2026 Edition — American Canadian School of Medicine

Your Complete Guide to
Physician Loan Repayment
& Forgiveness

Every available program for U.S. citizen graduates of Caribbean medical schools. Eligibility is based on your citizenship, licensure, and practice location — not your school's LCME status. 20+ programs identified, over $1.5M in documented repayment opportunities.

Federal (8 Programs) State (50 States) Military (3 Branches) Specialty & Research Employer & Negotiated

Top Published Awards — 2026

$300K Michigan State LRP (10 yr)
$250K STAR LRP — SUD/Behavioral
$160K VA Health Professions LRP
$120K NHSC Rural Community LRP
$105K NHSC SUD Workforce LRP
$100K Pediatric Specialty LRP
$80K NHSC Core LRP (per 2-yr term)
Full Bal. PSLF — 10-yr, tax-free
01

Federal Loan Repayment & Forgiveness Programs

Eight distinct federal programs are available to licensed U.S. citizen physicians. Eligibility is based on citizenship and licensure — school of origin is never a criterion. ACSOM graduates qualify on equal footing with LCME graduates for all programs below.

1A — NHSC Core

NHSC Loan Repayment Program

Up to $80K per 2-yr term, renewable
IMG Eligible
  • 2-year full-time service at NHSC-approved HPSA site
  • $80K primary care full-time; $55K behavioral health; $42.5K half-time
  • Spanish bilingual enhancement: additional $5,000 one-time award
  • Eligible: Family Med, Internal Med, Pediatrics, OB/GYN, Psychiatry, Geriatrics
  • loans qualify as "qualifying educational loans"
  • Continuation contracts available — can retire full debt over time
Apply annually at nhsc.hrsa.gov. Awards based on outstanding qualifying loan balance.
1B — NHSC Rural Community

NHSC Rural Community LRP

Up to $105K 3-yr term, tax-free
IMG Eligible
  • 3 years full-time at rural NHSC-approved SUD treatment facility in HPSA
  • $105K full-time; $55K half-time — tax-free
  • Targets rural communities combating opioid epidemic (RCORP-funded preferred)
  • Covers institutional loans
  • Maternity care providers receive MCTA bonus
Apply via nhsc.hrsa.gov. Deadline March 31 annually. Check eligibility in My BHW portal.
1C — NHSC SUD Workforce

NHSC Substance Use Disorder (SUD) Workforce LRP

Up to $75K 3-yr term, tax-free
IMG Eligible
  • 3 years at NHSC-approved SUD treatment facility in HPSA
  • $75K full-time; $37.5K part-time — tax-free
  • Excellent fit for psychiatrists and addiction medicine physicians
  • DATA 2000/MAT waiver holders receive application preference
  • Both primary care and behavioral health HPSA scores accepted
Strong option for psychiatry-track graduates. Apply at nhsc.hrsa.gov alongside 1A for comparison.
1D — STAR LRP

STAR LRP (SUD Treatment & Recovery — Title VII)

Up to $250K 6-yr term — largest single federal award
IMG Eligible
  • 6 years full-time at STAR LRP-approved facility in mental health HPSA or high overdose county
  • Covers loans
  • Distinct from NHSC SUD Workforce LRP — separate Title VII authorization
  • Ideal for psychiatrists and addiction medicine graduates with long-term commitment
Apply via bhw.hrsa.gov. Not interchangeable with NHSC SUD program — cannot be held simultaneously.
1E — PSLF

Public Service Loan Forgiveness

Full Remaining Balance tax-free after 10 years
IMG Eligible
  • 120 qualifying monthly payments while working full-time at 501(c)(3) or government employer
  • Most teaching hospitals and nonprofit health systems qualify
  • Residency years count toward the 120 payments (residency exclusion was defeated, April 2026)
  • IDR/IBR keeps payments near $0 during residency — still count toward PSLF
  • TX & CA physicians: contractor rule allows PSLF even if employed by a group contracted to nonprofit
  • Can be stacked with NHSC LRP and state programs simultaneously
CRITICAL: Do NOT refinance federal loans to private if pursuing PSLF. Loans are private — not PSLF-eligible. Keep federal and private loan strategies separate.
1F — Pediatric Specialty

