Life and medicine

He resigned from residency. Then the HRSA fined him $1 million. Here’s what happened next.

Despite these setbacks, Jonathan Pierce, DO, is thriving today. His story is a tale of resilience—and of the osteopathic profession coming together to assist a physician in need.

Four years ago, Jonathan Pierce, DO, a National Health Service Corps (NHSC) scholar, graduated from medical school debt-free and matched into a family medicine residency program in Greenville, North Carolina.

The years of schooling, training and diligence put Dr. Pierce on track to realize his dreams. But life was about to throw several curve balls his way, starting with a residency program that wasn’t a good fit.

Nine months after beginning residency, Dr. Pierce was given the choice to resign or be terminated from his program. After resigning, he struggled to get into a new residency program and received a bill from the Health Resources and Services Agency (HRSA), which administers the NHSC program, for $1 million. He had failed to fulfill his end of the contract, the letter stated, and he now owed HRSA three times what they’d paid for his training–plus interest.

In crisis, Dr. Pierce turned to his alma mater, Edward Via College of Osteopathic Medicine in Blacksburg, Virginia (VCOM-Virginia), and the AOA, which provides advocacy support as a member benefit. With their help, he landed a residency spot and is likely on track to complete his service obligation to the NHSC, which will void the $1 million bill.

Here’s how the osteopathic medical profession came together to assist a DO in need.

Residency mismatch

Early on in his residency, Dr. Pierce found that the program’s fast pace wasn’t working for him. As his patient load increased, he had a hard time keeping up.

“When the patient volume got too high for me, I became depressed,” he says. “I was unable to see myself falling behind. I just plodded through when I should have gotten help.”

A few months later, Dr. Pierce’s program director told him what he already knew: It wasn’t working out. Given the choice to resign or be terminated in July, Dr. Pierce resigned in good standing, hoping to start a new residency on July 1.

The search for a new position

What followed was about two years of anguish. After resigning, he applied to as many programs as he could and got a few interviews, but no offers. He spoke with the NHSC, who put him on suspension and told him to start a residency program by July 2017.

In the 2017 match season, he applied broadly to family medicine and psychiatry programs but didn’t land a spot.

While Dr. Pierce was facing professional difficulties, challenges arose in his personal life. In 2017, he and his wife, Kate, had a daughter, Ella, who was diagnosed with systemic juvenile idiopathic arthritis (SJIA), a rare inflammatory disease that caused her to be hospitalized multiple times.

A million-dollar bill

A few months before Ella was diagnosed, Dr. Pierce got a letter stating that he owed HRSA over $1 million. His scholarship was in default because he hadn’t found a residency position, and HRSA expected its money in six months.

Realizing the gravity of the situation, Dr. Pierce contacted VCOM-Virginia, who connected him to the AOA Department of Education, headed by Senior Vice President Jim Swartwout. Swartwout then brought in the AOA’s legal team, including Brian Kim, JD, AOA vice president of accreditation and associate general counsel, and Patrick Gaudet, JD, AOA staff attorney. The AOA provides broad-impact advocacy support to members.

Understanding that securing a residency position was necessary to resolve the situation, the AOA legal team and VCOM-Virginia worked together to help Dr. Pierce identify a program that might be a better fit. Dr. Pierce interviewed for a position in a family medicine program in an underserved area of West Virginia and got the job the same day.

After living for roughly two years with his career in limbo, Dr. Pierce says he’ll never forget the euphoric feeling of receiving the call from the program director offering him a position.

‘It was a win’

“The first person I called was Brian Kim,” he says. “It was a win for us.”

For the AOA legal team, the next step was working with the NHSC to try to get Dr. Pierce’s scholarship back on track.

“This was fundamentally a debt collection case,” Kim says. “With debt collection, the debtor needs someone they can lean on. I told Dr. Pierce, ‘I’ll talk with the NHSC, you don’t have to worry about it.’”

Kim discussed Dr. Pierce’s situation with NHSC officials, who were reluctant to allow Dr. Pierce back in the scholarship despite the fact that he landed a residency position in a location that met NHSC’s loan repayment criteria.

NHSC did, however, because of the AOA’s advocacy, grant Dr. Pierce a waiver from making payments on his million-dollar debt because of the financial hardship he and his wife faced from their daughter’s medical bills.

“The government was coming down on me and the AOA stopped that hammer,” Dr. Pierce says. “Despite all the unknowns with this situation, I’ve been greatly reassured by the fact that I am not alone in this.”

After Dr. Pierce completes his residency in 2021, Kim says NHSC may allow him to re-enter the scholarship and complete his four-year service obligation. If this happens, he won’t have to pay the $1 million.

Moving forward

After going to counseling for the depression that surfaced during his first residency position, Dr. Pierce has thrived in his second residency in Bluefield, West Virginia—so much so that he’ll likely graduate six months early because his program director wants to give him credit for his earlier training.

