Speculating about loans and paying them off?

[orangecremely]

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[Thesimplelifeofamyloid]

Probably avoid family medicine if that's the case. It can be done, but it will be a lot harder.

 

[howdoiknow]

Do you plan on working full time for the first 5-10 years out of residency? Asking because 50% of female physicians tend to quit or go part-time. If the answer is yes then expect $220-$240k for FM (pre-tax) and closer to $300k in the south/midwest (my friends are all signing for this much 4.5 days/week).

It should be easy to refinance and pay it off in 3 years then live like a king for the rest of your life.

The trap I see many fall into is leasing a brand new BMW DURING residency (it's okay if you buy a 3-4 year old used non-performance model lexus and maintain it). Or throwing a $200k 3-day wedding first year as an attending. Then you gotta keep up with the appearances so buy a $800k house with 0% down (physician mortgage) and a $80k luxury SUV. Don't do that for 2-3 years and you'll be fine

 

[ACSurgeon]

Okay disclaimer: I’m a premed and just am having anxiety on how feasible it is to pay off my loans by myself if I go to medical school.

So I recently read of a study where it said a majority of the medical students have parents who paid for their education. I will be taking out loans and self-paying, so average tuition and living costs amount to 70k and in 4 years that’s 280k, and adding in interest, it’s going to be quite a load. Suppose that I match into family medicine and get a salary of 180k, how reasonable is it to pay off all of my student loans within 4-5 years? I’m not afraid to live super frugally, btw. That means no new car, no housing, no lavish dining and stuff. I do want to help my parents with their living expenses though, so a percentage of my earning will be dedicated to them.

If you become an attending the financial aspect will work out better than most other things you could have done. Sure; you’ll be behind those with no loans, but by no means will you be poor or unable to pay the loans.

It seems like the loan forgiveness options are becoming more realistic to happen, but no guarantee. I am just finishing up paying over 400k in loans in the next year (five year plan). So yea it’s doable.

 

[Obnoxious Dad]

Okay disclaimer: I’m a premed and just am having anxiety on how feasible it is to pay off my loans by myself if I go to medical school.

So I recently read of a study where it said a majority of the medical students have parents who paid for their education. I will be taking out loans and self-paying, so average tuition and living costs amount to 70k and in 4 years that’s 280k, and adding in interest, it’s going to be quite a load. Suppose that I match into family medicine and get a salary of 180k, how reasonable is it to pay off all of my student loans within 4-5 years? I’m not afraid to live super frugally, btw. That means no new car, no housing, no lavish dining and stuff. I do want to help my parents with their living expenses though, so a percentage of my earning will be dedicated to them.

Your choice of specialty is only one of several factors that determine your ability to pay back loans. A big key is the state in which you practice because salaries and cost of living vary markedly by state. If you practice in New York City your salary relative to your cost of living will be lousy and it will take you forever to pay off your loans. However, if you live in Appleton, Wisconsin your salary would be higher, your cost of living will be chump change and you can pay your loans off in five years. Check this out from the Bureau of Labor Statistics:

Family Medicine Physicians

www.bls.gov

Furthermore, from the outset you need to be frugal. Minimize your undergraduate loans. If you can get into your public home state medical school, go there. Do a lot of soul searching about cost of living in cities where you might train as a resident.

Good luck.

 

[Damson]

If you become an attending the financial aspect will work out better than most other things you could have done. Sure; you’ll be behind those with no loans, but by no means will you be poor or unable to pay the loans.

It seems like the loan forgiveness options are becoming more realistic to happen, but no guarantee. I am just finishing up paying over 400k in loans in the next year (five year plan). So yea it’s doable.

how can one repay 400k in 5 years? that's insane!

 

[ACSurgeon]

how can one repay 400k in 5 years? that's insane!

By working hard and living well below their means.

 

[howdoiknow]

how can one repay 400k in 5 years? that's insane!

It's not insane. One can pay $800k in 5 years. There was a psych resident on here who paid off $300k in two years moonlighting as a RESIDENT. The key is to not be attached to east/west coast. From talking to residents in my desired specialty most are making $65k base pay + another $60k+ moonlighting (with TONS of opportunities).

