Not quite right. If you are paying back in residency making $50k then you pay either the full amount or go with IBR which is 10% of your income towards the loan which comes out to $416/month.
UQ-Ochsner 2016
- Thread starter Omidvar
- Start date
Not quite right. If you are paying back in residency making $50k then you pay either the full amount or go with IBR which is 10% of your income towards the loan which comes out to $416/month.
I have no idea what you are agreeing or disagreeing with. First off, I am not so confident that the merger will happen since it was already supposed to happen once and was called off at the last minute because the AOA refused to get rid of the last vestiges of the former quackery of the osteopathic degree: OMM. That said, sure I think in the long run it will eventually happen somehow, some way.
But I don't see how that has any bearing on the quote of mine you replied to.
I don't know that I can answer that question meaningfully. I already chose UQ over applying to DO programs back before UQ-O was accredited (though to be fair my backup was that UQ was accredited so I could have done all 4 years there and still be guaranteed eligible to train and practice in the US).
In terms of DO vs UQ-O MD I think I've already given as much of my thoughts on the matter as I can. I don't really have too much to add.
Regarding going DO that isn't accredited... I don't know. That seems like a rather larger risk to me given that it may not be accredited in a timely manner (or at all). Given my own personal experience dealing (directly and in multiple fashions) with accrediting agencies I would personally find that a larger risk than I am willing to take. Tack on the fact that you are having a minimum of 2 years private loans makes that seem too risky for my tastes. But that's me and it is not adequately enough informed on the specifics to your situation and question.
Well, I think the most helpful I can be here is to try and summon @Phloston to provide some answers since he did the PhD/MBBS program.
Some questions I can try and take a stab at:
1: Don't think so. The MD program is pretty new and I don't know of anyone who is UQ-O having tried for the PhD as well. But there have been MBBS/PhD (at least one I know of, though I don't know how it actually ended up working out)
2: You do your M1&2 years, then your PhD years, then your clinical years. So you aren't cramming a PhD into 4 years of medical school, but are taking 6 years to do both.
3: In reference to #1, the issue at that time was that there was no scholarship available and it would have cost the guy a bunch of money to do it. There was some stipulation that if you manage to get some (rather meager) level of funding for your research then they would write off the rest of the tuition for your PhD years. But that was when I was a 4th year and I've told you literally all I know about it, so I have no idea how that landscape has changed.
4: It will probably help, at least for academic programs. Community programs it probably won't make much of a difference. How much of a difference it will make for academic programs... no idea. Probably not a huge amount, especially considering there are US grads with MD/PhD as well. I probably wouldn't do it just to try and improve match success. But if you want to do a PhD you should.
5: Once again my info is out of date, but at least back then they were fairly neutral on it. Neither actively encouraging or discouraging. However Ochsner certainly does support such endeavors (a few people got the MPH's and other master's level degrees by taking a year between M1&2 and 3&4). I think overall you would probably be at least nominally supported in such an endeavor.
I would recommend sending a PM to Phloston if you want some more details about it all.
You are indeed correct and this is something that I have been consistently saying myself.
That said, it is also incorrect to say that there isn't enough evidence and rationale to predict UQ-O will be at least on par if not better than the best IMG programs out there. In other words, the extrapolation is reasonable and so are preliminary thoughts, so long as it is clear that this is what you are doing (rather than making a definitive claim).
Firstly, Canadian schools are also LCME accredited.
Secondly, his point is valid. Having a lack of data on hard endpoints is one thing. But there is other evidence and logic to make the extrapolations, exactly like you are doing with the response to the 3 new US med schools that opened. The analogy is sound (at least as sound as any analogy can be, as they are all flawed in some way by their very nature).
Discussing the fact that US schools are LCME accredited vs IMG programs that are ECFMG accredited and certified is beside the point.
There is some data and there are plenty of reasons to rationally extrapolate what that may mean, as I have done numerous times.
