Updates in Student Loans, feat. Michael Foley

We’re back once again with Michael Foley to talk updates in the student loan sphere on today’s #WellnessWednesday. We thank again the partnership from SMFM Thrive to make these podcasts possible!

Michael is a comprehensive financial advisor who runs his practice out of Scottsdale, Arizona, under North Star Resource Group. Michael was trained at Duke University and holds his Certified Financial Planner designation alongside his Certified Student Loan Professional designation. Although Michael serves a diverse group of clients with their financial and student loan needs, with two physician parents, Michael has found a specialty in working with those in the healthcare space.  Michael is a registered representative and investment advisor representative of Securian Financial Services. Securities and investment advisory services offered through Securian Financial Services, Inc. Member FINRA/SIPC. North Star Resource Group is independently owned and operated. 6720 N Scottsdale Rd Ste 290, Scottsdale, AZ 85253. “

Miss the PSLF Waiver? There may be another option after July 2023.

o   Must be employed at a qualifying employer at the time of your application for forgiveness though.

o   Can still get retroactive credit for periods of time with FFEL loans or while in certain period of forbearance/deferment.

o   Must consolidate prior to May 1st, 2023 though if there are FFEL loans involved.

New guidelines around PSLF qualifying month, starting July 2023

o   Things needed to get PSLF credit:

§  1. Working at a qualified employer,

§  2. making eligible payments,

§  3. for 120 months. These stay the same but the definitions of the first two have updates.

o   Eligible payment changes

§  Borrowers can now make retroactive payments to get credit for periods of time that they were in deferment or forbearance in the past and get them counted towards PSLF. Even periods of time where their payment would have been $0.

§  New consolidation rule: Weighted average of months.

·       Example: 1 loan 30k with 60 months combined with another loan with 30k with 0 months. New month count for consolidated loan will be 30 payments.

o   Changes to Qualifying employment

§  Flat 30hrs per week at a qualifying employer.

§  Allow qualifying employers to certify employment for a contractor if that individual is providing services that by State law cannot be filled or provided by an employee of that organization. Doctors at nonprofit hospitals in California and Texas.

Biden Forgiveness Update

Stuck in court after being struck down by a federal judge in Texas. Will likely be seen by the Federal Supreme Court which could take some time! Supreme Court will start the first oral hearings in February 2023. 

Forbearance period extension pushed out contingent on the court case:

·       Recertification dates extended

o   If falls 6mo after the loans turn back on, it will be pushed out by 1 year.  

·       Consult your CPA – a tax filing extension might be favorable on the student loan side of things if your 2021 income was lower than 2022.

Other meaningful updates in the Federal Student Loan space

Actions/Considerations:

1.     Don’t rule out the PSLF program even if you are a contractor with a hospital in CA or TX

2.     Consider consolidating any outstanding FFEL Loans prior to May 2023.

o   But be careful in consolidating all your loans (new weighted average rule).

3.     Don’t recertify income prematurely (given recertification extension)

o   Also, think before you file your taxes in the new year. Be sure to consult the CPA AND the student loan counselor if you made more in 2022 than in 2021. Potential for savings when payments do turn back on.

4.     Hold on changing repayment plans until after July 2023 if there is a lot of unpaid interest.

5.     Keep an eye on this court case- BUT remember that this is entirely separate from the PSLF program. Many are getting these confused.

6.     Be VERY careful with refinancing loans right now given the changes in the Federal space. Once you jump ship, you can never go back.

Additional Resources:

Bio: https://www.northstarfinancial.com/advisors/michael-foley/

https://www.ed.gov/news/press-releases/education-department-announces-permanent-improvements-public-service-loan-forgiveness-program-and-one-time-payment-count-adjustment-bring-borrowers-closer-forgiveness

https://www2.ed.gov/policy/highered/reg/hearulemaking/2021/futureofpslffactsheetfin.pdf?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=

Contact:

FoleyTeam@NorthStarFinancial.com

Like to schedule a review of your student loans?

1. Please complete this BRIEF QUESTIONNAIRE (takes about 5 minutes).

2. Please also send a copy of your Federal Student Loan data file from www.studentaid.gov (instructions at the top of the questionnaire). Email: FoleyTeam@northstarfinancial.com

3. Scheduling link will be emailed following your completing the questionnaire.

Applying to Urogynecology / FPMRS, with Dr. Edward Kim

We welcome back Dr. Edward Kim, an FPMRS fellow at the University of Pennsylvania, who’s talking with us today about how to apply for urogynecology fellowship!

Disclosures: We’re from a large academic institution. What we say may not apply to those from smaller programs or those from community programs! Please feel free to reach out to us though for other specifics or connections on advice.