I'm going to stereotype a bit here but you need an immigrant mentality. Just look at how so many Indians can afford $200k weddings. It's because they're meticulous with their finances. They know where every dime comes and goes. They research the best investments for retirements, the best cars for your buck (obviously they splurge on BMWs once they have the money like anyone else, but will typically drive an accord or a camry first).

There are families of 4 living just fine on $30k/year (with some gov help obviously) and some doing it on their own with $50k.

As a resident you're *surviving* on $60k/year
in any non-major city: 15k rent, $3k food/take out (more than enough assuming your hospital gives u $3k/yr for cafe food), $8k/yr nice reliable car, $5k leisure activities. This is $31k to live pretty decently (you can cut it down even more if u live at home/partner/more frugal). You'd have $15-$20k left (assuming you invested $0 but its probably best to match 401k/etc)

Now you become a family doc making $250k ($170k post-tax) or $300k ($200k post-tax) in my area. If you're married and business-savvy you can further reduce your tax burden, but let's assume you're financially incompetent and give the gov a big chunk of your earnings.

Even if you double your lifestyle cost from when you were a resident to $62k (its REALLY hard to spend this much if you're single but let's assume you're eating steak, lobster, and champagne everyday), you'd still have $110k left, if you saved $30k you now have $80k ($400k in 5 years). If you made $200k post-tax it would be even easier.

If you worked semi-rural (literally 1 hr drive from me you can get a $300k/yr job with $200k loan repayment). This 1 hour drive is nearly traffic-free all year long. It's better than the 20 minute drive to the city job that pays $240k because that 20 min drive turns into 1+ hours in the winter/traffic w/tons of accidents.

 

[Candidate2017]

how can one repay 400k in 5 years?

The usual ways like getting an inheritance, winning the lottery, marrying/divorcing well, playing on an NFL practice squad for 5 years. If none of those are available, get an attending physician job

 

[GoSpursGo]

Moving to pre-med.

 

[YCAGA]

how can one repay 400k in 5 years? that's insane!

It is insane that this surprises so many medical students and residents, and even attendings. It feels like almost no one sits down and does the math (that takes like 10 minutes) to see that a huge salary combined with living a comfortable but middle-class lifestyle for a few years means that you can pay off pretty much any debt burden as a physician in the US.

 

[howdoiknow]

It is insane that this surprises so many medical students and residents, and even attendings. It feels like almost no one sits down and does the math (that takes like 10 minutes) to see that a huge salary combined with living a comfortable but middle-class lifestyle for a few years means that you can pay off pretty much any debt burden as a physician in the US.

When I was applying to med school I calculated the worst-case scenario was to attend a brand new DO school which cost $400k + remediating 1 year ($80k) + previous debt ($70k) + ballooning to $600k+ during residency, and SOAPing into FM. Even with this worst-case scenario my quality of life would have been much better than just about any other job I was qualified for. Meanwhile, I see premeds (and med students) freak out about spending $40 for a logitech 720p camera for interviews.... Thankfully I am attending an affordable MD school that has opened me many doors into competitive specialties.

 

[Ms Procrastinator]

Don't sweat it too much OP. As long as you're responsible, the amount of debt you end up with should be manageable.

 

[voxveritatisetlucis]

You shouldn’t go into medicine for the money, but even with 300,000 in loans, medical school would still have a positive net present value.

 

[ALNMD2018]

It's not insane. One can pay $800k in 5 years. There was a psych resident on here who paid off $300k in two years moonlighting as a RESIDENT. The key is to not be attached to east/west coast. From talking to residents in my desired specialty most are making $65k base pay + another $60k+ moonlighting (with TONS of opportunities).

I'm going to stereotype a bit here but you need an immigrant mentality. Just look at how so many Indians can afford $200k weddings. It's because they're meticulous with their finances. They know where every dime comes and goes. They research the best investments for retirements, the best cars for your buck (obviously they splurge on BMWs once they have the money like anyone else, but will typically drive an accord or a camry first).

