---
kind: "section"
citation: "42 U.S.C. § 292s"
title: "42"
title_heading: "The Public Health and Welfare"
number: "292s"
heading: "Medical schools and primary health care"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/292s"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter V — Health Professions Education"
  - "Part A — Student Loans"
  - "Subpart ii — federally-supported student loan funds"
---

# §292s. Medical schools and primary health care

- (a) **Requirements for students—**
  - (1) **In general—** Subject to the provisions of this subsection, in the case of student loan funds established under [section 292q of this title](/usc/42/292q.md) by [schools](/usc/42/300j–21.md?p=6) of medicine or osteopathic medicine, each agreement entered into under such section with such a [school](/usc/42/300j–21.md?p=6) shall provide (in addition to the provisions required in [subsection (b)](/usc/42/292q.md?p=b) of such section) that the [school](/usc/42/300j–21.md?p=6) will make a loan from such fund to a student only if the student agrees—
    - (A) to enter and complete a residency training [program](/usc/42/274l–1.md?p=4) in primary health care not later than 4 years after the date on which the student graduates from such [school](/usc/42/300j–21.md?p=6); and
    - (B) to practice in such care for 10 years (including residency training in primary health care) or through the date on which the loan is repaid in full, whichever occurs first.
  - (2) **Inapplicability to certain students—**
    - (A) The requirement established in [paragraph (1)](#a-1) regarding the student loan fund of a [school](/usc/42/300j–21.md?p=6) does not apply to a student if—
      - (i) the first loan to the student from such fund is made before July 1, 1993; or
      - (ii) the loan is made from—
        - (I) a Federal capital contribution under [section 292q of this title](/usc/42/292q.md) that is made from amounts appropriated under [section 292t(f)](/usc/42/292t.md?p=f)[^1] of this title (in this section referred to as an “exempt Federal capital contribution”); or
        - (II) a [school](/usc/42/300j–21.md?p=6) contribution made under [section 292q of this title](/usc/42/292q.md) pursuant to such a Federal capital contribution (in this section referred to as an “exempt [school](/usc/42/300j–21.md?p=6) contribution”).
    - (B) A Federal capital contribution under [section 292q of this title](/usc/42/292q.md) may not be construed as being an exempt Federal capital contribution if the contribution was made from amounts appropriated before October 1, 1990. A [school](/usc/42/300j–21.md?p=6) contribution under [section 292q of this title](/usc/42/292q.md) may not be construed as being an exempt [school](/usc/42/300j–21.md?p=6) contribution if the contribution was made pursuant to a Federal capital contribution under such section that was made from amounts appropriated before such date.
  - (3) **Noncompliance by student—** Each agreement entered into with a student pursuant to [paragraph (1)](#a-1) shall provide that, if the student fails to comply with such agreement, the loan involved will begin to accrue interest at a rate of 2 percent per year greater than the rate at which the student would pay if compliant in such year.
  - (4) **Waivers—**
    - (A) With respect to the obligation of an individual under an agreement made under [paragraph (1)](#a-1) as a student, the [Secretary](/usc/42/292o.md?p=6) shall provide for the partial or total waiver or suspension of the obligation whenever compliance by the individual is impossible, or would involve extreme hardship to the individual, and if enforcement of the obligation with respect to the individual would be unconscionable.
    - (B) For purposes of [subparagraph (A)](#a-4-A), the obligation of an individual shall be waived if—
      - (i) the status of the individual as a student of the [school](/usc/42/300j–21.md?p=6) involved is terminated before graduation from the [school](/usc/42/300j–21.md?p=6), whether voluntarily or involuntarily; and
      - (ii) the individual does not, after such termination, resume attendance at the [school](/usc/42/300j–21.md?p=6) or begin attendance at any other [school](/usc/42/300j–21.md?p=6) of medicine or osteopathic medicine.
