I'm 6 figures deep in debt from school, and with an interest rate of 7%, I feel like I'm suffocating. Does anyone have recommendations for high-paying residency programs?
I'm 6 figures deep in debt from school, and with an interest rate of 7%, I feel like I'm suffocating. Does anyone have recommendations for high-paying residency programs?
I'm 6 figures deep in debt from school, and with an interest rate of 7%, I feel like I'm suffocating. Does anyone have recommendations for high-paying residency programs?
Public Service Loan Forgiveness. Residency, then work for a non-profit (Academic, Jail, State Hospital. Or your own "non-profit" practice. Pay loans for 10 years under IBR (actually pay as you earn is even cheaper), and all remaining balances are forgiven. Poof. You're welcome.
There is no contract for this. The possibility of this loophole being closed is high when the public gets wind of all the people earning $200K/year wiping out their entire school debt with a program designed for teachers and social workers.Public Service Loan Forgiveness. Residency, then work for a non-profit (Academic, Jail, State Hospital. Or your own "non-profit" practice. Pay loans for 10 years under IBR (actually pay as you earn is even cheaper), and all remaining balances are forgiven. Poof. You're welcome.
You can avoid that by filing "married filing separately." Just use turbotax or whatnot to estimate what kind of tax hit you'll take from filing separately. If it's not too bad, you can do IBR just based on your income.I was interested in this route until I was informed that my wife's salary would be used in calculating the monthly payment. The math came out to 50k/year toward the loan. At that rate, I realized I was not going to have problems with a remaining balance after 10 years...
I was interested in this route until I was informed that my wife's salary would be used in calculating the monthly payment. The math came out to 50k/year toward the loan. At that rate, I realized I was not going to have problems with a remaining balance after 10 years...
There is no contract for this. The possibility of this loophole being closed is high when the public gets wind of all the people earning $200K/year wiping out their entire school debt with a program designed for teachers and social workers.
You can avoid that by filing "married filing separately." Just use turbotax or whatnot to estimate what kind of tax hit you'll take from filing separately. If it's not too bad, you can do IBR just based on your income.
It'd be a pretty cold shot to not grandfather all the people currently making the effort.
No one is really going to care... I ran the numbers and assuming I did a fellowship then, the eventual cost would equal somewhere between a zero% interest loan and actually making money on the deal as the total payment would be less than the disbursement of the loan. The loophole is going to close and it's going to close hard.
Well fortunately for those of us now starting residency, we'll at least get to see how they first respond prior to our job search.
Public Service Loan Forgiveness. Residency, then work for a non-profit (Academic, Jail, State Hospital. Or your own "non-profit" practice. Pay loans for 10 years under IBR (actually pay as you earn is even cheaper), and all remaining balances are forgiven. Poof. You're welcome.
i understand that you still pay income tax on the amount forgiven though, no? depending on one's debt and the interest accumulating, its not as sweet as it sounds.. but still will save money for most folks
No, you don't pay tax with PSLF.
Well fortunately for those of us now starting residency, we'll at least get to see how they first respond prior to our job search.
From what I understand MCW could be a great program in the midwest for good pay and good moonlighting. Salary is $54k and you could start moonlighting PGY-2. Milwaukee is very inexpensive as well.
I would agree with others who have said that moonlighting is where you are going to be able to make the difference, not in your salary. You can add $10-15K easily to your salary per year moonlighting. I would look for a program in a city with a low cost of living (no Boston or New York!) where you can moonlight starting in PGY3. I don't know if there are places where you can moonlight during PGY2.
I would also check out the call schedule for PGY3. The less call you have, the more you can moonlight, and the less stressed you will feel by doing both moonlighting and call.
I don't know if there are places where you can moonlight during PGY2.
I would also check out the call schedule for PGY3. The less call you have, the more you can moonlight, and the less stressed you will feel by doing both moonlighting and call.
Is it unusual for a program contractually limit moonlighting to their institution only, preventing residents from finding their own (possibly better paying) gigs? How would they found out if you just did your own thing anyway? Kinda lame to mess with your nonresidency free personal time.
