March 19, 2019

Med school loan repayment program places doctors in Michigan’s underserved areas

Newly graduated doctors have an opportunity to reduce their medical school loans by $75,000 in exchange for working in Michigan's underserved areas, thanks to an innovative state-funded program called MIDOCs.

MIDOCs, supported by a $5 million appropriation by the state Legislature in Fiscal Year 2019, will add select Graduate Medical Education residency slots in medically underserved areas of Michigan. The program seeks to attract and retain physicians in the state by offering up to $75,000 in loan repayment in exchange for a two-year, post-residency commitment to practice in a rural or urban underserved setting in Michigan.

“Helping physicians to stay in our state to practice medicine will make Michigan a healthier place in the long run and ensure access to care in all communities,” said Robert Gordon, director of the Michigan Department of Health and Human Services. “It will also empower medical students to choose a career based on impact rather than financial necessity, allowing them to commit their career to helping the underserved.”

​​​​The MIDOCs program is an initiative of the MIDOCs Consortium, a partnership of medical schools at Central Michigan University, Michigan State University, Wayne State University and Western Michigan University Homer Stryker, M.D., School of Medicine. MIDOCs was created to address the physician shortage in Michigan by increasing the number of residency slots; to increase access to care in high-need, rural and urban underserved areas throughout the state by retaining residents to practice in these communities after their training; and to help alleviate crushing medical school debt for doctors practicing in Michigan’s medically underserved communities.
Of Michigan’s 83 counties, 90 percent have at least a partial designation as a primary care physician shortage area. While the number of medical schools in Michigan has increased in recent years – graduating the most doctors in history – the number of Graduate Medical Education residency slots remained capped until the MIDOCs program.

Within 10 years, consortium members said, the program could produce as many as 500 primary care physicians working in Michigan’s underserved areas, cutting the predicted doctor shortage by more than 50 percent.

Public Sector Consultants estimated that by 2020 Michigan could have a shortage of up to 600 primary care physicians. According to the Michigan Physician Profile, maintaining the status quo will require nearly 900 new primary care physicians by 2020.

“My district and communities across the state need more primary care physicians,” said State Sen. Peter MacGregor (R-Rockford). “This program will not only create the physicians we need in the communities that need it the most, but will also help ensure they stay in those communities after their training is complete.”

MIDOCS will increase the number of training slots for newly-graduated medical students in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry and general surgery. The consortium-sponsored residencies would be open to the newly minted physicians who commit to practicing medicine in Michigan for a minimum of two years following their training.

The federal government, through Medicare, pays for residencies. However, the number of residencies was effectively capped by the Balanced Budget Act of 1997, limiting the number of doctors the nation’s teaching hospitals can train. Congress has not approved an increase in that funding since 1997. Any new residency slots must be funded by other organizations.

Medical school graduates must enter a residency program in a teaching hospital, which can last from three to seven years, depending on the specialty. If a newly graduated physician cannot secure a residency, he or she will not be able to practice medicine in the United States.

“There is fierce competition nationwide for a limited number of residency slots each year,” said Jack D. Sobel, M.D., dean of the Wayne State University School of Medicine. “We must find innovative ways to increase the number of resident training positions if we are to successfully meet the state and nation’s growing needs for more physicians.”

A record-high 38,376 newly-graduated physicians applied for 35,185 resident positions this year, the most ever offered in the nationwide residency match program.

Even if medical students secure a residency, they must decide what field of medicine they wish to practice. That decision is often steered by debt. The Association of American Medical Colleges reports that the average medical student debt for 2016 was $190,000. Many new physicians choose higher-paying specialties and decline to practice in urban and underserved areas so that they can pay off their education debt sooner.

“This innovative legislation and collaborative effort expands capacity in residency programs. It provides unique financial incentives for new doctors to choose to practice in primary care and commit to care for medically underserved regions and patients,” said State Rep. Mary Whiteford, (R-South Haven), chair of the Health and Human Services Appropriations Subcommittee. “MIDOCS represents a new avenue for the state to support participating medical schools in a highly targeted and effective way.”

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