Pediatric Specialty LRP (HRSA)

Up to $100K 3-yr term
IMG Eligible
  • 3 years full-time at approved facility in HPSA, MUA, or serving MUP
  • Can apply while still in fellowship — service clock begins in training
  • Pediatric medical subspecialists, surgeons, child/adolescent behavioral health
  • Covers loans
Cannot be held simultaneously with STAR LRP or NHSC programs — choose the best fit for your specialty.
1G — VA LRP

VA Health Professions Education Foundation LRP

Up to $160K $40K/yr × 4 years
IMG Eligible
  • Minimum 2 years at a VA medical facility
  • Shortage specialties: Psychiatry, Family Practice, Internal Med, EM, Gastroenterology, Urology, Geriatrics
  • Other specialties considered case-by-case
  • Covers loans
  • VA employment includes excellent federal benefits, retirement, and pension
Apply through VA HR. Availability varies by facility and federal fiscal year.
1H — IHS LRP

Indian Health Service (IHS) LRP

Up to $50K per 2-yr term, renewable
IMG Eligible
  • 2-year service at IHS-approved facility serving American Indian & Alaska Native communities
  • Annual renewals available until all loans are repaid
  • Covers federal and private loans
  • Primary care, psychiatry, surgery, emergency medicine and more eligible
Apply at ihs.gov/loanrepayment. Highly competitive — apply in first year after residency.
1I — NIH Research Track

NIH Loan Repayment Programs

Up to $50K per 2-yr contract, renewable
IMG Eligible
  • Minimum 20 hrs/week in NIH-mission research at a domestic nonprofit or government institution
  • Tracks: Clinical Research, Pediatrics, Health Disparities, Contraception/Infertility
  • Does NOT require rural/underserved commitment — ideal for academic physicians
  • Can be combined with academic hospital employment for simultaneous PSLF eligibility
Best for ACSOM graduates pursuing academic medicine or physician-scientist tracks. Renewable via lrp.nih.gov.
02

State Loan Repayment Programs — 50 States + DC

Every U.S. state and territory operates at least one loan repayment program. These require U.S. citizenship and state licensure only — school of origin is never evaluated. Most accept both federal and private loans.

State Program Max Award Commitment Key Notes
MichiganMSLRP$300,0002-yr contracts, nonprofit HPSA, 40 hrs/wkTax-free. Employer contributes 20% (nonprofit) or 50% (for-profit). FM, IM, Peds, OB/GYN, Psych.
IowaRural Iowa Primary Loan Repayment$200,000Up to 5 years, rural practiceOne of the highest state awards. Rural focus.
OklahomaOklahoma Medical LRP$160,0004 years, rural/underserved$25K yr1 to $55K yr4. Strong graduation incentive.
GeorgiaGBHCW GPELRP$150,0004 years full-time, rural county <50K popService-cancelable loan. New cycle Aug 2026.
GeorgiaPhysicians for Rural Areas Assistance (PRAA)$100,0002-yr commitment, rural underserved$25K/yr, max $100K. Separate from GPELRP.
CaliforniaSteven M. Thompson Physician Corps LRP$105,0003 years, underserved communityRenewable. Strong program for urban underserved.
CaliforniaCA State LRP$50,0002 years, HPSA siteRenewable: $20K/yr renewal, then $10K/yr.
CaliforniaLA Care Physician LRP$300,0005 years, Medi-Cal networkEmployer-based. Highest CA potential ($5K/mo × 5 yrs).
NebraskaNE Primary Health Care LRP$60,000/yr2 years, shortage areaVery competitive per-year rate.
MontanaMT Rural Physician Incentive (MRPIP)$150,0006-month increments, up to 5 years$10K at 6 mos to $20K at 60 mos. Rural only.
KansasKS State LRP$95,000Primary care, HPSA sitePhysician shortage area required.
MinnesotaRural Physician LRP$120,000+Rural shortage areaStrong rural repayment track.
MinnesotaUrban Physician LRP$116,0003-4 yrs, urban underserved HPSAUnique urban track. FM, IM, Peds, OB/GYN, Psych.
MinnesotaMN State LRP (HPSA)$40,0002 yrs full-time or 4 yrs part-timeStandard HPSA program.
IdahoRural Physician Incentive (RPIP)$100,0004 years primary care, rural HPSAFM, IM, Peds, OB/GYN, Psych, Gen Surg, EM.
TexasTX Primary Care Innovation Grant LRP$120,000+4 years, HPSA siteU.S. citizen or LPR. TX Medical Board license required.
KentuckyKY State LRP$70,0002 years, HPSAStandard state program.
Washington DCDC Health LRPVaries2-3 years, HPSAAvailable in shortage areas within DC.
HawaiiHI State LRPVaries2 years, nonprofit HPSAFM, IM, Peds, Psych, OB/GYN, Geriatrics.
MissouriMO Health Prof. State LRP$50,0002 years, underserved areaStandard program.
All 50 States + DCNHSC State LRP (via HRSA grants)$25K-$75K typical2 years, full-time HPSAEvery state eligible. Apply through your state Primary Care Office.
Finding your state's program: Use the AAMC searchable database at students-residents.aamc.org, or search "[Your State] Primary Care Office loan repayment." The NHSC State LRP map at nhsc.hrsa.gov lists all active state programs. NHSC State LRP and PSLF can be pursued simultaneously — they are not in conflict.
03

