Student Debt Question (can you pay off aggressively with EM salary?)

[DOdreaminguy]

I'm a new member interested in doing emergency medicine or internal medicine hospitalist positions (and applied to DO schools this cycle). I'm concerned that with my undergrad debt, I'll be looking at $400K+ in debt by the time I finish a DO. I see most EM salaries in the 270K range working 12-16 shifts/month. It seems a lot of people want to go the IBR or PSLF route.

What I'm wondering is, what if I'm willing to really grind and hustle, working two jobs - basically work my butt off as an attending for 2-3 years and put as much as possible towards those loans? Is it realistic to assume you can make enough in EM (locum work, 24 hour shifts or hospitalist work working two jobs) to be able to pay that amount off in a few (3-5) years? I've seen a lot of locum EM jobs that offer $150/hr for 24 hr shifts 2-3 times per week and read some threads on here where people talk about knowing hospitalists that work 21+ shifts/month and make $300K+. That's the kind of role that interests me - where you work extra hard but make extra cash.

An alternative scenario would be to to work 12-16 shifts/month as an EM physician and spend every off day possible working in Urgent Care, moonlighting, etc. What I'm basically asking is, can you give up most of your days off for 2-3 years, work at multiple jobs, work a tremendous number of hours and quickly pay the debt down that way? I know it's easier said than done.

Sorry if this is a dumb question, just wondering if it's unrealistic to earn that much in EM/IM even with two jobs.

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[docycle]

400k+ by the time you're done? Idk about that unless you're going to like MSU (>80k) as an OOSer. All others are around 60k and below.

Your question has been gone over in many a thread. The basic answer, like with all things like this (which really isn't too much different than asking "Can I handle 24 credits plus a full time job?" or the like), is yeah -- it's possible to work as much as you say. Burnout, however is a huge concern, if you're talking about 21+ shifts a month. I don't know if you're aware of this, but most groups will have you switching between days and nights, which will limit your ability to work a large amounts of shifts. However, I don't think you need to do 21+ shifts a month to hit your proposed target (300k).

If you're asking if it's perfectly doable to earn 300k+ as an EP, that is a resounding hell yes, and can actually be accomplished quite easily depending on where you practice. You don't need to be hitting 20 shifts unless those are 8s.

@The White Coat Investor might want to elaborate if he feels up to it. But seriously just UTFSE, man.

tl;dr: yes, quite doable to pay down debt aggressively. 21 shifts/mo with a shift being a 10 or 12? Probably not sustainable if having to switch between days and nights as in most groups.

 

[DrBowtie]

While income is part of the equation, the most controllable and variable part of the equation is expenses and lifestyle.

 

[docycle]

While income is part of the equation, the most controllable and variable part of the equation is expenses and lifestyle.

You mean I can't ball out after residency or I'll never be free from my debt????

Aw shucks.

 

[DOdreaminguy]

Thank you so much for your responses. I've been doing searches for the past couple of weeks, but it was tough to get straight talk - heck, it's tough to even get straight talk on salary. I hear IM numbers from $150-300. Mostly I wanted to make sure I don't dig a hole I can never get out of. Just knowing 300 is possible in IM and EM if I'm willing to work extra hard is appreciated.

 

[123456123456]

I am interested in EM and a few other specialties. I work as an ER scribe and have discussed this with many docs. They say do not worry about it, you will make enough to live a nice life and pay your debt. Many have nice houses/cars in nice areas and are no means struggling. Just live as cheap as possible in med school. The idea of a big debt scares me also

 

[docycle]

I wanted to make sure I don't dig a hole I can never get out of.

As much as these guys sometimes whine about it, that simply just isn't going to be the case.

Just knowing 300 is possible in IM and EM if I'm willing to work extra hard is appreciated.

Very achievable.

IM is kind of a different story though. More toward 100-120/hr vs. EM's 150-200.

 

[The White Coat Investor]

I'm a new member interested in doing emergency medicine or internal medicine hospitalist positions (and applied to DO schools this cycle). I'm concerned that with my undergrad debt, I'll be looking at $400K+ in debt by the time I finish a DO. I see most EM salaries in the 270K range working 12-16 shifts/month. It seems a lot of people want to go the IBR or PSLF route.