Thanks a lot! Very helpful!
D
deleted158872
Then when you're an attending, can you still be eligible for IBR/PAYE?
- Joined
- Jul 13, 2015
- Messages
- 198
- Reaction score
- 70
Here is the FAQ, straight from their web page.
http://www.acgme.org/acgmeweb/Portals/0/PDFs/Nasca-Community/FAQs.pdf
In regards to OMM,
My grandmother's physician is an M.D who strictly performs OMM in a sports medicine clinic. He can't accept more patients because he is so backed up (he is NOT PM&R, he is a family doc who does only OMM). I shadowed him and was rather pessimistic that OMM would be anything more than a luxury massage. I was surprised by what his patients had to say. "This doctor has helped me more than any other, etc..,etc.." Yes, n=1 but its a service that works well for some people. The main focus of OMM is physical stress related injuries. People have been seeking these services because it works for them and is much safer than opiate medications. I will not comment on the other touted benefits of OMM, because they do seem to be a stretch. But if I injure my back from lifting weights or from EMS, I'm going to this physician if my scans check out as clear. If your in medical school, then you should understand down regulation. Opiates are not a viable option for long-term pain (more than a few years).
Yes, I agree it should be at least on par with other IMG programs. But you do not know what life events could unfold in medical school, and how this could impact your work ethic. This is my entire point of attacking the argument of "well your not considering what other people may be looking for in medical school." If John Long D.O and Bill Will MBBS are going for the same residency spot in the U.S, and they have the same step 1 score and closely related qualifications, John Long will get the residency spot in the vast majority of cases. The amount of money involved also raises the stakes. Ochsner is more expensive then the majority of D.O programs in the states. I'm not seeing in "black-and-white" if your highly interested in returning back to the U.S.
If you don't care about U.S residency but is merely a preference (and I understand why one would not), then IMG could certainly be a better choice. This is all I have said from post #1. I don't think I am being unreasonable. I am receptive of the program and potential reasons for applying.
Last edited:
- Joined
- Apr 18, 2015
- Messages
- 91
- Reaction score
- 46
I know it's difficult to find some things in Australia or they're 3x the price there. What supplies should I be looking at bringing?
* 1st year textbooks/study aids? (if you carry-on, you bypass the weight issue)
*special clothes? (white coat? scrubs? specific shoes?)
* Steth/ Sphygmomanometer?
I'm seeing a lot of study aids (netter's flashcards, etc) that are being sold used in the UQ marketplace for 3x the price I can get new on Amazon.
* 1st year textbooks/study aids? (if you carry-on, you bypass the weight issue)
*special clothes? (white coat? scrubs? specific shoes?)
* Steth/ Sphygmomanometer?
I'm seeing a lot of study aids (netter's flashcards, etc) that are being sold used in the UQ marketplace for 3x the price I can get new on Amazon.
D
deleted158872
I heard UQO students get USMLE prep books and question banks for free?
Last edited by a moderator:
Would be very interested to know as well. Please share if you find out and I'll do the same. As far as books, I believe that no outside books are required and extensive prep material are provided for steps 1 and 2.
OTE="UncomfortablyNumb, post: 16763068, member: 685611"]I know it's difficult to find some things in Australia or they're 3x the price there. What supplies should I be looking at bringing?
* 1st year textbooks/study aids? (if you carry-on, you bypass the weight issue)
*special clothes? (white coat? scrubs? specific shoes?)
* Steth/ Sphygmomanometer?
I'm seeing a lot of study aids (netter's flashcards, etc) that are being sold used in the UQ marketplace for 3x the price I can get new on Amazon.[/QUOTE]
Wou
OTE="UncomfortablyNumb, post: 16763068, member: 685611"]I know it's difficult to find some things in Australia or they're 3x the price there. What supplies should I be looking at bringing?
* 1st year textbooks/study aids? (if you carry-on, you bypass the weight issue)
*special clothes? (white coat? scrubs? specific shoes?)