Military Service Loan Repayment Programs

All three military branches offer physician loan repayment. These programs require military commission and active duty service. For physicians committed to serving, military service eliminates loan debt while providing salary, housing, full benefits, and pension.

3A — U.S. Army

Army Active Duty Health Professions LRP

Up to $120K $40K/yr × 3 years; up to $250K over career
IMG Eligible
  • Active duty Army service commitment
  • Healthcare Professions LRP: $40K/yr for shortage specialties, max $250K over career
  • Additional sign-on bonuses available — can be applied directly to loans
  • Full military benefits, housing allowance, and pension
  • Covers loans
Program amounts and available specialties change frequently. Contact an Army Health Care Recruiter for current cycle details.
3B — U.S. Navy

Navy Health Professions Loan Repayment Program

Up to $40K/yr varies by specialty
IMG Eligible
  • Active duty Navy service with Navy commission
  • Primary care, surgery, and subspecialty tracks available
  • Combined with housing, full benefits, and military salary
Navy LRP availability is competitive and specialty-specific. Verify current cycle offerings with a Navy recruiter.
3C — U.S. Air Force

Air Force Health Professions LRP

Up to $80K $40K/yr × 2 years
IMG Eligible
  • Active duty Air Force service; must hold commission in the Medical Corps
  • 28% federal tax withholding provided by Air Force (helps offset tax impact)
  • Additional specialty bonuses may be available
Not always offered. Check with USAF Medical Service Corps for current cycle availability before planning around this option.
04

Employer, Hospital & Specialty Repayment Programs

Negotiated directly with employers or through specialty-specific programs. These stack on top of federal and state programs for maximum payoff.

4A — Hospital / Health System

Sign-On & Retention Packages

$20K–$150K+ employer varies; typically 2-4 year commitment
IMG Eligible
  • Rural critical-access hospitals often offer the most aggressive packages ($50K-$150K)
  • FQHCs combine NHSC site approval with employer repayment
  • Academic medical centers offer tuition assistance for subspecialty training
  • Stacks cleanly with NHSC LRP, state LRP, and PSLF simultaneously
  • Negotiate loan repayment into every employment contract — ask every time
Get all repayment commitments in writing before signing any employment contract.
4B — FQHC Employment

Federally Qualified Health Center Employment

NHSC-eligible + employer package simultaneous stacking opportunity
IMG Eligible
  • Working at an FQHC qualifies for NHSC LRP, state LRP, PSLF, and employer repayment simultaneously
  • FQHCs often offer loan repayment as a direct employment benefit on top of NHSC
  • Found in every state — rural, urban, and suburban locations available
  • Strong demand for primary care, psychiatry, OB/GYN, and internal medicine
  • FQHCs actively recruit Caribbean graduates — no LCME preference
FQHCs are one of the highest-value placement options for an ACSOM graduate maximizing debt elimination.
4C — Rural / Critical Access Hospital