There are families of 4 living just fine on $30k/year (with some gov help obviously) and some doing it on their own with $50k.

As a resident you're *surviving* on $60k/year
in any non-major city: 15k rent, $3k food/take out (more than enough assuming your hospital gives u $3k/yr for cafe food), $8k/yr nice reliable car, $5k leisure activities. This is $31k to live pretty decently (you can cut it down even more if u live at home/partner/more frugal). You'd have $15-$20k left (assuming you invested $0 but its probably best to match 401k/etc)

Now you become a family doc making $250k ($170k post-tax) or $300k ($200k post-tax) in my area. If you're married and business-savvy you can further reduce your tax burden, but let's assume you're financially incompetent and give the gov a big chunk of your earnings.

Even if you double your lifestyle cost from when you were a resident to $62k (its REALLY hard to spend this much if you're single but let's assume you're eating steak, lobster, and champagne everyday), you'd still have $110k left, if you saved $30k you now have $80k ($400k in 5 years). If you made $200k post-tax it would be even easier.

If you worked semi-rural (literally 1 hr drive from me you can get a $300k/yr job with $200k loan repayment). This 1 hour drive is nearly traffic-free all year long. It's better than the 20 minute drive to the city job that pays $240k because that 20 min drive turns into 1+ hours in the winter/traffic w/tons of accidents.

Can you please elucidate the numbers for resident earning more? Thank you!

 

[sylvester500]

Can you please elucidate the numbers for resident earning more? Thank you!

From what I have read online, moonlighting during residency can net you some good cash. Local IM residency gives PGY3s $1800 per ICU shift work, or $1200 per general hospital shift worked. Do one each of those per month: 1200+1800 = 3000. $3000/mo. x 12 mo = 36k per year extra. 24 hours extra work per month gets you basically a living wage on top of an already livable wage. The 60k can similarly be achieved with more work (just add one more ICU shift per month).

Boom. You're a king/queen in residency, if you're willing to work for it.

 

[Blueprint Med School]

Have you thought about PSLF, serving in the Military, or Rural Family Medicine scholarship options?

Ditto about moonlighting. Especially now in the era of short staffing, there is shifts to be taken and loan payments to be made.

David D, MD - USMLE and MCAT Tutor
Med School Tutors

 

[deleted50541]

There are so many factors that come into play here and a lot of good advice has already been given.

I think you need to change your frame of mind about paying for med school. You need to think about it as an upfront investment that will pay strong dividends down the line.

Learning to budget too is a critical skill to develop. With appropriate planning and an anticipated high earning potential, it's not unreasonable to have your student loans paid off in your first few years of practice if that's your goal.

As I heard time and time again, continue to live like a resident those first few years and pay down your debts.

 

[kaycee18]

Is there a chance all student loans will be wiped out by Biden?

 

[jamaica jan sun princess]

Dave Ramsey fans would disagree with this strategy, but I plan on refinancing them at 2.5-3.5% and paying them off over 10-15 years. After so many years of delayed gratification and with no guarantees about how long I'll live, I'd rather enjoy some of the fruits of my labor sooner rather than later. It would suck to work like a dog for the first five years just to be diagnosed with a terminal illness or have an accident. Life is too short.

 

[howdoiknow]

Dave Ramsey fans would disagree with this strategy, but I plan on refinancing them at 2.5-3.5% and paying them off over 10-15 years. After so many years of delayed gratification and with no guarantees about how long I'll live, I'd rather enjoy some of the fruits of my labor sooner rather than later. It would suck to work like a dog for the first five years just to be diagnosed with a terminal illness or have an accident. Life is too short.

Dave Ramsey is for the average american that never pays off a $50 credit card bill and can't budget a birthday party. Every professional with a graduate degree should have the 2 neurons required to take advantage of credit card bonuses and refinance to 2% while aggressively investing in the market for 7-9% YOY returns (while young and can work tons)

 

[KnightDoc]

Is there a chance all student loans will be wiped out by Biden?

For doctors? Approximately 0.00%.

