Investing in health workers: a retrospective cost analysis of a cohort of return-of-service bursary recipients in Southern Africa.

BACKGROUND: Return-of-service (RoS) schemes are investment strategies that governments use to increase the pool of health professionals through the issuing of bursaries and scholarships to health sciences students in return for service after graduation. Despite using these schemes for many years, Eswatini, South Africa, Botswana and Lesotho have not assessed the costs and return on investment of these schemes. This study aimed to assess the costs and relative rates of contract defaulting in these four Southern African countries. METHODS: A retrospective cohort study was carried out by reviewing databases of RoS beneficiaries for selected health sciences programmes who were funded between 2000 and 2010. Costs of the schemes were assessed by country, degree type and whether bursary holders completed their required service or defaulted on their public service obligations. RESULTS: Of the 5616 beneficiaries who studied between 1995 and 2019 in the four countries, 1225 (21.8%) beneficiaries from 2/9 South African provinces and Eswatini were presented in the final analysis. Only Eswatini had data on debt recovery or financial repayments. Beneficiaries were mostly medical students and slightly biased towards males. Medical students benefited from 56.7% and 81.3% of the disbursement in Eswatini (~US$2 million) and South Africa (~US$57 million), respectively. Each South African medical student studying in Cuba cost more than five times the rate of medical students who studied in South Africa. Of the total expenditure, 47.7% and 39.3% of the total disbursement is spent on individuals who default the RoS scheme in South Africa and Eswatini, respectively. CONCLUSIONS: RoS schemes in these countries have loss of return on investment due to poor monitoring. The schemes are costly, ineffective and have never been evaluated. There are poor mechanisms for identifying beneficiaries who exit their contracts prematurely and inadequate debt recovery processes.

A Financial Literacy Pilot Project: Are Matriculating DPT Students Prepared to Manage Their Debt?

BACKGROUND: Student debt has become a significant problem for the profession of physical therapy. Higher debt levels can impact mental health and professional and personal decisions. The American Physical Therapy Association (APTA) has recommended improving physical therapy students' financial literacy. The purpose of this pilot study was to assess financial knowledge and anticipated student debt in Doctor of Physical Therapy (DPT) students entering two programs. METHODS: A financial knowledge survey consisting of 24 questions assessing 4 domains was disseminated by two methods to matriculating DPT students. Additional questions gathered demographic information, self-assessment of financial knowledge, anticipated student debt at graduation, and awareness and utilization of APTA financial resources. RESULTS: Survey response rate was 80%, with 125 students completing the survey. The mean score was 57% of questions answered correctly. 61% of students estimated loan amounts at graduation to be > $80,000, 46% > $100,000 and 18% > $150,000. 85% of students either had no awareness of the APTA financial education platform or had not accessed it. DISCUSSION: Scores were above those in previous studies on health professions students, but student loan literacy scores were below those of other college students. Due to the high amounts of anticipated education debt, DPT programs should increase awareness of APTA financial education resources and incorporate financial literacy education into their curricula.

Improving graduate education in legal psychology: Early career psychologists' recommendations on diversity, debt, and applying legal psychology in the real world.

OBJECTIVE: This article reviews how training programs and professional organizations can work together to better prepare legal psychology graduate students and early career professionals (ECPs) for their first postgraduate careers. METHOD: In 2019, the American Psychology-Law Society released a report exploring the unique needs of ECPs in the field of legal psychology. The surveyed ECPs overwhelmingly highlighted the importance of grappling with rising student debt, the critical need to diversify our field and better prepare students for jobs outside academia, and a desire for more policy and real-world experience. Much work remains to better support our ECPs. This article reviews the relevant literature and the 2019 survey findings to provide legal psychology graduate training programs and professional organizations with 12 recommendations to better address ECPs' stated needs and prepare students for their transition to postgraduate life. RESULTS: First, we describe how graduate programs and organizations can successfully diversify legal psychology by not only expanding membership but also creating an inclusive community in which members can thrive. Next, we outline how to best support students' financial needs by providing financial education early and advocating for expanded financial support. Finally, we discuss the importance of preparing students for a variety of careers to ensure greater student success and expand the impact of legal psychology. Specifically, graduate training and professional development should reflect the vast career opportunities throughout academia, clinical practice, industry, advocacy, and government. CONCLUSION: Together, these recommendations encourage graduate programs and organizations such as the American Psychology-Law Society to augment their support of graduate students and ECPs navigating an ever-changing career landscape. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Medical students in distress: a mixed methods approach to understanding the impact of debt on well-being.