What I'm wondering is, what if I'm willing to really grind and hustle, working two jobs - basically work my butt off as an attending for 2-3 years and put as much as possible towards those loans? Is it realistic to assume you can make enough in EM (locum work, 24 hour shifts or hospitalist work working two jobs) to be able to pay that amount off in a few (3-5) years? I've seen a lot of locum EM jobs that offer $150/hr for 24 hr shifts 2-3 times per week and read some threads on here where people talk about knowing hospitalists that work 21+ shifts/month and make $300K+. That's the kind of role that interests me - where you work extra hard but make extra cash.

An alternative scenario would be to to work 12-16 shifts/month as an EM physician and spend every off day possible working in Urgent Care, moonlighting, etc. What I'm basically asking is, can you give up most of your days off for 2-3 years, work at multiple jobs, work a tremendous number of hours and quickly pay the debt down that way? I know it's easier said than done.

Sorry if this is a dumb question, just wondering if it's unrealistic to earn that much in EM/IM even with two jobs.

Yes.

Yes.

IM is different though. They get paid less. I'd be pretty wary to do an IM residency if I owed $400K.

Keep in mind you can't do this long-term, You'll burn out. But for a year or two while going hog wild on student loans? Absolutely. Just keep living like a resident when you become an attending. All additional income goes toward loans. Voila- 2 years later, loans gone. Average EM income right now is ~ $350K FYI. Who knows where it will be in 9 years when you come out of the pipeline though. Also bear in mind tougher to match into EM as a DO, but still plenty of DOs in the field.

 

[KP2AZ]

Highly recommend reading the book "White Coat Investor." That's what one of my professors had me read last year as an MS-1. Super insightful about the minutia of how to tackle student loans. And remember that you are going to be working like a dog anyway right out of residency "paying your dues " in one way or another. Good luck

 

[TUVIX]

400k+ by the time you're done? Idk about that unless you're going to like MSU (>80k) as an OOSer. All others are around 60k and below.

Your question has been gone over in many a thread. The basic answer, like with all things like this (which really isn't too much different than asking "Can I handle 24 credits plus a full time job?" or the like), is yeah -- it's possible to work as much as you say. Burnout, however is a huge concern, if you're talking about 21+ shifts a month. I don't know if you're aware of this, but most groups will have you switching between days and nights, which will limit your ability to work a large amounts of shifts. However, I don't think you need to do 21+ shifts a month to hit your proposed target (300k).

If you're asking if it's perfectly doable to earn 300k+ as an EP, that is a resounding hell yes, and can actually be accomplished quite easily depending on where you practice. You don't need to be hitting 20 shifts unless those are 8s.

@The White Coat Investor might want to elaborate if he feels up to it. But seriously just UTFSE, man.

tl;dr: yes, quite doable to pay down debt aggressively. 21 shifts/mo with a shift being a 10 or 12? Probably not sustainable if having to switch between days and nights as in most groups.

Yeah I would say if you are going to make a big sacrifice to pay off loans you are better off going to a hospital in a really undesirable location that will pay more and maybe even pay back loans for you rather than work 21 shifts a month.

 

[dushash]

I'm not sure how it exactly works, but at least from what limited info I have (from my sister, she works IM) - many Hospitals will cover your loan completely if you work 10 years with them. 10 year may sound a lot, but if you'll find a good place where you want to stay, you will work 10 years anyway (and many more after that). So there is another option IMHO to just live as you go and not struggle trying to save on everything. I agree paying off a debt in 2 years is way better, but is not necessary.
Also, as probably many are nowadays, she is working 7 days, then resting 7 days. Her many colleges take a couple days of extra work during 7 days of "rest" week. They go to another Hospitals for shifts that pay a lot more and they basically pay no taxes on that extra job. And that's just IM. I bet other specialties have their own perks (including working at private offices besides Hospitals and so on).
I'm personally ok with having debt and paying it off gradually, but I can see how some may want to get debt free asap.
Just my 2c.

