I am currently an M1 in a rural town, I know nobody within 300 miles of where I study.

Coming from a big city, living in town with less than 200k is a complete shock to me. I found myself socially cut off from my parents and friends.

Up until last year, my parents have been very generous in financial support. They help me pay off credit card debts, some student loans, and help out for emergency expense.

Unfortunately, one of my parents got sick and they can no longer provide for my last minutes expense.

Most of my friends are engineers and are making 90-100k in their mid 20s.

I currently have 85k debt from undergrad/M.S program. 4 years in med school will cost me another 260k (principal + interest), from gradplus and stafford loan. Since I am already in my mid-20s, prospect of paying off 300k debt troubled me, In addition to being socially isolated 1000 miles from home.

I want to be pay off the debt and have enough money for my family. If I do Internal medicine, what will be my take home pay after my first year out of residency? Is it usually for physician to pay 45% tax?

for those who moved >800 miles from home, do you think med school make you become socially isolated?

I am currently an M1 in a rural town, I know nobody within 300 miles of where I study.

Coming from a big city, living in town with less than 200k is a complete shock to me. I found myself socially cut off from my parents and friends.

Up until last year, my parents have been very generous in financial support. They help me pay off credit card debts, some student loans, and help out for emergency expense.

Unfortunately, one of my parents got sick and they can no longer provide for my last minutes expense.

Most of my friends are engineers and are making 90-100k in their mid 20s.

I currently have 85k debt from undergrad/M.S program. 4 years in med school will cost me another 260k (principal + interest), from gradplus and stafford loan. Since I am already in my mid-20s, prospect of paying off 300k debt troubled me, In addition to being socially isolated 1000 miles from home.

I want to be pay off the debt and have enough money for my family. If I do Internal medicine, what will be my take home pay after my first year out of residency? Is it usually for physician to pay 45% tax?

for those who moved >800 miles from home, do you think med school make you become socially isolated?

OK, take a deep breath. You can find and make new friends. It's easy. Look around in class and find the ones who are not tools, won't get you in trouble, and do well in class. Maintain a certain standard of friends. Call home. Get on Skype or something.

Money may be a real bitc* in the near future. If you owe >300k there is no way in hell that I would not find whatever specialty fits your personality that pays the best. That is one helluva lot of $$$$ to pay back with predominantly after tax dollars. Your biggest problem, by my estimation, at this time is the financial headwinds that we all face. Unfortunately no one can answer those questions for you reliably at this time. Best wishes.

Agree with above.
I do think that you'll be able to pay off your loans, but it's going to suck for a while. You could do it doing internal medicine...they currently make in the mid 150's (if making money is your desire, could probably make that, or even more, first year out as a hospitalist depending on where you want to live, etc.). There are definitely things that pay more - anesthesia, radiology, etc.

I found getting involved in a few student organizations was a good way to make friends. It also looks good on your residency application, as long as you don't let it take too much time away from studying.

There are things to do in smaller cities...I think it's normal to be culture shocked but try to find out what your classmates do for fun. Smaller cities still have places to shop, have a coffee or beer,etc. And you can go visit the big city on school breaks or vacations.

You can't do anything about your debt right now except try not to spend excessive amounts of money. Buying used textbooks can be helpful...often the newest editions are not necessary, and it doesnt matter if there's a little highlighting in the books. Shop for clothes at Marshall's, Target, etc. instead of full price at the mall. Consider getting a roommate/sharing a house or apartment.

where does this 45% tax come from? No. False. Just because you are in the 28, 33 or 35% tax bracket does NOT mean you are being taxed at a rate of 28, 33 or 35%. Take a good look at this site please and make sure you understand it:

http://www.moneychimp.com/features/tax_brackets.htm

I think this person is probably talking about total taxes...in which case 45% would be about right in some states, for someone with 150k+ income.
This would be adding together federal and state taxes, and probably social security taxes/withholding as well. Particularly if you are self employed/own your own business or act as an independent contractor, the 45% could be true...might have to pay 2x the social security taxes, for example.

thats right, most of you poor souls pay state tax. i live in nevada. ss + medi = 7.65%. for 150k income, = 31.5% of it goes to uncle sam. check out this site too.

http://www.paycheckcity.com/netpaycalc/netpaycalculator.asp

I think you have to pay double social security withholding if you are self-employed or an independent contractor, which some docs are. Just something to keep in mind.