 

[howdoiknow]

For doctors? Approximately 0.00%.

The US is REALLY terrible at customizing their laws and they're usually all or nothing (like freezing student loans whether you're a teacher making $30k or a derm making $500k).

If biden, congress, or santa claus decided to cancel loans it wouldn't exclude doctors or have any wording like that. I could see income limits imposed but definitely it will not explicitly say "everyone but doctors"

 

[KnightDoc]

The US is REALLY terrible at customizing their laws and they're usually all or nothing (like freezing student loans whether you're a teacher making $30k or a derm making $500k).

If biden, congress, or santa claus decided to cancel loans it wouldn't exclude doctors or have any wording like that. I could see income limits imposed but definitely it will not explicitly say "everyone but doctors"

Of course not "everyone but doctors"! It's probably not happening at all. If anything happens, I'm pretty sure it will be limited in scope, and I'm VERY comfortable making a blanket statement that any income limits would exclude doctors.

There is no way anyone in government is going to mandate that American taxpayers take care of student loans for the 1%, or 5%, or whatever doctors are. Period.

The freeze that's about to end is a terrible example to extrapolate from. It was implemented during an emergency, and there was no opportunity to make rules and then process applications. The same would never happen with loan forgiveness.

 

[howdoiknow]

Of course not "everyone but doctors"! It's probably not happening at all. If anything happens, I'm pretty sure it will be limited in scope, and I'm VERY comfortable making a blanket statement that any income limits would exclude doctors.

There is no way anyone in government is going to mandate that American taxpayers take care of student loans for the 1%, or 5%, or whatever doctors are. Period.

The freeze that's about to end is a terrible example to extrapolate from. It was implemented during an emergency, and there was no opportunity to make rules and then process applications. The same would never happen with loan forgiveness.

How do you differentiate doctors who are in long residencies/research or switch specialties? There's a considerable amount of doctors that will make <90k for 5-10 years. Or doctors working part time in a saturated market, or at an NGO that pays peanuts. Can't make a blanket statement like that.

 

[KnightDoc]

How do you differentiate doctors who are in long residencies/research or switch specialties? There's a considerable amount of doctors that will make <90k for 5-10 years. Or doctors working part time in a saturated market, or at an NGO that pays peanuts.

The answer is that most examples you are asking about would be covered by PSLF, for as long as it lasts in its current form. I have no answer for someone working part time in a saturated market.

Maybe that would be an exception, and I'd have to modify my blanket statement to specify full time doctor, although I'm quite sure they would be smart enough to not allow people with high earning potential to temporarily bring their income under a threshold in order to wipe out hundreds of thousands of dollars in debt.

Also, for the record, I really did not report anything here.

 

[frosted2]

Dave Ramsey is for the average american that never pays off a $50 credit card bill and can't budget a birthday party. Every professional with a graduate degree should have the 2 neurons required to take advantage of credit card bonuses and refinance to 2% while aggressively investing in the market for 7-9% YOY returns (while young and can work tons)

I got a GOOD laugh out of this. Thanks!!!!!



Credit card churning is a fantastic hobby.

 

[Moko]

For transparency: moderators may edit/remove content that is inappropriate for our forums even without the content being reported by other users. Personal attacks are never appropriate on these forums. Reasonable people can disagree on matters of substance, and it is possible to disagree without being disagreeable. Thank you for your understanding.

For everyone else, here's a random comic:

 

[Blueprint Med School]

Dave Ramsey is for the average american that never pays off a $50 credit card bill and can't budget a birthday party. Every professional with a graduate degree should have the 2 neurons required to take advantage of credit card bonuses and refinance to 2% while aggressively investing in the market for 7-9% YOY returns (while young and can work tons)

I am a big Ramsey fan and I do agree with this to a degree. While I do think he is truly onto something (and well supported by research) on the Cash is King philosophy as far as 'cash in hand is harder to spend on the heart than a card in hand' there are a ton of little upgrades that can increase ones efficency. For example, you simply have to pay your utilities and HVAC and other stuff like that online, using cash is inefficient when you can route those bills through a credit card and get rewards through it. Where I think he shines is philosophy like "slightly used is the gold standard".