1. What is Urogynecology or FPMRS?

1. Female pelvic medicine and reconstructive surgery

2. We are a subspecialty of either Ob/Gyn or Urology that focuses on medical management, surgical management and research of women’s pelvic floor conditions. Vast majority of our surgeries are elective and outpatient or at the most overnight stays. Compared to other gyn surgical subspecialties like gyn onc or MIGS, there is very little inpatient care needs or consults. Our patient population is predominantly older patients with exceptions at institutions that do gender affirming surgeries, peripartum pelvic floor care, etc. Our research areas range from basic science to NIH-funded research network.

3. Historically, the name FPMRS was created to replace or supplement the name urogynecology in order to relay that our scope of practice can go beyond urologic and gynecologic conditions. However, more recently, the name FPMRS is being re-discussed as the word female is not inclusive especially given that more of us are seeing gender diverse patients and perform gender affirming surgeries.

4. Long story short, urogynecology and FPMRS are synonymous for the time being but it may evolve.

5. In terms of the duration of training: For Ob/Gyns it’s a 3 year fellowship and for Urologists it’s a 2 year fellowship. For Ob/Gyns, these 3 years include 12 months of research, as it is for all ABOG certified subspecialties.

6. Your training will cover a variety of pelvic floor conditions as defined by American Urogynecologic Society’s (AUGS) scope of practice:

1. Urinary Incontinence

2. Pelvic organ prolapse

3. Voiding dysfunction

4. Neurogenic bladder

5. Urethral diverticula

6. Vesico-vaginal and recto-vaginal fistulae

7. Congenital anomalies of the pelvic floor

8. Fecal incontinence

9. Recurrent UTI

10. IC/BPS

11. Managing pelvic floor surgery complications and mesh complications

12. And at some programs:

a)    Transgender care and gender affirming surgeries

b)    Peripartum pelvic floor care

c)     Pelvic pain

d)    Etc.

1. Years I - II

1. NOTE: Urogyn is EARLY application and EARLY match just like Urology. Urogyn timeline is thus a few months earlier than other Ob/Gyn subspecialties. Applications OPEN in NOVEMBER/DECEMBER and CLOSE by January of PGY3 year, interview in SPRING of PGY3 year and match by AUGUST of PGY4 year. So solidifying your interest in urogyn earlier in residency is beneficial.

2. If you are at a residency with big urogyn presence and have fellowship. Typically you will rotate through or be exposed to urogyn as junior residents. If so,

1. See what your attendings and fellows do. Talk to them about why they went into it. Do you like major and minor urogyn surgeries? How about the predominantly older patient population?

2. See what kind of scholarly activities are happening in the division. Ask if you can be more involved with research. This will help you get “plugged in” with the division.

3. Do well on CREOGs but not a huge deal until your third year. Show an upward trend if you can.

3. If you are not at a residency with big urogyn presence

1. Identify a local urogyn faculty or urogyn division.

2. If your residency and host institution allow, do an away rotation. Try to impress them and get a great letter. Ideally, you should have at least one urogyn write a letter of recommendaiton for you.

3. At the least, do scholarly work like a book chapter or full on research project.

4. PGY2s should consider either:

1. AUGS Resident Scholars Program that gives funding to attend AUGS meeting to network and be exposed to the greater urogyn world

2. ABLE Scholar Travel Award that is similar to the resident scholars program but focused on residents from diverse backgrounds

3. You can apply as a PGY3, but by the time you attend AUGS, your fellowship application process will already be in full swing. So try to go in PGY2 year to network if you can.

2. Third Year

1. Identify people that can write your letter of recommendation.

2. Continue your research projects and other scholarly activities

3. If you haven’t already, apply for either resident scholar programs that I mentioned

4. Applications open in November/December!

1. So in the summer/early fall time, look at AUGS’ listing of fellowship programs. Look at each program’s information. Make a list of programs you’d be interested in

2. Sit down with your mentor/fellows and edit or add to the list

a)    Talk about: research heavy? Academic versus private after graduation? Specific niches like gender affirming care, basic science research, dual degree opportunities?

1. Applications

1. Overview: Applications open in November/December and close in January typically. Interview invitations will be sent out around February. Interviews are from March to June. With the match in August.

2. In early fall of PGY3 year, update your CV and get the application material together.

3. Write your personal statement and have your mentors review it. Help the readers understand why urogyn and what you want to accomplish in your career.

4. Most programs will not review the application as soon as the application opens in Nov/Dec. Do submit on the earlier side because you don’t know what the process is like at your top choice programs. But don’t rush at the cost of making mistakes in your application.

5. All programs will send out interview invites on a single designated day typically in February.

1. Just like in residency, be prompt about responding to interview invites as to not end up on the waitlist.

2. Interviews

1. Back in our day for Nick Fei and I, we spent a lot of money on in-person interviews! Virtual interviews are wallet-friendly and schedule-friendly, but they are also exhausting! Allow yourself some breaks and downtime between interviews if you can and try to optimize the number of interviews you do.