    - (C) If an individual resumes or begins attendance for purposes of [subparagraph (B)](#a-4-B), the obligation of the individual under the agreement under [paragraph (1)](#a-1) shall be considered to have been suspended for the period in which the individual was not in attendance.
    - (D) This paragraph may not be construed as authorizing the waiver or suspension of the obligation of a student to repay, in accordance with [section 292r of this title](/usc/42/292r.md), loans from student loan funds under [section 292q of this title](/usc/42/292q.md).
- (b) **Requirements for schools—**
  - (1) **In general—** Subject to the provisions of this subsection, in the case of student loan funds established under [section 292q of this title](/usc/42/292q.md) by [schools](/usc/42/300j–21.md?p=6) of medicine or osteopathic medicine, each agreement entered into under such section with such a [school](/usc/42/300j–21.md?p=6) shall provide (in addition to the provisions required in [subsection (b)](/usc/42/292q.md?p=b) of such section) that, for the 1-year period ending on June 30, 1997;[^2] and for the 1-year period ending on June 30 of each subsequent fiscal year, the [school](/usc/42/300j–21.md?p=6) will meet not less than 1 of the conditions described in [paragraph (2)](#b-2) with respect to graduates of the [school](/usc/42/300j–21.md?p=6) whose date of graduation from the [school](/usc/42/300j–21.md?p=6) occurred approximately 4 years before the end of the 1-year period involved.
  - (2) **Description of conditions—** With respect to graduates described in [paragraph (1)](#b-1) (in this paragraph referred to as “designated graduates”), the conditions referred to in such paragraph for a [school](/usc/42/300j–21.md?p=6) for a 1-year period are as follows:
    - (A) Not less than 50 percent of designated graduates of the [school](/usc/42/300j–21.md?p=6) meet the criterion of either being in a residency training [program](/usc/42/274l–1.md?p=4) in primary health care, or being engaged in a practice in such care (having completed such a [program](/usc/42/274l–1.md?p=4)).
    - (B) Not less than 25 percent of the designated graduates of the [school](/usc/42/300j–21.md?p=6) meet such criterion, and such percentage is not less than 5 percentage points above the percentage of such graduates meeting such criterion for the preceding 1-year period.
    - (C) In the case of [schools](/usc/42/300j–21.md?p=6) of medicine or osteopathic medicine with student loans funds under [section 292q of this title](/usc/42/292q.md), the [school](/usc/42/300j–21.md?p=6) involved is at or above the 75th percentile of such [schools](/usc/42/300j–21.md?p=6) whose designated graduates meet such criterion.
  - (3) **Determinations by Secretary—** Not later than 90 days after the close of each 1-year period described in [paragraph (1)](#b-1), the [Secretary](/usc/42/292o.md?p=6) shall make a determination of whether the [school](/usc/42/300j–21.md?p=6) involved has for such period complied with such paragraph and shall in writing inform the [school](/usc/42/300j–21.md?p=6) of the determination. Such determination shall be made only after consideration of the report submitted to the [Secretary](/usc/42/292o.md?p=6) by the [school](/usc/42/300j–21.md?p=6) under [paragraph (6)](#b-6).
  - (4) **Noncompliance by school—**
    - (A)
      - (i) Subject to [subparagraph (C)](#b-4-C), each agreement under [section 292q of this title](/usc/42/292q.md) with a [school](/usc/42/300j–21.md?p=6) of medicine or osteopathic medicine shall provide that, if the [school](/usc/42/300j–21.md?p=6) fails to comply with [paragraph (1)](#b-1) for a 1-year period under such paragraph, the [school](/usc/42/300j–21.md?p=6)—
        - (I) will pay to the [Secretary](/usc/42/292o.md?p=6) the amount applicable under [subparagraph (B)](#b-4-B) for the period; and
        - (II) will pay such amount not later than 90 days after the [school](/usc/42/300j–21.md?p=6) is informed under [paragraph (3)](#b-3) of the determination of the [Secretary](/usc/42/292o.md?p=6) regarding such period.