BACKGROUND: Nearly three in four U.S. medical students graduate with debt in six-figure dollar amounts which impairs students emotionally and academically and impacts their career choices and lives long after graduation. Schools have yet to develop systems-level solutions to address the impact of debt on students' well-being. The objectives of this study were to identify students at highest risk for debt-related stress, define the impact on medical students' well-being, and to identify opportunities for intervention. METHODS: This was a mixed methods, cross-sectional study that used quantitative survey analysis and human-centered design (HCD). We performed a secondary analysis on a national multi-institutional survey on medical student wellbeing, including univariate and multivariate logistic regression, a comparison of logistic regression models with interaction terms, and analysis of free text responses. We also conducted semi-structured interviews with a sample of medical student respondents and non-student stakeholders to develop insights and design opportunities. RESULTS: Independent risk factors for high debt-related stress included pre-clinical year (OR 1.75), underrepresented minority (OR 1.40), debt $20-100 K (OR 4.85), debt >$100K (OR 13.22), private school (OR 1.45), West Coast region (OR 1.57), and consideration of a leave of absence for wellbeing (OR 1.48). Mental health resource utilization (p = 0.968) and counselors (p = 0.640) were not protective factors against debt-related stress. HCD analysis produced 6 key insights providing additional context to the quantitative findings, and associated opportunities for intervention. CONCLUSIONS: We used an innovative combination of quantitative survey analysis and in-depth HCD exploration to develop a multi-dimensional understanding of debt-related stress among medical students. This approach allowed us to identify significant risk factors impacting medical students experiencing debt-related stress, while providing context through stakeholder voices to identify opportunities for system-level solutions.

Voices of the accelerated: key themes when considering implementation of an accelerated medical school program.

In this rapid communication, accelerated undergraduate medical education is examined using prior literature as well as experiences of those who have completed or are in the process of completing accelerated medical curricula. The Consortium of Accelerated Medical Pathway Programs (CAMPP) hosts an annual multi-institutional conference for all its members. During the meeting in July 2023, a virtual panel was convened from multiple constituent programs (N = 4) including medical students (N = 2), resident physicians (N = 4), and faculty (N = 2). Panel participants represented current learners or graduates from accelerated pathways of varying specialties (N = 5) to share firsthand experiences about acceleration to an audience representing over 25 medical schools. Five key themes were identified for accelerated students and trainees: Reduced debt as motivating factor to accelerate, Feeling prepared for residency, Ideal accelerated students are driven, Ability to form early professional relationships, and Less time for additional clinical experiences. Discourse from the CAMPP panel can inform current and developing accelerated programs at institutions looking to create or improve accelerated learning.

Educational Debt and Income Among Pharmacists and Other Health Professionals.

OBJECTIVE: Given the substantial increases in student educational loan debt in recent years, the objective was to assess trends in educational debt-to-income ratios for graduates of pharmacy, medicine, dentistry, optometry, and veterinary medicine programs in the United States in the 2017-2022 period. METHODS: A retrospective analysis of 2017-2022 data for educational debt and income for select health professions was conducted. Annual income data were collected from the American Community Survey, and educational debt data were collected from health professions organizations. Educational debt-to-income ratios for each health profession were calculated, as was the mean change per year in debt-to-income ratio. RESULTS: With the exception of medicine, educational debt consistently exceeded income across the selected health professions in the 2017-2022 period. Debt-to-income ratios of pharmacists and the remaining health professionals decreased on average per year between 2017 and 2022. Physicians had the lowest debt-to-income ratios and dentists had the highest debt-to-income ratios in the study period. CONCLUSION: Debt-to-income ratios fell below the 2017 levels for the health professions of interest, suggesting that average growth in income outpaced that of debt for the study period. Regardless, debt remains high and may influence health care professionals' postgraduate training and career decisions, and in turn affect access to health care. Therefore, a call to action is proposed to address educational debt burden. Several strategies are suggested, including federal policy changes, implementing tuition reductions or minimal increases, facilitating financial aid options, and reducing underlying costs of health professions programs.

Who Bears the Burden? Understanding the Socioeconomic Patterns of Educational Debt in Orthopaedic Surgery Residency Candidates.