* Steth/ Sphygmomanometer?
I'm seeing a lot of study aids (netter's flashcards, etc) that are being sold used in the UQ marketplace for 3x the price I can get new on Amazon.[/QUOTE]
Wou
- Joined
- Apr 18, 2015
- Messages
- 91
- Reaction score
- 46
I could be totally wrong on this one but I believe that the regular 4-year students are not provided the extra prep material and would therefore be required to buy it from the book store (if they're interested in sitting for the boards).
Yes. You are always eligible for IBR/PAYE. The only catch is that it has to be Federal loans. Can't be private. There was an attempt to change the rules so that you paid 10% of your salary no matter what, but if you make enough that the 10% is more than what your normal payment would be it caps at the normal payment rate.
Interesting. Seems like they've pursued a slightly different pathway. Good for them.
Not only an n of 1, but popularity has nothing to do with how scientifically valid or actually helpful something is. Don't forget that homeopathy is very popular, particularly in Europe, and is a $35 billion worldwide industry and is nothing but the rankest of quackery that not only does not work but cannot work. Yet people still swear by it, say that "This homeopath has helped me more than any other, etc, etc". So your story about your grandma's doctor is entirely irrelevant and does not address my point that OMM is in fact quackery. There are some aspects of it that are not - physical therapy, massage, and some manipulations do have evidence to support them. However that is only a small sliver of what OMM is.
OMM is based on the idea of myofascial release and involves things like "repositioning" organs like the spleen and pancreas in order to achieve health benefits.
Once again, entirely irrelevant to my comment about OMM being quackery. You even recognize this by saying:
Yes, that is because the basis of approach for OMM is pseudoscientific. The parts that you are separating out are nothing more than what a good PT could (and should) do. And I absolutely agree that PT should be used more and more often. But that is also entirely irrelevant to the question of what OMM is and whether it is quackery or not. It is not PT, though small aspects of it do overlap, and it is quackery.
I happen to be PGY-2 and have a very strong background in science and research. Which is why I not only know enough about opiates and receptor regulation but enough about what OMM is, how to approach the question of its validity, and how to analyze and parse the relevant data to know it is quackery.
And life events impacting work ethic can't happen in US schools? This argument is utterly nonsensical. You could go to Harvard med and your girlfriend dumps you, you decide to try heroin, and then fail all of your steps multiple times and then get kicked out of med school. What on earth does that have anything to do with the question at hand?
Except that you have yet to make any sort of reasoned, logical, and relevant argument in this vein. I have long been commenting about the specifics of UQ and some of the added stresses of going to a foreign country that may prove to be more difficult for certain personality types to handle. So what people are looking for in medical school along with their personal predilections does in fact matter when making such a decision.
This is not only a completely evidence free statement but also comparing apples to oranges and not quite logically sound. I have discussed this quite a bit so I won't rehash it fully (you can read my comment history).
In an absolute sense, yes, because Dr. Long has access to AOA residencies that Dr. Will does not. But if you compare only likelihoods of attaining ACGME residencies then the distinction is not so clear. There are programs that will not look at IMG's no matter what their scores are. There are programs that will not look at DO's no matter what their scores are. There is no announced data as to which those are in order to make a comparison here, so it would be wrong to argue it one way or another. However, when you look at the actual numbers of those who matched it is clear that IMG's still get plenty of spots. In fact, more as both an absolute number and percentage of spots. This is because there are about 6,000 more spots in the ACGME match than there are US applicants even when MD and DO (that apply to ACGME residencies) is combined.
So it doesn't really make sense to try and argue that a DO will be more likely to get a US residency spot than an IMG because the two aren't actually competing for the same spots. Meaning that one is not trying to displace the other - there is room for both.