 

[docycle]

I'm not sure how it exactly works, but at least from what limited info I have (from my sister, she works IM) - many Hospitals will cover your loan completely if you work 10 years with them. 10 year may sound a lot, but if you'll find a good place where you want to stay, you will work 10 years anyway (and many more after that). So there is another option IMHO to just live as you go and not struggle trying to save on everything. I agree paying off a debt in 2 years is way better, but is not necessary.
Also, as probably many are nowadays, she is working 7 days, then resting 7 days. Her many colleges take a couple days of extra work during 7 days of "rest" week. They go to another Hospitals for shifts that pay a lot more and they basically pay no taxes on that extra job. And that's just IM. I bet other specialties have their own perks (including working at private offices besides Hospitals and so on).
I'm personally ok with having debt and paying it off gradually, but I can see how some may want to get debt free asap.
Just my 2c.

The hospital paying your loans thing is something to look into I guess. I don't know if they pay it all straight away once you sign a contract or if you literally have to wait ten years for them to pay it (which would make no sense since interest would simply just be accruing thereby wasting money). Such positions btw, from what I have seen, usually involve getting shafted on salary. Not saying that's every person's situation, but I'm just saying to be wary about such deals. Especially if the hospital is paying up front, they'll want a nice return on that investment.

Yeah 7 on 7 off is a pretty common IM schedule. Dunno about EM though, which is what OP seemed to be into. I think it could be set up? But as a junior EP I don't know if they'd give you that kind of flexibility. It seems like the schedules aren't at all set in stone -- you work one schedule one month and a completely different one the next month. Supposedly that's just how it works out. Though who knows -- maybe you just make that a requirement when job searching and see if they'd be willing to accomodate.

How are they not paying taxes on the extra job? If anything they'd be paying more taxes on it since it puts them in a higher bracket. Jw how it works out that employees are not paying taxes on income they receive working for US-based entities, unless said employees enjoy pretending that the IRS does not exist.

 

[dushash]

How are they not paying taxes on the extra job? If anything they'd be paying more taxes on it since it puts them in a higher bracket. Jw how it works out that employees are not paying taxes on income they receive working for US-based entities, unless said employees enjoy pretending that the IRS does not exist.

Sorry, what I meant was, for extra shifts at another Hospital, they are paid bigger bucks (compared to their own hospital) and all taxes are covered by that another Hospital - I'm not sure how it works, I should have asked her for details before posting, but as I understood: there are lots of hospitals that are desperately seeking for physicians for some shifts and they understand that those who come to work for those shifts are doing so in their "free" time - so they pay a lot more than usual and cover all taxes - so essentially whatever you get paid - it's all yours. It's not uncommon to get $2-3K for one shift. Couple of extra shifts like that during your free week and it adds up to $8-12K additional income per month. I understand not everyone does that and it's exhausting, but it's just what I've heard from her and I doubt she lies to me.

 

[DOdreaminguy]

Part of what I'm concerned about is setting up that first nest egg. 400K in debt is, let's say, $5-6K per month on a 10-year repayment plan. The thing is, if as an IM you only make 180K (say 120 after taxes), that's $10K per month. If you're spending 5-6K per month on student loan payments, that's only 4K/month to live on.

Here's my point - once you have that first $100K or $200K in the bank, it's a lot easier to maintain a steady-state at 4K/month in spending because you have a buffer. When you're living check-to-check as a doctor fresh out of residency, that's gotta be tough and scary, especially with a family. That's why I'm considering this strategy of working two jobs for a year or two to get ahead then coast at 14 shifts/month. Sounds like many of you are saying that is very possible (to work two jobs and nearly double your salary) in both EM and IM. Also, I'm saying $400K because of 100K in undergrad/grad debt (career changer) + cost of med school + interest accrual during residency.

 

[dushash]

Part of what I'm concerned about is setting up that first nest egg. 400K in debt is, let's say, $5-6K per month on a 10-year repayment plan. The thing is, if as an IM you only make 180K (say 120 after taxes), that's $10K per month. If you're spending 5-6K per month on student loan payments, that's only 4K/month to live on.

$180K for IM is probably lowest you can find. Probably in some highly desirable areas like Long Island, NY, where there is no shortage of physicians . IMHO all other places should have higher than that salaries. I've seen lots of $240K if you are not picky about location. Also, keep in mind that you can always go on just maintenance "minimal repay" - like $1.8K - $2K per month if needed during first couple of years to simply get settled, mortgage etc. before you start repaying off aggressively. I understand it's opposite of what you want, but IMHO if you are going to be repaying your loan for at least 10 years - why not do it while being comfortably settled in your life.