TL;DR - Master his fundamentals of living efficiently and below your means and then add the advanced tactics like 'howdoiknow' mentioned.

David D, MD - USMLE and MCAT Tutor
Med School Tutors

 

[cincincyreds]

Okay disclaimer: I’m a premed and just am having anxiety on how feasible it is to pay off my loans by myself if I go to medical school.

So I recently read of a study where it said a majority of the medical students have parents who paid for their education. I will be taking out loans and self-paying, so average tuition and living costs amount to 70k and in 4 years that’s 280k, and adding in interest, it’s going to be quite a load. Suppose that I match into family medicine and get a salary of 180k, how reasonable is it to pay off all of my student loans within 4-5 years? I’m not afraid to live super frugally, btw. That means no new car, no housing, no lavish dining and stuff. I do want to help my parents with their living expenses though, so a percentage of my earning will be dedicated to them.

Honestly I would be more worried about getting a residency after attending medical school.

 

[IlDestriero]

The US is REALLY terrible at customizing their laws and they're usually all or nothing (like freezing student loans whether you're a teacher making $30k or a derm making $500k).

If biden, congress, or santa claus decided to cancel loans it wouldn't exclude doctors or have any wording like that. I could see income limits imposed but definitely it will not explicitly say "everyone but doctors"

No, but they are very good a phasing out benefits by taxable income. They do it all the time. That’s why I say you shouldn’t bet the farm on getting your debt forgiven. They could easily attach an income limit and phase out.

 

[voxveritatisetlucis]

I think that there are a significant amount of med students and doctors who are out of touch with economic realities of the general public. Most make anywhere between 3 to 5 times the median income, yet consider themselves middle to upper-middle class. the average person considers these salaries “upper class”/97th percentile.

 

[ALNMD2018]

From what I have read online, moonlighting during residency can net you some good cash. Local IM residency gives PGY3s $1800 per ICU shift work, or $1200 per general hospital shift worked. Do one each of those per month: 1200+1800 = 3000. $3000/mo. x 12 mo = 36k per year extra. 24 hours extra work per month gets you basically a living wage on top of an already livable wage. The 60k can similarly be achieved with more work (just add one more ICU shift per month).

Boom. You're a king/queen in residency, if you're willing to work for it.

Thank you so much for this! I was curious if you have any idea how research/grants can add to this? Numbers wise...

 

[Med Ed]

From what I have read online, moonlighting during residency can net you some good cash. Local IM residency gives PGY3s $1800 per ICU shift work, or $1200 per general hospital shift worked. Do one each of those per month: 1200+1800 = 3000. $3000/mo. x 12 mo = 36k per year extra. 24 hours extra work per month gets you basically a living wage on top of an already livable wage. The 60k can similarly be achieved with more work (just add one more ICU shift per month).

Boom. You're a king/queen in residency, if you're willing to work for it.

Moonlighting can be great, especially now that hourly rates have increased, but a few caveats:
1. You have to be competent enough to perform the work. The example you cite is for PGY-3's, who spent the PGY-1 and PGY-2 years getting licensed and gathering enough experience to actually do the shifts.
2. If you're single the money you earn will likely be taxed at the 22% rate, plus payroll and any state taxes. If you are on IBR then increased income will also increase your loan repayment. If the moonlighting is intended to repay debt then this isn't a problem.
3. You will still be subject to ACGME work hour limits, so depending on your schedule moonlighting may only be possible on your "easy" months.
4. Moonlighting typically has to be approved by the program. If you go outside and try to do something "off the books" you may be responsible for acquiring your own malpractice coverage.
5. If you have a spouse and/or kids, you may prefer to spend your precious free time with them instead of slogging through another 12+ in the ICU.

 

[collegestud2013]

Okay disclaimer: I’m a premed and just am having anxiety on how feasible it is to pay off my loans by myself if I go to medical school.