Which is why I have argued that UQ-O will be better than other IMG programs because we (just like any other IMG) are not competing for the same spots as US grads. There will be that pool of spots that are simply categorically unaccessible to IMG's (and DO's). There will be that pool of spots that a US grad will always get preference for. But there will also be those ~6,000 spots that only IMG's are competing for and some of the other ~22k spots that aren't part of the inaccessible pool that we are competing for. And in that competition there are very good reasons why UQ-O will be preferenced above other IMG programs (obviously some more than others).
The one real difference, as has been discussed by myself and others on this very thread, is that only in the US is the DO a respected medical degree. Everywhere else it is a quack degree on par with naturopaths, homeopaths, chiropractors, and the like. So if you want to practice medicine in France or Denmark you are likely to have an easier time of it with an Aussie MBBS than a US DO degree behind your name. But if you only want to practice in the US, then I agree you will likely have an easier time getting a residency as a DO only because you have access to the AOA residencies that nobody else (as of yet) can compete for.
That may be changing with the AOA/ACGME merger, but it can only serve to improve the chances of IMG's. If one assumes that the formerly AOA-only residencies will give any consideration to IMG's then that opens a lot more spots for us to compete for. If one assumes that none of the formerly AOA-only residencies will even consider IMG's, then it won't improve our odds as much, but we will still get a trickle down effect from having US MD grads competing for those formerly AOA spots thus decreasing the competition for ACGME residencies that would consider IMG applicants.
The money is indeed a legitimate issue. Which is exactly what I have said multiple times. And I have never said it is black and white since that would be asinine. But the money also has nothing to do with the question of returning to do residency and practice in the states. You seem to have a lot of trouble staying on point when making an argument and make rather black and white statements that gloss over important nuance for someone trying to argue that things aren't black and white and arguing your opinions on these matters.
Sure, except that everything you have said before this is either off topic or misses the mark. So if this is all you wanted to say, you could have saved everyone including yourself some time by truncating your comment to that last statement and leaving it at that.
People should ask MEP and/or contact OMSA to ask for the Brisbane guide. These sorts of things are covered explicitly and in detail.
Yes, thanks to the work of OMSA you do get Step 1 resources for free. Two books free in M1 year and 2 QBanks free in M2 year, along with student led tutes both years. These are only available to UQ-O students as they are expensive and we have a unique need and requirement to take and pass the Steps. There was an attempt to expand these resources out to the general UQ traditional cohort but it proved too expensive and the SoM tried to do away with all of it. OMSA campaigned hard and managed to preserve it for the UQ-O students. This is an ongoing issue since, of course, the SoM is always trying to save money. But that is what OMSA is for - to advocate for the specific and special needs of UQ-O students that are indeed different from the general cohort. In areas where the needs/interests overlap UQMS is more than adept and established at handling those, which is why the two are officially sister organizations.
I believe that there are also some Step 2 resources provided by Ochsner, but these are much less than Step 1 largely because one needs much less prep for Step 2. The cohort Step 1 scores have been improving and are now roughly (on average) on par with US Step 1 scores (which means we need to continue improving). However Step 2 scores have been consistently well above the average US scores.
Correct, because you are only provided with 2 books and 2 QBanks. There is access to various study books (like BRS) in the libraries, but people still prefer to have their own copies sometimes. Even I had a few, though less than most. There are also plenty of UQ traditional students studying for the Step 1 that do not get any resources. There is a difference between being provided some resources for free and all resources for free. Quite frankly, if you don't mind spending lots of time at the library you could in fact get away without purchasing a single textbook or review book of any kind for your entire 4 years. In fact for my 4 years I spent a total about $175 on books and QBanks. Considering that a single QBank runs $3-400 and a single large textbook runs easily $100-150+ I'd say that's not bad.
