, psychiatric/mental health nurse practitioner and certified registered nurse anesthetist.

An introduction to the Army Reserve begins with the Army Medical Department Officer Basic Leaders Course (OBLC), a 2-week program that exposes officers to the variety of mental and physical challenges they will face as members of the healthcare team.

After completing OBLC, reservists serve a minimum of 2 days each month and are required to participate in annual training for at least 2 weeks each year. During this time, duties may include attending professional seminars or nursing education courses provided by the Army.

The Health Professional Loan Repayment Program is a loan repayment program only available to reservists. The program pays up to $20,000 per year of outstanding professional education loans (up to a total of $50,000) for critical care, medical-surgical, perioperative and psychiatric nurses, and nurse anesthetists.

Army Reserve eligibility requirements include:

• U.S. citizen or permanent resident

• 21 to 42 years of age (age waiver may be available)

• minimum of a baccalaureate degree, associate degree or diploma in nursing from an accredited school

• current, valid, unrestricted license to practice as a registered nurse

• must meet the Army's physical and moral standards.

Army healthcare recruiters can answer questions about the application process and help applicants understand the responsibilities and privileges of being an officer.

The entire process, from the first meeting with an Army recruiter to the commissioning ceremony, usually takes about 3 months.

Faculty Loan Repayment Program
A teaching position can also help NPs repay student loans. The Faculty Loan Repayment Program (FLRP) encourages NPs and other health professionals to serve as faculty members at health professions schools. Eligible programs include medicine, dentistry, nursing, pharmacy, physical therapy and clinical psychology.

Participants agree to serve as a faculty member for a minimum of 2 years. In return, the federal government agrees to pay, for each year of service, up to $20,000 of the outstanding principal and interest on student loans.

FLRP health professions faculty from disadvantaged backgrounds can receive up to $40,000 toward repayment of student loans in exchange for educating tomorrow's clinicians. Eligible applicants must be U.S. citizens (either U.S. born or naturalized), U.S. nationals or lawful permanent residents. Applicants also must hold a degree or be enrolled in an approved graduate training program in nursing and commit to a full-time or part-time faculty position for a minimum of 2 years.

Loan repayments are in addition to faculty salary and benefits. The academic institution cannot guarantee an FLRP contract, and FLRP loan repayments should not be a part of any salary negotiations between the participants and employers. The FLRP verifies every 6 months that participants are meeting program requirements and fulfilling their service obligation.

In addition to these options, many education employers offer student loan repayment as a benefit of employment. So, do your research before resigning yourself to years of debt.

Resources for Loan Repayment
• National Health Service Corps: www.nhsc.hrsa.gov/loanrepayment

• Indian Health Service: www.ihs.gov/loanrepayment

• U.S. Army: www.healthcare.goarmy.com

• Faculty Loan Repayment Program: www.hrsa.gov/loanscholarships/repayment/Faculty

References
1. Chronicle of Higher Education. There Are as Many Student-Loan Debtors as College Graduates. www.chronicle.com/blogs/innovations/there-are-as-many-student-loan-debtors-as-college-graduates/31944

2. Consumer Finance Protection Bureau. Private Student Loans. www.files.consumerfinance.gov/f/201207_cfpb_Reports_Private-Student-Loans.pdf

3. Federal Reserve Bank of New York. Grading Student Loans. http://libertystreeteconomics.new
yorkfed.org/2012/03/grading-student-loans.html

Elizabeth Rosto Sitko is a freelance writer who lives in Plymouth Meeting, Pa.

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