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Is a Return of Service Program right for you?

A program like this can help to ease the burden of repaying your loans — but only if you’re prepared to make a long-term commitment

Every medical professional gets there at some point: the end of school and the beginning of practice. It can be a very exciting transition — but there are some harsh realities that come along with it. Like paying back those student loans. But don’t worry — there are many federal and provincial/territorial programs that can help lighten your financial load as you take the first important steps of your medical career. Among these is a type of program called Return of Service …

… but what does “return of service” even mean? Simply put, it’s a way to get help paying back your student loans if you agree to work in a certain place for a certain amount of time. It’s kind of like a pro athlete signing a contract to play for a specific team. Return of Service programs work differently depending on where you are and which program you’re dealing with. Some of them — like one in Ontario — will even allow you to sign up when you’ve just completed medical school. We’ll try to break it all down so you can get a sense of whether it’s something that you’d like to do.

Generally, these kinds of provincial/territorial and federal loan forgiveness programs apply to family doctors. Why? Because the programs provide incentives to young physicians (like you) to work in underserved and rural areas to help alleviate shortages. It’s all about improving access to health care.

Each program has its own nuances, but they typically work like this: in exchange for your commitment to practising in an underserved community for a specific length of time, you will receive financial support, interest relief and/or training. If, for some reason, you aren’t able to fulfill your commitment, you will be required to repay all the costs associated with your placement (everything from salary, benefits and stipends to the loan interest you’ve had forgiven). 

In Ontario, one of these programs is the Resident Loan Interest Relief Program. It applies to federal loans and loans from any province/territory that haven’tbeen consolidated into bank loans. If you enrol in this program, which you have to do between June and September, you won’t have to pay the principal (the primary amount you’ve borrowed) or the interest on your student loan during your residency. In exchange, you must commit to working in the province of Ontario for five years at the end of residency. As an added bonus, your loans won’t require repayment (meaning they won’t start to accumulate interest) until 30 days after the end of your residency. What’s cool about this particular program is that it’s available for all specialties, not just family medicine. 

Other provincial programs, like the one in Manitoba, offer international medical graduates (IMGs) with a pathway to licensure in Manitoba in exchange for service in the province (and it also saves you from having to match your residency through CaRMS). 

In Saskatchewan, the Rural Physician Incentive Program offers incentives to new physicians (including IMGs) if they establish a practice in a rural or remote Saskatchewan community. There are some specific criteria you have to meet for this program, but the gist of it is that you’ll get an incentive starting at $10,000 that increases for each year of practice, up to four years. 

This all might sound pretty enticing to someone who is starting off their career with six figures of debt to pay off, but there are some important things to consider before you commit to one of these programs. Here are some tips to help you make an informed decision: 

Tip #1: review your contract with a professional

Your provincial or territorial medical association will likely offer help with this sort of thing: it will probably review your contract for free as part of your membership benefits. Getting a legal professional to take a look at your agreement can help you better understand the terms and clauses, and the penalties you might be facing (and there will be a lot of them). Be sure to look closely at the conditions for things like maternity leave, too — every program will handle it differently.

Tip #2: get a sense of your job prospects in the region

It sounds obvious, but this point can be easy to overlook: if you agree to work in a certain community, can you get a job there? For some specialties, job opportunities may not be as plentiful as you think — and if you can’t find employment, you’ll still be on the hook to stay in the region for the term that you agreed to. 

Tip #3: consider your lifestyle

Rural practice can be really rewarding — many of these small communities have limited access to health care, and one physician can really make a difference. You’ll get to know your patients, inside and outside the office. But the rural life has its challenges, too. Resources and support staff may be in short supply and extra responsibilities may fall heavily on your shoulders, such as long on-call hours and lots of administrative tasks. 

Also, you may be living far from your family and friends — not to mention the breadth of services and activities that may not be available to you in a small community. If you have a family, you’ll also have to figure out whether your spouse will be able to work and where your kids will go to school. It’s a pretty big decision to make …

Tip #4: do your research

… but thankfully, there area lot of things you can do to arm yourself with the knowledge you’ll need to make the right decision. Consider visiting the community to see what it feels like (good vibes are a real thing), and chat with colleagues who have done a locum in the area. And don’t forget to talk with your MD Advisor about how much you’ll be able to save by participating in one of these programs; getting the math right will give you an accurate sense of how worthwhile it will be. 

Paying off your loans is a huge challenge, but so is committing to living and working in a small community. A Return of Service program can be the perfect solution for some young physicians looking to accelerate the repayment of their loans, but for others the long-term commitment and small-town lifestyle may not be worth it. In the end, only you can decide whether it will work for you.

* MD Advisor refers to an MD Management Limited Financial Consultant or Investment Advisor (in Quebec), or an MD Private Investment Counsel Portfolio Manager.