Rural Hospital & Critical Access Hospital Employment

$50K–$200K+ combined packages typically 2-4 year commitment
IMG Eligible
  • Critical Access Hospital designation triggers NHSC, state, federal, and employer repayment eligibility simultaneously
  • Many offer $100K+ sign-on bonuses in addition to NHSC/state awards
  • Housing, vehicle, and moving allowances often included
  • Rural hospitals aggressively recruit any licensed U.S. physician regardless of school
  • Rural placement is where the most aggressive stacking of programs occurs — a rural FM physician could access 4-5 simultaneous programs
Rural placement is where the most aggressive stacking of programs occurs. A rural FM physician can typically access four to five simultaneous programs at once.
05

Income-Driven Repayment — Managing Loans During Training

During residency your income is low (~$60-70K) but your loan balance is large. IDR plans keep monthly payments near zero while training years count toward PSLF or long-term forgiveness.

Plan
Monthly Payment
Forgiveness Timeline
Best For
IBR — Income-Based Repayment
10-15% discretionary income
20-25 years (may be taxable)
Legacy federal borrowers; payment cap ceiling
RAP — Repayment Assistance Plan 2026 NEW
5% discretionary income above 150% poverty
30 years; interest subsidy during residency
New borrowers replacing SAVE plan post-July 2026
PSLF + IDR (Combined — BEST)
IDR payments during residency and training
Full balance after 10 yrs at qualifying employer — tax-free
Any physician at nonprofit hospital pursuing PSLF
Private Loan Strategy
Per loan agreement; deferment during residency available
Paid via NHSC/state awards or employer packages
loans: target with repayment program awards

Key Facts for Repayment Planning

Your loan is a private institutional loan — it is NOT eligible for federal IDR, PSLF, or income-driven forgiveness. However, it IS explicitly eligible as a "qualifying educational loan" under NHSC LRP, NHSC Rural Community LRP, NHSC SUD Workforce LRP, STAR LRP, VA LRP, IHS LRP, and all state LRP programs. Strategy: use IDR/PSLF for any federal loans you may carry; use NHSC/state/military/employer awards to directly retire the balance. Do not consolidate your loan with federal loans — keep them entirely separate.

06

The ACSOM Stack Strategy

Most programs can be stacked simultaneously. A single physician in the right setting can activate four to five programs at once. Below are two real-world scenarios demonstrating full debt elimination.

Scenario A

Primary Care / Family Medicine Physician — Rural FQHC

NHSC LRP — 2yr initial + continuation contracts $80,000+ tax-free
Michigan MSLRP or Iowa Rural LRP (state) $150K–$200K over 5-10 yrs
FQHC or rural hospital employer sign-on/retention $50K–$100K
PSLF — nonprofit FQHC employer, 10 years Full federal balance — tax-free
Loan retired by NHSC/state award proceeds $0 balance private loan
Total Potential $330K–$450K+ in relief
Scenario B

Psychiatrist — Academic Medical Center / SUD Track

STAR LRP — 6-year SUD/behavioral health commitment $250,000 tax-free
VA LRP — psychiatry shortage specialty $160,000 ($40K/yr × 4)
PSLF — academic/VA hospital employer Full remaining balance — tax-free
NIH Research LRP (if research track) $50,000 per 2-yr contract
Loan balance paid via STAR/VA proceeds $0 balance private loan
Total Potential $460,000+ in relief
07

Your Loan Repayment Master Checklist

A timeline of actions from year one through graduation, residency, and first attending position to maximize repayment program access.

Year 1 Meet with ACSOM Financial Aid. Understand your loan terms. Confirm deferment options during residency.
Year 1 Research your target state's LRP and NHSC sites where you want to practice after residency.
Final Year Identify if your application cycle qualifies for any "students in training" programs. ACSOM students: skip NHSC S2S; go directly to post-residency programs.
Match Day Confirm your residency program's employer PSLF eligibility. Teaching hospitals are 95%+ 501(c)(3) qualifying employers.
Residency Day 1 Submit PSLF Employment Certification Form for any federal loans. Track payments at studentaid.gov.
Residency — Ongoing Enroll in IDR/IBR for any federal loans. Keep payments low. Submit Employment Certification Form annually.
Residency — Final Year Apply to NHSC LRP (opens spring, deadline ~March 31). Apply to your target state's LRP simultaneously.
Before Signing Negotiate loan repayment into your employment contract. Ask about sign-on, retention, and NHSC site status before signing anything.
Attending Year 1 Confirm NHSC site approval with employer. Stack state LRP on top if practicing in a HPSA-designated area.
Attending — Ongoing Apply NHSC/state award proceeds directly to loan balance first — private loans have no PSLF pathway.
Year 10 Submit PSLF application for remaining federal loan balance. Continue NHSC continuation contracts as needed to fully retire remaining debt.
08