I am having exactly the same concerns right now about my loans... I havnt started med school yet, but my only acceptance was to an expensive private school. I expect that when I am done I will have ~300 from med school on top of ~100 from undergrad and a masters....(sigh)

With that much debt I figure there is no possible way that I can go into internal med. With some quick calculations, I figure that even if I pick a specialty that makes (on avg) ~250 to start, I will still have to live like a student for at least 10 years, and forget buying a house.

Am I still going to have to "marry a doctor" even once I am one? This amount of debt makes my stomach churn just to think about.... and I have no idea how I am going to handle it [especially without being miserable and resentful that I cant enjoy the money I will finally be making in 10 years]. If anyone has suggestions, or anecdotes about dealing with massive amounts of debt, it would be welcomed.

Thanks,
dd

I am having exactly the same concerns right now about my loans... I havnt started med school yet, but my only acceptance was to an expensive private school. I expect that when I am done I will have ~300 from med school on top of ~100 from undergrad and a masters....(sigh)

With that much debt I figure there is no possible way that I can go into internal med. With some quick calculations, I figure that even if I pick a specialty that makes (on avg) ~250 to start, I will still have to live like a student for at least 10 years, and forget buying a house.

Am I still going to have to "marry a doctor" even once I am one? This amount of debt makes my stomach churn just to think about.... and I have no idea how I am going to handle it [especially without being miserable and resentful that I cant enjoy the money I will finally be making in 10 years]. If anyone has suggestions, or anecdotes about dealing with massive amounts of debt, it would be welcomed.

Thanks,
dd

This is one of the few situations where I might consider signing up for a military scholarship or HPSP. However, if you don't want to then could wait until closer to end of med school, and if you still want to do primary care look into loan repayment options then. Other options include going for a higher paying specialty like anesthesiology or radiology.

ddprev,

This is a sticky situation. You have a few options:

1. apply again to a less expensive state school
2. become comfortable with the fact that you will be saddled with an exorbitant debt level, the repayment of which will not be comfortable (or worthwhile) at any future income level
3. look at the military option and see how that plays out
4. come to the conclusion that medical school is not worth the cost

You will not likely find a job where the employer is willing to pay off that amount of educational debt. Assuming that you do, it ultimately comes out of your pay, and is taxed the same as regular income.

I would seriously look into other options rather than signing on for that level of debt and worrying about it later. Don't take your financial cues from Medicare or SS.

I am sad for what you are going through. It is a reality for almost everyone in this country.
My only advice if you have a lot of unsecured debt like credit cards, lines of credit, stores, car loans etc and you feel you are absolutely insolvent you might consider filing for bankruptcy protection in Ch 7 , by the time you finish med school, residency fellowship etc... might be almost erased from your credit report. Ch 7 will wipe out all your unsecured debts however student loans are not included and you will have to pay them anyway.
Finally if you are going to be an AMG you should try for a specialty with higher earning potential than IM unless you want to be cards or GI.
Only my 2 cents.
Good luck

Sorry,car loans are secured but they can still be worked out under BK law.

Of course do not file if you are going to med school before you have secured your school loan as you need a good credit to get it.
NA

I am sad for what you are going through. It is a reality for almost everyone in this country.
My only advice if you have a lot of unsecured debt like credit cards, lines of credit, stores, car loans etc and you feel you are absolutely insolvent you might consider filing for bankruptcy protection in Ch 7 , by the time you finish med school, residency fellowship etc... might be almost erased from your credit report. Ch 7 will wipe out all your unsecured debts however student loans are not included and you will have to pay them anyway.
Finally if you are going to be an AMG you should try for a specialty with higher earning potential than IM unless you want to be cards or GI.
Only my 2 cents.
Good luck



I think this is poor advice for several reasons.

1) Despite what most think, a bankruptcy does not disappear from your record. True, it's effects will be off your credit reports after 10 years, but you will still be required to disclose this on various forms for the rest of your life. This will not be limited to credit issues. It may effect your ability to rent residential or commercial real estate, your ability to get a security clearance, job applications, professional licensure, et al. It never goes away.