2. You all know this by this point in your career but:

1. Do your homework on the program! Some programs have good information about their programs on their websites or on their AUGS program listing. Try not to ask questions that is reasonably evident lest you want to be seen as not interested in the program. Ask people you know about the programs. Networking at AUGS will come in handy.

2. Know the program faculty and what their interests are

3. Have a list of questions:

a)    Surgical modality breakdown: robotic, vaginal, laparoscopic, etc.

b)    What kinds of non-bread and butter urogyn things do they do? Gender affirming care, peripartum pelvic floor issues, etc.?

c)     What is their research year structure? One full year? Or 12 months broken up throughout?

d)    What kinds of research do their fellows do? Basic science? Clinical?

1. For logistical questions like calls, transportations, try to save those for the fellows or perhaps the PD

1. It’s hard to get a sense on virtual interview days but try to see if the division members seem friendly and collegial with one another.

2. See if everyone in the division makes it to the interview. Programs that are vested in their fellowship will try very hard to pick a time and day that works for everyone, block out their ORs and clinics, etc.

1. Rank Lists

1. Make your rank list and seek feedback from your mentors. Think about geography and what you want in a program. 3 years is a long time and you will have a lot more free time in urogyn fellowship compared to residency or even other ob/gyn subspecialties! So being at a place that you can be with family, friends, or things you like doing are also something to consider.

2. Be sure to reach out to a few programs that you really loved. You voluntarily telling your top choices that they are your top choices is not against the NRMP rules.

1. Some programs do not write back at all.

2. To really support your emails of interest; Ask your mentors to reach out on your behalf.

3. It’s hard to know which programs want thank you emails or not. Try to lean on the side of doing them. Again, some program and interviewers will not write back. That’s okay!

#MedEd: Transitioning to Residency

Today we’re joined for a special #MedEd episode by a few guests: Halley Staples, MD, who is a PGY-3 in OB/GYN at WashU in St. Louis; Helen Morgan, MD, who is a clinical professor at U Michigan; and Anita Malone, MD, associate residency program director and assistant professor at U Michigan.

This team in part recently published a narrative experience study of students transitioning into residency in OB/GYN which was fascinating. We talk to them a bit about their experiences and takeaways from their work, as well as their thoughts on the challenging transition time.

#MedEd: Applying into Pediatric and Adolescent Gynecology (PAG)

Today we welcome back Dr. Aimee Morrison, a current resident in OB/GYN at UPenn heading into specialization in Pediatric and Adolescent Gynecology (PAG). She shares with us some tips on the application experience and getting set up optimally to pursue this specialty — which is wonderful given it’s a smaller specialization with fewer mentors available.

Some highlights from the episode:

• PAG is a two-year fellowship typically; some one-year programs do exist.

• There’s a wide variety in care, which is often multidisciplinary in nature. There’s a good amount of endocrine issues (PCOS, CAH), as well as disorders or delays in sexual development; surgical care in Mullein anomalies and congenital malformations; and trans care, menstrual problem management, and contraception.

• Aimee suggests getting involved with some exposure in years I and II, and often times this might be through an REI with a specific PAG interest, given the limited number of PAG specialists currently in existence.

  • Starting a research project or two is also helpful for applications - and in PAG, because of small numbers, case reports/series, literature reviews, and retrospective chart reviews are very normal and typical.

• If you can, get involved with and go to NASPAG!

  • Can even open you up to mentoring opportunities from far away!

Financial Wellness with Michael Foley, CFP, CSLP

We have a special Wednesday episode this week, brought to you in part by the SMFM Thrive Initiative! SMFM Thrive is a wellness program for MFMs - but we hope that this week’s podcast will be helpful even to those outside of MFM land!

Our guest is Michael Foley. Michael is a comprehensive financial advisor who runs his practice out of Scottsdale, Arizona, under North Star Resource Group. Michael was trained at Duke University and holds his Certified Financial Planner designation alongside his Certified Student Loan Professional designation. Although Michael serves a diverse group of clients with their financial and student loan needs, with two physician parents, Michael has found a specialty in working with those in the healthcare space. 

DISCLOSURE: Michael is a registered representative and investment advisor representative of Securian Financial Services. Securities and investment advisory services offered through Securian Financial Services, Inc. Member FINRA/SIPC. North Star Resource Group is independently owned and operated. 6720 N Scottsdale Rd Ste 290, Scottsdale, AZ 85253

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Check out some additional resources from Michael:

My Bio: https://www.northstarfinancial.com/advisors/michael-foley/

CSLP Blog: https://cslainstitute.org/blog/

Student Aid Updates: https://studentaid.gov/h/announcements-events

Medical Economics articles: https://www.medicaleconomics.com/authors/michael-foley-cfp-cslp?page=3

And to schedule an initial consultation with Michael click here.