So I recently read of a study where it said a majority of the medical students have parents who paid for their education. I will be taking out loans and self-paying, so average tuition and living costs amount to 70k and in 4 years that’s 280k, and adding in interest, it’s going to be quite a load. Suppose that I match into family medicine and get a salary of 180k, how reasonable is it to pay off all of my student loans within 4-5 years? I’m not afraid to live super frugally, btw. That means no new car, no housing, no lavish dining and stuff. I do want to help my parents with their living expenses though, so a percentage of my earning will be dedicated to them.

The days of full-time FM docs salaries only making $180k are largely gone. Doing full-time FM/IM work nowadays either as PCP or hospitalist setting these days should get you to at least low $300ks after including bonuses (assuming it's not academics or the VA, where pay is still in the low to mid $200s, and not in highly saturated market). If you work a bit more than average (eg taking extra shifts as a hospitalist) you can hit $400k+ in most markets without completely burning yourself out. Also keep in mind that FM/IM have the shortest residencies (3 years vs 5-7 years for many specialists) so you'll be able to start paying the loans of sooner.

But yes, $280k + interest is going to be a lot not matter what specialty you go into. Hopefully you have a cheaper in-state school option or can get at least partial scholarship/financial aid to reduce the burden.

 

[frosted2]

The days of full-time FM docs salaries only making $180k are largely gone. Doing full-time FM/IM work nowadays either as PCP or hospitalist setting these days should get you to at least low $300ks after including bonuses (assuming it's not academics or the VA, where pay is still in the low to mid $200s, and not in highly saturated market). If you work a bit more than average (eg taking extra shifts as a hospitalist) you can hit $400k+ in most markets without completely burning yourself out. Also keep in mind that FM/IM have the shortest residencies (3 years vs 5-7 years for many specialists) so you'll be able to start paying the loans of sooner.

But yes, $280k + interest is going to be a lot not matter what specialty you go into. Hopefully you have a cheaper in-state school option or can get at least partial scholarship/financial aid to reduce the burden.

I read the first sentence and thought this was going to be doom and gloom... I was pleasantly surprised by the rest of it. Do you think this trend of preferring things stay with PCPs (and the income increase) will eventually trickle over to pediatrics as well or will peds pretty much be stuck where it is in terms of income? I only ask because I'll have right at/over half a mil when I am done with everything.

 

[collegestud2013]

I read the first sentence and thought this was going to be doom and gloom... I was pleasantly surprised by the rest of it. Do you think this trend of preferring things stay with PCPs (and the income increase) will eventually trickle over to pediatrics as well or will peds pretty much be stuck where it is in terms of income? I only ask because I'll have right at/over half a mil when I am done with everything.

I think there's slowly a trend to shift reimbursements to more closely balance supply and demand. It's pretty well known that in the past there's a large income disparity between PCP and the higher paying specialists thus there's too many specialists and not enough PCPs. In the last decade since Obamacare was passed the trend from CMS has been to slowly increase reimbursements for primary care while largely decreasing reimbursements for most specialists (often done by lowering reimbursements for procedures that are usually done by specialists), and private insurance reimbursements usually change in the same direction as CMS reimbursements. Many of the older internists will tell you that there wasn't much money doing general IM a few decades ago but now they are making more per hour than before (even when adjusted for inflation) as IM hospitalists. And some will say primary care right now is the hidden gem with the pay you can get for the amount of work. I suspect the trend will continue until pay for procedural specialists is only slightly higher than for primary care on an hourly basis. This combined with the longer training time of specialists will then give people less financial incentive specialize. T

The high salaries of many specialists that you see in salary reports can be a bit misleading if maximizing finances is your goal. The high-paying specialties almost always have a longer training time and won't start making attending salaries until 2-4 years after a typical IM/FM completes their 3 year residency (2-4 years may not seem like a lot but it actually is a pretty big financial difference once you consider that you also have more money to invest earlier), and when they do make their higher salaries they get hit with very high taxes (remember that with the U.S. progressive tax system it's more efficient to make an even amount of money every year than make very little one year and then a lot the next year) so they don't come out ahead until a good 10-15 years after their training.