Ipswich was always difficult for us. We had been working hard to prepare a robust system for tutes at St. Lucia when they decided to very last minute announce Ippy was opening and that we would provide tutes of equal caliber there. That was a tough scramble. And, of course, tutes will always be dependent on who is leading them. The M2 tutes tend to be better because it is M3 & 4 students who did well on the Step and are paid to tutor. The purpose of the M1 tutes is more to get you familiarized with the exam itself, understand the mechanics of it, know the format and how it works, and cover some basic material as a means by which to reinforce what is already learned in the regular UQ curriculum, provide some insight as to what topics need more of your own independent study time, and get you in the habit of thinking about and preparing for the Step 1 early. This will quite literally be the most important exam you will ever take and it is vitally important to take it before M3 starts. While there are obviously going to be some with extenuating circumstances, if you do not take the exam before beginning M3 year it is nearly an absolute certainty that it will be to your detriment, no matter what score you are aver you will get if you take it between M2 & 3. Of course, you don't get the QBanks until M2 year, but even what you do get as an M1 is a boost over your US counterparts since we are obviously at a disadvantage relative to them and the Step 1.
And no, the resources aren't extensive. Extensive costs money and it was difficult enough to get any resources let alone extensive. However, absolutely and without question by far the most valuable resources are the QBanks and FA. The QBanks are the single most expensive resource (and not provided gratis by US schools) and remain a big boon to the UQ-O cohort. FA is cheap, but at least you don't have to worry about getting it. In any case, getting around $800 worth of the most vital study aids for the Step 1 seems to be a pretty decent accomplishment by OMSA.
The reality is that the only real resource that US students get that UQ-O doesn't are the shelf exams. If your US counterparts get tutorials they are also unpaid and will be hit or miss. They certainly do not get QBanks which are, quite literally, a must have if you are serious about doing well on the exam. And they don't get the QBook or FA which is easy enough to get at $60 combined, but at least you don't have to worry about procuring them and can use that money for a decent dinner and some drinks out one night in Aus.
Also, there has been some talk about trying to get shelf exams for UQ-O students as well and as of now you get a few NBME practice exams, including at least 1 under simulated test conditions. These resources are not for everyone and as is typically the case those that need the tutes the most are also generally the ones to go the least, but as they say one can lead a horse to water... Anyways, the resources are there and just like everything else in the rest of your education and career your outcomes will be what you make of them. Use them or don't; no matter where you go nothing will be spoon fed to you.
- Joined
- Jul 13, 2015
- Messages
- 198
- Reaction score
- 70
Not going to quote all that. You guys will argue for the sake of arguing. My point is:
(a) have fun generating scientifically valid results regarding subjective pain. You won't. Thus, you can't prove its quackery nor its merit. Philosophy 101.
(b) It's not nonsensical. If your going to harvard med and life turns for the worst, you'll still have residency spots if you graduate and pass step 1. If all you do is pass step 1 at ochsner, you stand a fair chance at no opportunities in accordance with previous IMG statistics. You can't just go to ochsner and get by. You'll have to do much better than U.S med students to take their spots, D.O or M.D
(c) D.Os > IMGs for U.S residency acceptance is not without data. You are fooling yourself and are stubborn if you are willing to argue this point. Yes, there are MORE programs that won't accept IMGs on average than D.Os. This doesn't warrant further discussion. There is no hidden response. Search a D.O school, and you'll see the match results for the respective school. It'll be 100% or 99% after scramble. It's that simple. On AVERAGE, D.O > IMG for U.S residency acceptance. We can't consider ACGME residencies just yet, so don't include the unknown as a point of argument. The purpose of this point is at the end of the day, D.Os will have a residency spot in the U.S.
(a) have fun generating scientifically valid results regarding subjective pain. You won't. Thus, you can't prove its quackery nor its merit. Philosophy 101.