I haven't heard of programs doing this. I'm sure some do, but I wouldn't call it the norm. My place allows in-house moonlighting starting in PGY-2. The only limitations (other than hour restrictions) for doing moonlighting after that is that many places I contacted don't hire pre-PGY-3's.Is it unusual for a program contractually limit moonlighting to their institution only, preventing residents from finding their own (possibly better paying) gigs? How would they found out if you just did your own thing anyway? Kinda lame to mess with your nonresidency free personal time.
?Free personal time? What's that? We OWN you.
But seriously...you will need your program's reference to be credentialled to work as a physician somewhere else. And, unless you intend to lie, which would be most unprofessional of you, moonlighting applies to your duty hours reporting.
Yes I understand that. But what I am saying is a program should not say, "yes you can moonlight...but only for us." Especially when there are NO in house opportunities at all. Even if there were plentiful opportunities, we should be able to moonlight wherever we want, as long as its within the 80 hr limit, no?
I'm 6 figures deep in debt from school, and with an interest rate of 7%, I feel like I'm suffocating. Does anyone have recommendations for high-paying residency programs?
Yes I understand that. But what I am saying is a program should not say, "yes you can moonlight...but only for us." Especially when there are NO in house opportunities at all. Even if there were plentiful opportunities, we should be able to moonlight wherever we want, as long as its within the 80 hr limit, no?
Since the new work hour rules were put into place, there has been no pgy1 moonlighting allowed per ACGME. I was moonlighting as a pgy1.
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most programs are going to approve *most* external moonlighting opportunities.....the only ones they likely wouldn't approve are shady or ethically questionable ones(such as non-physicians employing a psychiatry resident to be an adderall mill) or external moonlighting gigs that overlap with what should be time working on a rotation as part of the residency program.....
usually most moonlighting is done on the weekends or evenings/nights when pgy-3's and 4's are not going to have any responsibilities with the residency program.
Furthermore, duty hours for pgy 3's and 4s are never going to be an issue with moonlighting. I moonlight what is considered a bunch probably(probably make 90k or so this year doing it), but I've never even come remotely close to a work hours violation.....also keep in mind that I think you can go over 80 hrs one week, so it's the average over like 4 weeks that matters.....so if your hours(rotations + moonlighting) were 90 hrs, 60 hrs, 40 hrs, 65 hours you would be way way under the hour limits.
but basically, unless your external moonlighting gig is really ridiculous, the program is going to ok it. If word got out that a psych program was trying to make moonlighting difficult for pgy3's and 4's, that wouldnt be good for the program in terms of its ability to attract decent people.
I sometimes wonder how much of a concern this is to some programs, as they know they willl fill regardless, or how concerned programs are in general about their residents, as some display their level of resident investment right at the start by having substantially lower salaries in the first place as compared to other local programs. Makes one want to pursue higher paying moonlighting gigs just to catch up to the status quo, and to deal with those programs as little as possible outside of the minimum hours required for the actual residency.
No. My program has internal and external opportunities, but they don't approve every external opportunity for various reasons. Internal opportunities offer significant protection and easier access to supervision. Our external opportunities are arranged so our internal malpractice covers us (they take a small cut, but it's reasonable). Moonlighting is a privilege, not a right, as long as you are bound to the acgme contract renewal you sign every year.
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What do you mean it is a privilege? How on earth can it be a "privilege" to be "allowed" to work for a reasonable wage on top of working for peanuts for years in a situation that can only be described as Dickensian, whilst meanwhile your medical school loans have accumulated nearly as much in interest over the last four years as you've made in salary during that entire period? Are you applying for the job of Program Director somewhere?
And in fact, it IS a right. Assuming you've passed Step 3, you can quit your job after intern year, get a state medical license, and "moonlight" until you hit Medicare age at some urgent care place if you so choose. That's called "working."
I moonlight only so as to accumulate dough to pay off the capitalized interest on my loans, not so I can buy some Porsche or whatever or take off for weeks at a time to Bora Bora. Only my PD would describe this situation as a "privilege."
It's a "privilege" because THEY have the "right" to revoke your ability to moonlight and maintain good standing in your program. You certainly have the right to leave a residency program and work. Just like many jobs have non-competes that don't let you work for other agencies, your residency program determines what you're allowed to do without jeopardizing your position in the program. You're simply not entitled to do whatever you want while you're a resident unless you want to have your position threatened.