Peds might see some increase in reimbursements but I suspect it may not have as much pressure as adult medicine since peds tends to be saturated; there's just not nearly as many sick kids out there as adults, and with birth rates in the U.S. declining and the existing population aging and living longer there's going to be more of a shift in care focused on the geriatric population.

If you're going to have $500k in loans I don't think any specialty will comfortably let you pay it all off on your own (don't forget that the high paying specialties usually have longer training times so they're not as efficient at paying off loans as they may appear). Your best bet with that high loans is probably to do some type of forgiveness program like PSLF or some of the state-sponsored primary care programs.

 

[sylvester500]

Thank you so much for this! I was curious if you have any idea how research/grants can add to this? Numbers wise...

Being completely honest, I have no clue. But, I think I'm equally interested as you are.

 

[collegestud2013]

Thank you so much for this! I was curious if you have any idea how research/grants can add to this? Numbers wise...

If you're in academic medicine, and are able to get some grants (which in general are VERY competitive to get these days, especially the government funded ones) each one usually fixed amount set aside for salary support so you may be. IF you are reasonably well funded you can reduce your clinical time in exchange for more dedicated research time without taking much of a salary hit, especially in the lower paying specialties. But if money is higher on your priorities academic medicine probably shouldn't be high on your list of places to work. You're likely going to take a $50-$200k pay cut when compared to your peers in PP in the same specialty as you and same stage in career while overall only working slightly less; and this is especially true for younger physicians in academics which seem to get exploited by far the most.

 

[voxveritatisetlucis]

Is it possible for somebody to make a mid career shift from private practice to academic medicine, or does it only happen in the reverse direction?

 

[KnightDoc]

Is it possible for somebody to make a mid career shift from private practice to academic medicine, or does it only happen in the reverse direction?

I would imagine mostly the reverse because it will be impossible to gather the credentials and experience necessary for academia while in private practice (research and publishing). I assume you could always be a lecturer. I also assume that's not what you are thinking of here.

 

[Dogruffle01]

Is it possible for somebody to make a mid career shift from private practice to academic medicine, or does it only happen in the reverse direction?

My PI went form academic —> private practice —> academic.

 

[deleted50541]

Is it possible for somebody to make a mid career shift from private practice to academic medicine, or does it only happen in the reverse direction?

It can be done, but it's not common. I've known a handful of surgeons in my training/early career who've come from private practice to an academic setting for various reasons. Most weren't heavy into research, but were interested in teaching/resident education. There were also financial reasons related to maintaining their own practices, which I suspect were the primary drivers.

I went from academics to a hospital-based private practice model. I work with surgical fellows and do some academic work (e.g. journal clubs, lectures, manuscript reviewer, editor for a quarterly seminar publication) to keep the door open for a possible later career change back to academics. But it's not a strong focus of our practice.

 

[NITRAS]

If you're going to have $500k in loans I don't think any specialty will comfortably let you pay it all off on your own (don't forget that the high paying specialties usually have longer training times so they're not as efficient at paying off loans as they may appear). Your best bet with that high loans is probably to do some type of forgiveness program like PSLF or some of the state-sponsored primary care programs.

I think you really don’t know how much some specialties can make.

Most of the a busy proceduralists can easily break $500k within a few years. Ortho, plastics, NSx can get closer to 7 figures.
Even me, as a lowly paid internist who makes way less than that, could pay off 500k in probably 4 years if i focused on it. That’s $150k/year, which is like $12/k month. Lots of FM and IM pcp‘s make into the $400k’s. That would be doable, but pretty tough for me, but it is only a season.

At being 36 y/o, having been an attending for over six years, it is easier to look back and say that you can do a lot for a season.

(This is napkin math, I’m sure you could get more detailed if you want to.).

 

[voxveritatisetlucis]

I think you really don’t know how much some specialties can make.

Most of the a busy proceduralists can easily break $500k within a few years. Ortho, plastics, NSx can get closer to 7 figures.
Even me, as a lowly paid internist who makes way less than that, could pay off 500k in probably 4 years if i focused on it. That’s $150k/year, which is like $12/k month. Lots of FM and IM pcp‘s make into the $400k’s. That would be doable, but pretty tough for me, but it is only a season.