2) After the 2007 bankruptcy "reforms", a personal ch. 7 is quite difficult. A ch 13 "restructuring" is now much more common -- this merely restructures your debt without discharge it (or at least not all of it). Even so, If you file, your petition could get rejected if the court believes that you have the ability to make money in the future. There will be little sympathy for a student/resident who has an enormous future earning potential.

3) Don't base your future specialty primarily on income. All doctors make good money. Pick a specialty that you love -- you are going to be doing it for a long time.

4) What you really need to do is relax about the debt. Minimize expenses. Put off other costly life decisions as long as possible (having children, buying a house). Once you graduate from residency, you should easily be able to find a job paying > $120K. At that point, resist the temptation to "cash-in" and "live large". Continue to live like a resident pauper for another 2-3 years and you will be able to cut that debt way back (easily by more than $100K). Moonlight, work like a dog. Then after the debt is under control, ease up a little bit. You can do it.

Ed

I think this is poor advice for several reasons.

1) Despite what most think, a bankruptcy does not disappear from your record. True, it's effects will be off your credit reports after 10 years, but you will still be required to disclose this on various forms for the rest of your life. This will not be limited to credit issues. It may effect your ability to rent residential or commercial real estate, your ability to get a security clearance, job applications, professional licensure, et al. It never goes away.

2) After the 2007 bankruptcy "reforms", a personal ch. 7 is quite difficult. A ch 13 "restructuring" is now much more common -- this merely restructures your debt without discharge it (or at least not all of it). Even so, If you file, your petition could get rejected if the court believes that you have the ability to make money in the future. There will be little sympathy for a student/resident who has an enormous future earning potential.

3) Don't base your future specialty primarily on income. All doctors make good money. Pick a specialty that you love -- you are going to be doing it for a long time.

4) What you really need to do is relax about the debt. Minimize expenses. Put off other costly life decisions as long as possible (having children, buying a house). Once you graduate from residency, you should easily be able to find a job paying > $120K. At that point, resist the temptation to "cash-in" and "live large". Continue to live like a resident pauper for another 2-3 years and you will be able to cut that debt way back (easily by more than $100K). Moonlight, work like a dog. Then after the debt is under control, ease up a little bit. You can do it.

Ed

Thats great advice!

4) What you really need to do is relax about the debt. Minimize expenses. Put off other costly life decisions as long as possible (having children, buying a house). Once you graduate from residency, you should easily be able to find a job paying > $120K. At that point, resist the temptation to "cash-in" and "live large". Continue to live like a resident pauper for another 2-3 years and you will be able to cut that debt way back (easily by more than $100K). Moonlight, work like a dog. Then after the debt is under control, ease up a little bit. You can do it.

Ed

Agreed. I think most people let loose after residency because they get this "shock" salary that's several times (possible 3-6x) their resident income. Then they pay the minimum payments on their debt, buy the house/car/boat they want, and then it takes them a decade or two to pay off their loans.

If I were in their position, I would live humbly for the next 5 years after residency (rent a small apartment), get rid of all that debt (especially with 6.8% interest nowadays) and then when all that's been paid off start purchasing bigger things.

As for internal medicine, it might very well be hard to pay off 300K, but is completely doable if you live humbly for the first 5 years or so after residency. If you're making 150K (or more, if a hospitalist (some make 200K starting out)), after taxes that 80K after taxes. A single person can live very reasonably on 30K net income a year - heck, even a couple can live reasonably on that. That comes to 50K of cash each year which could pay your debt > 6 years and you're debt free (not counting the fact that your salary will likely increase during that time as well).

edmadison and mercap thanks for the advice.

There's one additional variable that concerns me: the impending healthcare reform.

While it is feasible to payback $300k with current salaries, what will happen if they are reduced as much as some say? A sub $100k income (specialty dependent) would make loan repayment much more difficult.

HPSP isn't looking too bad all of the sudden.

Hmm, Im not so sure about this thread and the responses so far.

I dont even want to respond much past that some of the stuff Im reading here is bordering on ridiculous, the self employed do not pay double the maximum social security withholdings...

300K debt burden is NOTHING to sneeze it. You are coming to grips with the mathematical reality of that level of indebtness and unlike Obama you cant print Ben Franklins freely to make it go away.

You have a challenge, a very serious one. I suggest you man up and tackle it.

Be focused, sincere and aware but do not be despondent.

Your life is not at risk, you will make it.