As vistaril rightly points out, most places place few or only reasonable restrictions, but work too many hours, the wrong hours, not having enough time between shifts, etc., and your program can revoke your moonlighting or put you on probation, and that sort of thing can have repercussions down the line when credentialing applications or even state license applications ask if there's ever been any disciplinary action against you (according to my state board at least, and our local managed care company, such academic--that's what it would be considered--probation counts, and not reporting it can cause you problems).
This stuff clearly happens rarely, but it doesn't do anybody any good to go into these situations feeling entitled when you don't really hold the cards.
+1. It's perfectly reasonable for any employer to restrict you from taking other jobs. Especially if you agreed to that policy when you accepted the job. Moonlighting policy is usually out in the open at the residency interview.
i think it's important to remember a few things(which I've partly already touched on):
1) Programs don't have any interest/anything to gain from pgy3-4 residents *not* moonlighting. Why would they care if I'm covering a unit on the weekend an hour away vs playing golf?
2) Programs generally want happy residents. I would imagine it would be *very difficult*(in already difficult field from the programs perspective) to recruit decent candidates if all the pgy3+ residents are bitter and resentful towards the program, which a no(or unreasonably limited) moonlighting policy would generate. Applicants pick up on those vibes.
3) Any program that prevented pgy-3 residents from moonlighting would likely justify it on the basis of the resident 'not being ready' for such clinical duties. If that were the case, you can bet the residents who want to moonlight would attack each subsequent rotation they are on for every little detail that isn't designed to maximize training/education experience. Programs don't want to have to deal with this.
So while in theory the program does have total control over your ability to moonlight, the reality is that these things are going to practically limit it, or We did have one resident a couple of years ago have a moonlighting job rejected, but it was truly some ridiculous gig that screamed pill mill.
Exactly. And by "not ready clinically," they really mean if you're struggling in your program.How it was explained to me was that they really only care if: it is a shady place to moonlight, you are over duty hours, or not ready clinically.
It's a "privilege" because THEY have the "right" to revoke your ability to moonlight and maintain good standing in your program. You certainly have the right to leave a residency program and work. Just like many jobs have non-competes that don't let you work for other agencies, your residency program determines what you're allowed to do without jeopardizing your position in the program. You're simply not entitled to do whatever you want while you're a resident unless you want to have your position threatened.
As vistaril rightly points out, most places place few or only reasonable restrictions, but work too many hours, the wrong hours, not having enough time between shifts, etc., and your program can revoke your moonlighting or put you on probation, and that sort of thing can have repercussions down the line when credentialing applications or even state license applications ask if there's ever been any disciplinary action against you (according to my state board at least, and our local managed care company, such academic--that's what it would be considered--probation counts, and not reporting it can cause you problems).
This stuff clearly happens rarely, but it doesn't do anybody any good to go into these situations feeling entitled when you don't really hold the cards.
I know of a couple of programs that have no moonlighting pgy3 , some but little moonlighting pgy4. One of them somehow manages to get over 14 residents every year ... During the interview season, moonlighting seemed a bit of a secret thing to talk about at a lot of programs.
That's because you're supposed to go to your interviews acting like you are eager to work for absolutely free, you are so enthusiastic about learning the essentials of psychiatry and providing care to patients that the thought of compensation hasn't even crossed your mind and to be honest you'd feel more comfortable just not discussing that part of it, and maybe not even being compensated seeing as that could corrupt the purity of your learning experience.
There are definitely programs that will accommodate this wish.
My point is, you SOUNDED like a PD in your post above what with using admin-speak. Now normally you don't sound like a PD... unless you've gotten a new job?
You know, I was chasing this white rabbit the other day, and he went in this hole, and...
Folks in non-psychiatric fields moonlight a LOT less than we do (for lots of good reasons), and even the very good program at my medical school allowed very little moonlighting (at least, there wasn't much available that didn't involve a long drive, and even then, not much). There have been people at my program who have seriously pushed the limits of what they should be able to do and almost ruined it for the rest of us by being idiots. So when I say it's a privilege, I'm talking to the people who were moonlighting 50-60 hours a week despite being given multiple warnings and violating duty hours left and right.