BACKGROUND: Educational debt is commonly observed among applicants to orthopaedic surgery residency programs; however, an understanding of the debt burden among minority and nonminority applicants is not well established. Thus, this study aimed to fill these knowledge gaps by examining the extent of and factors shaping educational debt among orthopaedic surgery applicants. QUESTIONS/PURPOSES: (1) What is the educational debt burden among orthopaedic surgery residency applicants? (2) After controlling for relevant confounding variables, what factors are independently associated with increasing levels of educational debt? (3) After controlling for relevant confounding variables, are individuals classified as an underrepresented minority or those with educational debt and socioeconomic disadvantage less likely to match in orthopaedic surgery? METHODS: A retrospective evaluation of orthopaedic surgery residency application data from the American Association of Medical Colleges was analyzed from 2011 to 2021. The American Association of Medical Colleges database was selected because every residency applicant must register and apply through the American Association of Medical Colleges. Therefore, these data exist for every residency applicant, and the sample was comprehensive. Self-reported data including premedical, medical, and total educational debt burden as well as classification as socioeconomically disadvantaged and application fee waiver use were collected. Applicants were dichotomously categorized as an underrepresented minority or a not underrepresented minority based upon self-identified race and ethnicity. Monetary values were reported in USD and inflation-adjusted to 2021 using the Consumer Price Index. We performed t-tests and chi-square tests for continuous and categorical variables, respectively. Significance was considered at p < 0.05. In all, 12,112 applicants were available in the initial cohort, and 67% (8170 of 12,112) of applicants with complete data were included from 2011 to 2021 in the final study cohort. Of these, 18% (1510 of 8170) were women, 14% (1114 of 8170) were classified as underrepresented minorities, and 8% (643 of 8170) were classified as socioeconomically disadvantaged. Sixty-one percent (4969 of 8170) of applicants reported receiving at least one scholarship, 34% (2746 of 8170) had premedical school debt, and 72% (5909 of 8170) had any educational debt including medical school. Among all applicants, the median (IQR) educational debt was USD 197,000 (25,000 to 288,000). Among those with scholarships, the median amount was USD 25,000 (9000 to 86,000). RESULTS: After controlling for the potentially confounding variables of gender and socioeconomic disadvantage, classification as an underrepresented minority applicant was independently associated with higher scholarship amounts than applicants characterized as not underrepresented minorities (ß = USD 20,908 [95% confidence interval (CI) 15,395 to 26,422]; p < 0.001), whereas underrepresented minority classification was not independently associated with a difference in total educational debt (ß = USD 3719 [95% CI -6458 to 13,895]; p = 0.47). After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with higher scholarship amounts (ß = USD 20,341 [95% CI 13,300 to 27,382]; p < 0.001) and higher total educational debt (ß = USD 66,162 [95% CI 53,318 to 79,006]; p < 0.001) than applicants not classified as socioeconomically disadvantaged. After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with decreased match rates (OR 0.62 [95% CI 0.52 to 0.74]; p < 0.001). CONCLUSION: These findings underscore the need for comprehensive scholarship initiatives to ensure equitable financial accessibility for applicants from all backgrounds. CLINICAL RELEVANCE: In the future, orthopaedic surgery may benefit from research comparing the effectiveness of various initiatives aiming to improve fairness in the burden of debt among applicants to orthopaedic surgery residency programs.

Supporting neurodivergent nursing students in their practice placements.

Neurodivergent conditions such as autism, attention deficit hyperactivity disorder (ADHD), dyslexia, dyspraxia, dyscalculia and Tourette's syndrome are common, and it is highly likely that practice assessors and supervisors will be asked to support neurodivergent nursing students in their practice learning environments. This article details the strengths that neurodivergent students can bring to nursing, as well as some of the challenges they may experience in practice settings. It outlines how practice assessors and supervisors can develop neuro-inclusive learning environments where neurodivergent students can thrive, as well as how to support them if they are not meeting their required proficiencies. The authors also discuss how appropriate reasonable adjustments can be implemented by using a collaborative approach with students.

The Price of Productivity: Evaluating the Cost of a Research Year.

OBJECTIVE: Research years during medical school are becoming increasingly common amongst applicants to competitive residency programs. As many of these positions are unpaid, it is important to consider the financial implications of these experiences and the feasibility of participation from students of all backgrounds. This study aims to quantify the cost of a research year during medical school. DESIGN/SETTING: We identified the top 50 NIH-funded medical schools of 2022 and obtained cost-of-living information for each of their respective counties. Estimated loan interest accrual resulting from a research year was calculated using information on the cost of attendance to medical school and annual interest rates for federal education loans. Cost-of-living calculations were stratified by geographic region, and interest accrual calculations by timing of research year and attendance at public versus private medical schools. RESULTS: Top 50 NIH-funded medical schools in the West are located in counties with the highest mean and median costs of living, each approaching nearly $45,000 per year. Medical schools in the Midwest are located in counties with the lowest mean and median cost of living, at less than $36,000 annually. Estimated loan interest accrual resulting from a research year ranges from $3177 to $17,789, depending on timing of the research year and type of medical school attended. CONCLUSIONS: This study exemplifies the significant financial burden that a research year can impose on medical students. As more residency applicants pursuing competitive specialties opt for research years during medical school, it is important to consider the associated financial implications. Many research year opportunities are unpaid or underpaid, which may prevent interested individuals from participating; this is especially the case for those who are from lower socioeconomic backgrounds. Moving forward, it is imperative that we ensure the availability of equitable and funded research year opportunities for students of all backgrounds.

Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review.

OBJECTIVE: Federal loan repayment programs (LRPs) are one strategy to address the shortage of behavioral health providers. This scoping review aimed to identify and characterize the federal LRPs' impact on the U.S. behavioral health workforce. METHODS: A scoping review was conducted in accordance with JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. The authors searched the Ovid MEDLINE, Web of Science, APA PsycInfo, EconLit, PAIS Index, and Embase databases, and gray literature was also reviewed. Two coders screened each article's abstract and full text and extracted study data. Findings were narratively synthesized and conceptually organized. RESULTS: The full-text screening identified 17 articles that met eligibility criteria. Of these, eight were peer-reviewed studies, and all but one evaluated the National Health Service Corps (NHSC) LRP. Findings were conceptually organized into five categories: descriptive studies of NHSC behavioral health needs and the NHSC workforce (k=4); providers' perceptions of, and experiences with, the NHSC (k=2); associations between NHSC funding and the number of NHSC behavioral health providers (k=4); NHSC behavioral health workforce productivity and capacity (k=3); and federal LRP recruitment and retention (k=4). CONCLUSIONS: The literature on federal LRPs and their impact on the behavioral health workforce is relatively limited. Although federal LRPs are an important and effective tool to address the behavioral health workforce shortage, additional federal policy strategies are needed to attract and retain behavioral health providers and to diversify the behavioral health workforce.

Efecto de la deuda económica sobre el bienestar psicológico de los residentes de cirugía: Resultados de un estudio nacional en Colombia / Effect of financial debt on the psychological well-being of surgery residents: Results of a national study in Colombia

Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.

Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.

Federal Student Loan Debt in Public Health and the Opportunities for Loan Repayment Programs.

OBJECTIVES: A need persists for graduates with public health training in government public health roles; however, earnings for these positions tend to be lower when compared with earnings for people with undergraduate or graduate training who are working in other sectors, such as private health care or pharmaceuticals. This study assessed federal student loan debt associated with education for public health, with an aim to quantify the need that may be met through the federal Public Health Workforce Loan Repayment Program (PHWLRP), which is one tool that policy makers have proposed to incentivize people with public health training to pursue employment in government public health. METHODS: We analyzed federal student loan data provided by the National Center for Education Statistics College Scorecard for the 2018-2019 academic year. We merged these data with the Integrated Postsecondary Education Data System to estimate the number of degrees awarded. We used Spearman rank correlation to compare associations between debt and annual earnings by award level (bachelor's, master's, and doctoral degrees). RESULTS: Across all award levels, the median level of federal student loan debt associated with education for public health was $33 366. The median annual earnings 1 year after graduation were $80 687 for graduates with doctoral degrees and $33 279 for graduates with bachelor's degrees. CONCLUSIONS: As policy makers attempt to strengthen the public health workforce with a focus on funding and implementing the PHWLRP, the existing levels of student debt should be considered to ensure that programs such as the PHWLRP are funded and reflect the needs of graduates and government public health employers.

Student loan debt and mental health: a comprehensive review of scholarly literature from 1900 to 2019.

PURPOSE: The review had two purposes. The first was to examine the nature and extent of published literature on student loan and the second was to systematically review the literature on student loans and mental health. MATERIALS AND METHODS: Data from academic databases (1900-2019) were analyzed using two methods. First, topic modeling (a text-mining tool that utilized Bayesian statistics to extract hidden patterns in large volumes of texts) was used to understand the topical coverage in peer-reviewed abstracts (n = 988) on student debt. Second, using PRISMA guidelines, 46 manuscripts were systematically reviewed to synthesize literature linking student debt and mental health. RESULTS: A model with 10 topics was selected for parsimony and more accurate clustered representation of the patterns. Certain topics have received less attention, including mental health and wellbeing. In the systematic review, themes derived were categorized into two life trajectories: before and during repayment. Whereas stress, anxiety, and depression dominated the literature, the review demonstrated that the consequences of student loans extend beyond mental health and negatively affect a person's wellbeing. Self-efficacy emerged as a potential solution. DISCUSSION AND CONCLUSION: Across countries and samples, the results are uniform and show that student loan burdens certain vulnerable groups more. Findings indicate diversity in mental health measures has resulted into a lack of a unified theoretical framework. Better scales and consensus on commonly used terms will strengthen the literature. Some areas, such as impact of student loans on graduate students or consumers repaying their loans, warrant attention in future research.