“Getting back into residency changed my life, and it’s all due to the support I received from the AOA legal team and my school,” he says. “Before, I felt trapped. Now I feel hopeful and optimistic.”

Dr. Pierce’s daughter is almost 2 years old now. She continues to struggle with SJIA and has a sensitive immune system, but the family hopes new treatments will emerge.


After his ordeal, Dr. Pierce advises medical students and residents to seek help early when difficulties arise.

“Looking back, I wish I had contacted my school sooner,” he says. “I thought I could do it on my own. But now I understand that medical schools want nothing more than for their alumni to succeed. If you’re in a situation where you can’t get into a residency program, talk to your school.”

DOs and osteopathic medical students facing any hardship should know that there are advocates in the profession who can help, Dr. Pierce notes.

“You are in the osteopathic profession and it really is a family,” he says. “You can lean on your medical school and the AOA when you need help.”

Note: The AOA legal department provides advocacy to support the profession but does not enter into attorney-client relationships with individual members.

Related reading:

He nearly failed medical school before rising to new heights

How this Texas DO became a voice for mental health as a med student


    1. Thomas Kelly, D.O.

      I had a fine by the NHSC for $800,000 at 21% interest. I got the fine lifted by serving in a NHSC site in Autaugaville, AL from 9/1989 to 9/1993. It’s great this young doctor got help and he worked off his obligation. I’m glad the AOA was there to help him.

  1. Pratistha Strong

    I had program to resign from two programs due to health/family emergencies. I found out that CMS has a time-clock that starts on residencies once a resident starts the contract. This was never told to me, by my school, by my program directors or anyone else. I am untouchable or I have to self fund my own residency.

    I eventually found my way…but just to let others know.

    1. Michael Waring

      I’m running into the time-clock problem also. How’d you find your way? I’ve seen postings where programs even refuse self-funding (!)

  2. William Wade, DO, MPH

    Fortunately, you reached out to your medical school and their legal team. According to recent reports, had you contacted your stat’s Physician Health Program, your license could have placed in suspension until you completed 90 days of inpatient alcohol and drug abuse treatment (allegedly for depression) and been saddled with insurmountable debt. Glad it is working out for you. Glad AOA went to bat for you.

      1. Catherine Anderson

        Yes, this is exactly what PHP programs do – they force physicians who suffer depression to go through punitive inpatient alcohol and drug abuse programs. There are no separate programs for depression. They are punitive because they cost a fortune and YOU have to pay for it, plus they suspend your license and you may or may not ever get it back. This is just one of the reasons that so many physicians commit suicide every year – an average of one per day in fact – that we know of. Physicians (MD and DO) know this so most don’t get help for their depression that almost always comes from abusive medical training and/or the abuse that comes after from the medical system in general. I know all this because I have had friends that have had to go through these programs for drug and alcohol abuse when all they suffered from was depression. I myself had to leave my abusive first (MD) residency as I was becoming depressed. Fortunately I had a wonderful DO advisor who helped me understand it would be in my best interest to find another program. I called the Dean of my school (KCUMB) and she assisted me in finding a DO residency in another state – a great residency whose mission was rescuing DO’s from punitive MD residencies. It was actually MUCH harder with longer hours of work, but I thrived in a supportive environment that gave me room to learn and grow as a physician. Guess that will change now that all the residencies are combined but glad to know the schools are still helping.

  3. Israel

    I’m very grateful you received such amazing support and pray for your continued success… all my very best to you and your family!

  4. Harriet A. Fellows, DO, FACN

    On the other hand…
    My husband took a NHSC scholarship for his midwifery program at Yale a very long time ago. In the fine fine print, the obligation to repay was clearly stated. And while he graduated “debt free”, his obligation was a debt he was honored and also forced to greet.
    We read a lot of minutia in med school. And, we all tend to ignore fine print. Lenders, drug manufacturers, scholarship programs bank on that.
    Wonderful that Via COM came through for a well deserving man and his family. Keep this in mind, though…CAVEAT EMPTOR

  5. Nunya bush

    What about all of the others who have no protections from hospitals, malignant programs and the profession of medicine

  6. Kevin Patton

    I know the NHSC is the government, and we all know the government is not too bright to begin with — but how did the NHSC expect Dr. Pierce to suddenly come up with $1 million to pay their fine when he resigned from his residency program and spent every penny on his daughter’s medical bills? Do they automatically assume every med student has parents who are multi-millionaires? NHSC scholarships are unsecured debt — so you would think it is in their best interest to help scholarship receipients do everything they can to finish residency so they can fulfill their obligations to NHSC.

  7. Adam matar

    My son finishd his first year residency in internetal medicen the hospital gave him 2 choices either to rescinded or terminated he chose to rescinded from the program, the hospital did not credited him the first year
    Can you help him gettìng residency

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