 

[docycle]

Part of what I'm concerned about is setting up that first nest egg. 400K in debt is, let's say, $5-6K per month on a 10-year repayment plan. The thing is, if as an IM you only make 180K (say 120 after taxes), that's $10K per month. If you're spending 5-6K per month on student loan payments, that's only 4K/month to live on.

Here's my point - once you have that first $100K or $200K in the bank, it's a lot easier to maintain a steady-state at 4K/month in spending because you have a buffer. When you're living check-to-check as a doctor fresh out of residency, that's gotta be tough and scary, especially with a family. That's why I'm considering this strategy of working two jobs for a year or two to get ahead then coast at 14 shifts/month. Sounds like many of you are saying that is very possible (to work two jobs and nearly double your salary) in both EM and IM. Also, I'm saying $400K because of 100K in undergrad/grad debt (career changer) + cost of med school + interest accrual during residency.

Interest shouldn't be accruing during residency, as you'll hopefully be making payments (tax-deductible, btw).

 

[abolt18]

Interest shouldn't be accruing during residency, as you'll hopefully be making payments (tax-deductible, btw).

On resident salary, no way you can cover all the interest, which is why many/most residents do PAYE, IBR, or forbearance. Personally planning to refinance for a WAY lower interest rate through companies like DRB or So-Fi as soon as I match.

 

[abolt18]

Highly recommend reading the book "White Coat Investor." That's what one of my professors had me read last year as an MS-1. Super insightful about the minutia of how to tackle student loans. And remember that you are going to be working like a dog anyway right out of residency "paying your dues " in one way or another. Good luck

Or just read his blog and you'll get basically the same info. www.whitecoatinvestor.com

 

[scoKraz4]

Interest shouldn't be accruing during residency, as you'll hopefully be making payments (tax-deductible, btw).

Yeah this isn't going to happen.

I know some DO's doing EM that owed a ton of money and they said just live like a resident for a few years after finishing and crush it. I'll be about 400k in debt by the time I finish as well. Came out of undergrad with about 100k already.

 

[abolt18]

OP, by the time I finish residency, my loans will be approaching 400K. average resident salary is 51K. My current plan includes the following.
During residency:
Max out my 401k+match. Refinance student loans for 3-4% interest rate. Moonlight a few times a year to supplement my income as needed.
After residency:
Give myself a pay raise to live off about 50-60K a year after taxes. All the rest of my money will be devoted to student loans, saving for a home downpayment, maxing out retirement funds and frontloading my investments, and slowly grow into my income, paying myself an additional 10K each year.

Student loans will be paid off quickly (2-5 years depending on my current specially choices), I'll be caught up on the time lost in saving for retirement. Financially independent before I'm 50.

 

[docycle]

Yeah this isn't going to happen.

MLing. I think feds are, what, like 7ish? So 28k per year is doable with MLing. You should even be paying it down slightly depending on the type of gig you can get. It's up to you whether or not you wanna keep your income low enough to keep interest payments tax deductible, though.

I know some DO's doing EM that owed a ton of money and they said just live like a resident for a few years after finishing and crush it. I'll be about 400k in debt by the time I finish as well. Came out of undergrad with about 100k already.

Lol @ this commonly used phrase "live like a resident." You mean live on the same wage available to an average American family. Just one person can be pretty comfortable on it. Hence I don't think it's some major sacrifice by any means.

 

[docycle]

On resident salary, no way you can cover all the interest, which is why many/most residents do PAYE, IBR, or forbearance. Personally planning to refinance for a WAY lower interest rate through companies like DRB or So-Fi as soon as I match.

Loan forgiveness is a ripoff. Why would anyone "forgive" you your loans? Oh yeah, if they could make money doing it. These programs are a way to keep you hooked to the debt over the long term, so the gov can profit more.

So it's quite simple. If you want to win over the long term, you pay it off fast. If you don't care about losing 6 figs on "loan forgiveness" programs, then go with those.

 

[ortnakas]

But for a year or two while going hog wild on student loans? Absolutely. Just keep living like a resident when you become an attending. All additional income goes toward loans.

This is my plan. Even with hoping for IM, and a pessimistic attending salary estimate of $180K, living like I still make $50K for a few years should get most of my debt paid off relatively quickly.

For full disclosure, my school is cheaper than most even with the full COA, and I have an employed spouse which makes it easier, but even without those things, it's a manageable plan.