How ACSOM Finances Your Medical Education

ACSOM directly reduces your debt burden through scholarships, merit awards, and an institutional private lending partnership — designed specifically for the post-Grad-PLUS environment.

Loan

ACSOM's primary financing vehicle — a private institutional loan that closely mirrors the former federal Grad PLUS structure: competitive interest rates, medical-school-specific terms, and deferment options during residency and fellowship. Eligible for repayment under all NHSC LRP, state LRP, STAR LRP, VA LRP, IHS LRP, military, and employer programs in this guide. Not eligible for federal PSLF or IDR.

Merit Scholarships & Grants

Awarded at admission and renewable annually based on academic performance. Directly reduces tuition owed before your first loan disbursement. Contact Financial Aid for current scholarship tiers and renewal requirements.

Flexible Tuition Payment Plans

Semester-based and monthly payment arrangements available. Contact Student Accounts to discuss options that reduce the total amount you need to borrow over your four years.

Financial Aid Counseling

One-on-one sessions to map your four-year borrowing strategy and post-graduation repayment plan, including which programs to apply to in which order based on your target specialty and practice location.

Founders Call Program

Every admitted student receives a personal call from ACSOM leadership to discuss the full financial pathway, scholarship opportunities, and their personalized road to residency.

Student Accounts

For loan queries, tuition payment arrangements, and semester billing — contact Financial Aid or Student Accounts on the ACSOM campus in Dominica. Direct: +1-800-418-0424.

Director of Recruitment
Mason Philpot — mason@acsom.edu.dm

Important Disclosures & Legal Notices

General Information Only — Not Financial, Legal, or Tax Advice. This guide is provided by the American Canadian School of Medicine (ACSOM) for general informational and educational purposes only. Nothing in this document constitutes financial advice, legal advice, tax advice, or a guarantee of eligibility for any program described. Individual eligibility depends on factors that vary by person, specialty, state of licensure, employer, loan type, HPSA designation, and annual program funding. Consult with a licensed financial advisor, certified student loan counselor (CSLP), and/or qualified attorney before making financial decisions.

Program Information Is Subject to Change. All program details, award amounts, eligibility requirements, application deadlines, and funding availability reflect publicly available information as of April 2026. Federal and state programs are subject to annual reauthorization, Congressional action, regulatory revision, executive action, and budget appropriations. Always verify current requirements directly with the administering agency before applying.

Private Loan Disclosure. ACSOM's institutional lending partnership with lenders provides private student loans. These are NOT federal loans and do not carry federal borrower protections, nor are they eligible for federal IDR plans, PSLF, or federal loan forgiveness programs. They ARE eligible as "qualifying educational loans" under NHSC, state, VA, IHS, military, and many employer repayment programs. ACSOM does not guarantee loan approval.

PSLF — Federal Loans Only. Public Service Loan Forgiveness applies only to federal Direct Loans. Private loans, including ACSOM's institutional loans, do not qualify for PSLF. Do not refinance federal loans to private loans if pursuing PSLF — this permanently disqualifies those loans from forgiveness.

No Guarantee of Residency Match, Licensure, or Professional Outcomes. All loan repayment programs require completion of a U.S. residency and state licensure. ACSOM does not guarantee residency placement, USMLE passage, state licensure, board certification, or employment.

ACSOM is not affiliated with or endorsed by NHSC, HRSA, the U.S. Department of Education, the VA, IHS, NIH, any state government agency, any military branch. Tax treatment of awards varies — consult a qualified tax professional. Some federal programs cannot be held simultaneously; always verify stacking rules with each program's administering agency.

© 2026 American Canadian School of Medicine. All rights reserved. This document may be reproduced for prospective student informational use only. Commercial redistribution is prohibited. Questions: financialaid@acsom.edu.dm