At being 36 y/o, having been an attending for over six years, it is easier to look back and say that you can do a lot for a season.

(This is napkin math, I’m sure you could get more detailed if you want to.).

I would also like to add to this great point by saying that a large part of remaining solvent/able to pay debts has to do with budgeting how income is spent rather than the amount of income. For example, I’ve seen speculation that Adrian Peterson, the first ballot hall of fame running back who earned nearly one hundred million dollars during his career, owes creditors nearly 10,000,000 dollars. Now instead of being able to retire, he is going from team to team, oftentimes Ok the practice squad. The point applies to medicine. I’m sure that some new attendings buy a Maserati and quaint trendy neighborhood condo with their new salaries. However, it is much smarter to pay down high interest rate loans and invest…don’t allow compound interest to work against you.

 

[collegestud2013]

I think you really don’t know how much some specialties can make.

Most of the a busy proceduralists can easily break $500k within a few years. Ortho, plastics, NSx can get closer to 7 figures.
Even me, as a lowly paid internist who makes way less than that, could pay off 500k in probably 4 years if i focused on it. That’s $150k/year, which is like $12/k month. Lots of FM and IM pcp‘s make into the $400k’s. That would be doable, but pretty tough for me, but it is only a season.

At being 36 y/o, having been an attending for over six years, it is easier to look back and say that you can do a lot for a season.

(This is napkin math, I’m sure you could get more detailed if you want to.).

Most med students can't get into Ortho, plastics, or neurosurgery. And yes they can probably pay off $500k in loans eventually on that salary but until then they basically have to largely live like a resident even after being an attending and keep expenses at a bare minimum (eg no kids, no decent house) and delay their other financial goals even further considering the long training time for these specialties.

The high salaries see with surgical subspecialists are a bit misleading if just looking at them at face value. You have to account for the longer training time compared to specialties like peds/FM/IM (6- 8 years vs 3 years), the long hours they're working as an attending to make that kind of money, crazy amount of taxes they're paying out at those tax brackets ($500k per year pre-tax can be a little as $290k after tax if you live in a high-income tax state like California and loan payments are made with after tax money), and the big practice expenses like malpractice insurance (which can cost $150-200k per year for the high-risk specialties like neurosurgery).They'll come out ahead eventually compared to lower paying specialties but usually not until mid to late career.

 

[NITRAS]

Most med students can't get into Ortho, plastics, or neurosurgery. And yes they can probably pay off $500k in loans eventually on that salary but until then they basically have to largely live like a resident even after being an attending and keep expenses at a bare minimum (eg no kids, no decent house) and delay their other financial goals even further considering the long training time for these specialties.

The high salaries see with surgical subspecialists are a bit misleading if just looking at them at face value. You have to account for the longer training time compared to specialties like peds/FM/IM (6- 8 years vs 3 years), the long hours they're working as an attending to make that kind of money, crazy amount of taxes they're paying out at those tax brackets ($500k per year pre-tax can be a little as $290k after tax if you live in a high-income tax state like California and loan payments are made with after tax money), and the big practice expenses like malpractice insurance (which can cost $150-200k per year for the high-risk specialties like neurosurgery).They'll come out ahead eventually compared to lower paying specialties but usually not until mid to late career.

We all make choices. My point is that we can pretty much all be in a position to pay off $500k in loans in a few years. Many people wouldn’t like those choices. An IM or a FM doc can do this. I don’t consider making over $300k which an after tax income of $200k+ (sorry i don’t live in a state that feels they have such a right to my money) to be living poorly. That leaves $50k+/year of after tax money. This isn’t a bad living. You can have kids, and do fun things.

It will delay things IIke buying expensive cars and big “doctor” houses, but you do you. People get to live with their choices. I don’t consider people “living like a resident“ to be a bad thing. I’d call it living well below their means to clean up a mess they have.

 

[nimbus]

how can one repay 400k in 5 years? that's insane!

One of my partners moved back into his parents house for a few years after he joined us.