      - (ii) Any amount that a [school](/usc/42/300j–21.md?p=6) is required to pay under [clause (i)](#b-4-A-i) may be paid from the student loan fund of the [school](/usc/42/300j–21.md?p=6) under [section 292q of this title](/usc/42/292q.md).
    - (B) For purposes of [subparagraph (A)](#b-4-A), the amount applicable for a [school](/usc/42/300j–21.md?p=6), subject to [subparagraph (C)](#b-4-C), is—
      - (i) for the 1-year period ending June 30, 1997, an amount equal to 10 percent of the income received during such period by the student loan fund of the [school](/usc/42/300j–21.md?p=6) under [section 292q of this title](/usc/42/292q.md);
      - (ii) for the 1-year period ending June 30, 1998, an amount equal to 20 percent of the income received during such period by the student loan fund; and
      - (iii) for any subsequent 1-year period under [paragraph (1)](#b-1), an amount equal to 30 percent of the income received during such period by the student loan fund.
    - (C) In determining the amount of income that a student loan fund has received for purposes of [subparagraph (B)](#b-4-B), the [Secretary](/usc/42/292o.md?p=6) shall exclude any income derived from exempt contributions. Payments made to the [Secretary](/usc/42/292o.md?p=6) under [subparagraph (A)](#b-4-A) may not be made with such contributions or with income derived from such contributions.
  - (5) **Expenditure of payments—**
    - (A) Amounts paid to the [Secretary](/usc/42/292o.md?p=6) under [paragraph (4)](#b-4) shall be expended to make Federal capital contributions to student loan funds under [section 292q of this title](/usc/42/292q.md) of [schools](/usc/42/300j–21.md?p=6) that are in compliance with [paragraph (1)](#b-1).
    - (B) A Federal capital contribution under [section 292q of this title](/usc/42/292q.md) may not be construed as being an exempt Federal capital contribution if the contribution is made from payments under [subparagraph (A)](#b-5-A). A [school](/usc/42/300j–21.md?p=6) contribution under such section may not be construed as being an exempt [school](/usc/42/300j–21.md?p=6) contribution if the contribution is made pursuant to a Federal capital contribution from such payments.
  - (6) **Reports by schools—** Each agreement under [section 292q of this title](/usc/42/292q.md) with a [school](/usc/42/300j–21.md?p=6) of medicine or osteopathic medicine shall provide that the [school](/usc/42/300j–21.md?p=6) will submit to the [Secretary](/usc/42/292o.md?p=6) a report for each 1-year period under [paragraph (1)](#b-1) that provides such information as the [Secretary](/usc/42/292o.md?p=6) determines to be necessary for carrying out this subsection. Each such report shall include statistics concerning the current training or practice status of all graduates of such [school](/usc/42/300j–21.md?p=6) whose date of graduation from the [school](/usc/42/300j–21.md?p=6) occurred approximately 4 years before the end of the 1-year period involved.
- (c) **Definitions—** For purposes of this section:
  - (1) The term “exempt contributions” means exempt Federal capital contributions and exempt [school](/usc/42/300j–21.md?p=6) contributions.
  - (2) The term “exempt Federal capital contribution” means a Federal capital contribution described in [subclause (I)](#a-2-A-ii-I) of subsection (a)(2)(A)(ii).
  - (3) The term “exempt [school](/usc/42/300j–21.md?p=6) contribution” means a [school](/usc/42/300j–21.md?p=6) contribution described in [subclause (II)](#a-2-A-ii-II) of subsection (a)(2)(A)(ii).
  - (4) The term “income”, with respect to a student fund under [section 292q of this title](/usc/42/292q.md), means payments of principal and interest on any loan made from the fund, and any other earnings of the fund.
  - (5) The term “primary health care” means family medicine, general internal medicine, general pediatrics, preventive medicine, or osteopathic general practice.
- (d) **Sense of Congress—** It is the sense of Congress that funds repaid under the loan [program](/usc/42/274l–1.md?p=4) under this section should not be transferred to the Treasury of the United States or otherwise used for any other purpose other than to carry out this section.

