In debt and on the frontlines of healthcare
By Nicole Brun-Cottan
I chose my work as a physical therapist because rehabilitation medicine focuses on freedom and function, and those things really matter for quality of life. I work with people who are experiencing serious trauma or who are learning how to survive with enduring disability.
First, let me explain that my work is not what you may imagine when you think of physical therapy. I treat people immediately after life-changing events when they are still in the hospital, often while they are still in the ICU. Daily, I literally get IN BED with patients who are so sick they often can’t sit up on their own. For the past 17 months, that has included COVID-19 patients.
I never planned to be a physical therapist in a hospital. I certainly never planned to be a physical therapist in an ICU during a pandemic. I’m exhausted. We’re all traumatized. We’ve seen so many people die. We’ve been told again and again that we are heroes, and I certainly have witnessed enough acts of heroism in the past 17 months to break your heart. I love my work, and I feel responsible to the people I help. I’m grateful for my job, but I’m not sure how much longer I can sustain it.
I’m exhausted. We’re all traumatized. I’m grateful for my job, but I’m not sure how much longer I can sustain it.
After this pandemic, another six years of this feels totally impossible. Why six years? Because that’s how long it will take for me to qualify for Public Service Loan Forgiveness, the federal program that is supposed to forgive student debt for public service workers after 10 years of regular payments — if the system works, which so far, mostly, it hasn’t.
In debt, trying to get out
Right now, I live with over $100,000 in student loan debt hanging over my head. I’m 43 years old, educated at the doctoral level required for entry into my field, working on average 40 hours a week or more, and living in my mother’s basement. My student loan debt is the only debt I carry.
When the loan payments went on pause for COVID-19 deferral, I started putting the equivalent into a savings account, hoping to eventually make a lump-sum payment on the highest-interest loans (some at over 7 percent).
In January of 2022, those monthly payments will start up again. If I didn’t have this student debt burden, I could be certain that I will be able to care for my parents as they age. I could save adequately for my own retirement. I could EASILY make a mortgage payment on a perfectly respectable house.
I’m 43 years old, educated at the doctoral level required for entry into my field, working on average 40 hours a week or more, and living in my mother’s basement.
When I signed on to this debt burden I thought PSLF would help, but the program is unreliable at best, with thousands of eligible people unaware that it even exists, and over 90 percent of applicants never actually getting relief. It is complicated to access and full of requirements that loan servicers fail to communicate. The program is so poorly designed and executed that it has generated multiple lawsuits and congressional inquiries.
I’ve heard the program is “being reformed,” but when I sent in the PSLF paperwork this year, I got a reply that said (to paraphrase), “We received your information, hold tight, we’ll follow up and let you know your status regarding how many qualifying payments you’ve made to date in order to be sure you’re on track for forgiveness.” That was more than six months ago. Crickets since then.
They can’t even confirm that I qualify or figure out how many qualifying payments I’ve made, and I’m supposed to believe that after 10 years, my debt will be forgiven? No thanks.
The stats back up the sense that qualifying borrowers can’t count on forgiveness. I send in the paperwork anyway, but right now I’m repaying on a standard 10-year plan (over 30 percent of my monthly salary) because I absolutely do not trust that the program works. If you just go along with it, trusting it will work out, the principal sum on the debt just balloons.
More than $10K
When President Biden’s administration talks about $10,000 in loan forgiveness, it feels totally disconnected from my reality: The interest on my debt alone will be considerably more than 10K over the life of the loan. So, it’s basically the government saying, “We’ll give you back LESS than one third of the money that we’re going to charge you in interest.” I don’t mean to sound ungrateful (because it’s better than nothing), but honestly, that offer sounds like a bad joke. It makes it hard to believe that my country cares at all what happens to working class people like me.
It’s not like I incurred this debt to go into finance, or big tech, or to work for a pharmaceutical company. No one goes into public service for the money. My choice was driven by a sense of responsibility to do something socially consequential and public-minded. Everyone I know in healthcare chose to do this work because we cared about other people and wanted to help our communities.
It makes it hard to believe that my country cares at all what happens to working class people like me.
I would welcome the opportunity to take a job in one of the many rural communities that are staggeringly underserved. I would relish the chance to take a job that focuses on neurologic rehabilitation or treating chronic pain, both areas that I am passionate about but that don’t necessarily pay well. I would be delighted to volunteer my time to health and wellness programs that address disparities in communities that lack access to preventative medicine.
As it stands, those choices are not available to me.
I guest lecture at the university I graduated from, and every year I feel conflicted about it. I talk to my students about resilience and about how to survive in healthcare right now, but what I often feel I should be saying is: If you have to take out loans to get this education, it’s not worth it. RUN. Do something else. This is not public service; this is indentured servitude.
Restructuring PSLF is only one part of the solution. We need to be talking about substantial loan forgiveness and low-interest loans for public service workers. We need to use every tool at our disposal to address this $1.7 trillion crisis that affects more than 8.5 million borrowers. It’s hard enough to be a teacher, or a nurse, or a social worker, or any kind of public service worker, without having a lifetime of debt looming over your head. We MUST reform this system and chart a path forward for the next generation, or I am certain that the crisis we are now facing in healthcare and education will only worsen and the people who have chosen to do the work that serves us all will be forced to make financially safer choices for themselves and their families.
Nicole Brun-Cottan, PT, DPT, is an acute care physical therapist at Kaiser Permanente NW and a guest lecturer at University of Puget Sound. She is a union steward and professional staff bargaining team member for the Oregon Federation of Nurses and Health Professionals, AFT Local 5017.
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