## Footnotes

[^1]: See References in Text note below.
[^2]: So in original. The semicolon probably should be a comma.

## Source credit

(July 1, 1944, ch. 373, title VII, § 723, as added Pub. L. 102–408, title I, § 102, Oct. 13, 1992, 106 Stat. 2015; amended Pub. L. 103–43, title XX, § 2014(c), June 10, 1993, 107 Stat. 216; Pub. L. 105–392, title I, § 131, Nov. 13, 1998, 112 Stat. 3574; Pub. L. 111–148, title V, § 5201(a), Mar. 23, 2010, 124 Stat. 606.)

## Notes

### Editorial Notes

### References in Text

Section 292t(f) of this title, referred to in subsec. (a)(2)(A)(ii)(I), contained provisions in par. (1) relating to appropriation of funds for Federal capital contributions to student loan funds, prior to repeal by Pub. L. 105–392, title I, § 132(b), Nov. 13, 1998, 112 Stat. 3575, eff. Oct. 1, 2002.

### Prior Provisions

A prior section 723 of act July 1, 1944, was classified to section 293c of this title prior to the general revision of this subchapter by Pub. L. 102–408.

### Amendments

2010—Subsec. (a)(1)(B). Pub. L. 111–148, § 5201(a)(1)(A), added subpar. (B) and struck out former subpar. (B) which read as follows: “to practice in such care through the date on which the loan is repaid in full.”

Subsec. (a)(3). Pub. L. 111–148, § 5201(a)(1)(B), added par. (3) and struck out former par. (3). Prior to amendment, text read as follows: “Each agreement entered into with a student pursuant to paragraph (1) shall provide that, if the student fails to comply with such agreement, the loan involved will begin to accrue interest at a rate of 18 percent per year beginning on the date of such noncompliance.”

Subsec. (d). Pub. L. 111–148, § 5201(a)(2), added subsec. (d).

1998—Subsec. (a)(3). Pub. L. 105–392, § 131(b), reenacted heading without change and amended text of par. (3) generally. Prior to amendment, text read as follows: “Each agreement entered into with a student pursuant to paragraph (1) shall provide that, if the student fails to comply with the agreement—

“(A) the balance due on the loan involved will be immediately recomputed from the date of issuance at an interest rate of 12 percent per year, compounded annually; and

“(B) the recomputed balance will be paid not later than the expiration of the 3-year period beginning on the date on which the student fails to comply with the agreement.”

Subsec. (b)(1). Pub. L. 105–392, § 131(a), substituted “4 years before” for “3 years before”.

Subsecs. (c), (d). Pub. L. 105–392, § 131(c), redesignated subsec. (d) as (c) and struck out heading and text of subsec. (c). Text read as follows: “The Secretary shall each fiscal year submit to the Committee on Energy and Commerce of the House of Representatives, and the Committee on Labor and Human Resources of the Senate, a report regarding the administration of this section, including the extent of compliance with the requirements of this section, during the preceding fiscal year.”

1993—Subsec. (a)(4). Pub. L. 103–43, § 2014(c)(1), added par. (4).

Subsec. (b)(1). Pub. L. 103–43, § 2014(c)(2)(A), substituted “1997;” for “1994,” and “3 years before” for “4 years before”.

Subsec. (b)(2)(B). Pub. L. 103–43, § 2014(c)(2)(B), substituted “25 percent” for “15 percent”.

Subsec. (b)(4)(B). Pub. L. 103–43, § 2014(c)(2)(C), substituted “1997” for “1994” in cl. (i) and “1998” for “1995” in cl. (ii).

### Statutory Notes and Related Subsidiaries

### Student Loan Guidelines

Pub. L. 111–148, title V, § 5201(b), Mar. 23, 2010, 124 Stat. 607, provided that: “The Secretary of Health and Human Services shall not require parental financial information for an independent student to determine financial need under section 723 of the Public Health Service Act (42 U.S.C. 292s) and the determination of need for such information shall be at the discretion of applicable school loan officer. The Secretary shall amend guidelines issued by the Health Resources and Services Administration in accordance with the preceding sentence.”