(b) It's not nonsensical. If your going to harvard med and life turns for the worst, you'll still have residency spots if you graduate and pass step 1. If all you do is pass step 1 at ochsner, you stand a fair chance at no opportunities in accordance with previous IMG statistics. You can't just go to ochsner and get by. You'll have to do much better than U.S med students to take their spots, D.O or M.D
(c) D.Os > IMGs for U.S residency acceptance is not without data. You are fooling yourself and are stubborn if you are willing to argue this point. Yes, there are MORE programs that won't accept IMGs on average than D.Os. This doesn't warrant further discussion. There is no hidden response. Search a D.O school, and you'll see the match results for the respective school. It'll be 100% or 99% after scramble. It's that simple. On AVERAGE, D.O > IMG for U.S residency acceptance. We can't consider ACGME residencies just yet, so don't include the unknown as a point of argument. The purpose of this point is at the end of the day, D.Os will have a residency spot in the U.S.
Last edited:
D
deleted158872
thanks.
i've been googling a list of hospitals/health centers that qualify for PSLF... could you tell me how to find that information or how to know which hospitals qualify?
I have posed questions about OMM: http://forums.studentdoctor.net/threads/is-osteopathy-science.1152603/
Last edited by a moderator:
D
deleted158872
...
Last edited by a moderator:
Wow. I really hope you aren't actually in medical school or planning to be. Your understanding of science and what it can and cannot tell us is woefully lacking. There are huge amounts of data on subjective pain. Yes, it is more difficult, but to say it is impossible is simply stupid and shows your profound ignorance on the topic. Furthermore, pain itself is not something necessary to assess in terms of determining whether OMM is quackery or not. That is how this whole concept of "converging lines of evidence" works, along with Bayesian analysis, and previous work in different fields of scientific inquiry.
If you took Philosophy 101 then you really should go back and repeat it... and then try and learn a little bit more than freshman level philosophy. Either that, or don't go treading into conversations where you are well out of your depth because you are likely to run into someone like myself who is not.
First off, citation needed. Please provide the evidence by which you make the assertion that barely passing med school and the Steps at Harvard will give you significantly more opportunities than doing the same as a UQ-O. (Hint, there isn't that data so you should cut bait and stop prattling on. My mother used to say that it is better to keep your mouth shut and be thought a fool than to open it and prove it).
And there is anecdotal evidence contrary to your position given that I know of one UQ-O that failed both Step 1 and Step 2, barely passed medical school, didn't do any meaningful research and still got a categorical spot that was not at Ochsner. I know of another that barely passed the Step 1, failed the CS, and also matched categorical not at Ochsner. I'm not going to hang my hat on those as telling of anything except that your argument is merely an evidence free statement and not likely to be meaningful nor true. A few black swans is all that is needed to show how weak your argument actually is.
Secondly, you are yet again arguing against straw men and ignoring the points I have made. Pay attention to the fact that you are arguing about "taking the spots" of US grads. I made it quite clear that IMGs are not "taking spots" and why.
Once again, pay attention to my actual arguments and statements. I have very clearly stated that if your goal is to practice medicine in the US that going for a DO program is likely a better option than going to any IMG program. I even said exactly that earlier in this thread. But there is more nuance to it than just that and having simplistic responses like yours is little more than wasting space on a thread.
Furthermore, you should actually, you know, back up your points with data. Please do show me the citation that demonstrates your claim that "Yes, there are MORE programs that won't accept IMGs on average than D.Os." Until you do, my point stands: we don't know what the actual landscape is, and it is reasonable to assume there is roughly parity or at least not a huge detriment. This is particularly supportable given that there is a clear geographic distribution of practicing DO's vs MD's and it is a fact that at least some programs will not consider DO's. Period. To pretend like you can quantify the exact amount is, well, in concordance with the rest of the scientific acumen you have thus far demonstrated.
Look at the requirements for PSLF and then see if the program in question meets it. The requirements are very broad and thus most places meet it:
- Government organizations at any level (federal, state, local, or tribal)
- Not-for-profit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code
- Other types of not-for-profit organizations that provide certain types of qualifying public services
OMM is based on the idea of myofascial release and the idea of being able to "reposition" organs. It also has its roots in vitalism, all of which are pre-scientific and well disproven notions. Some of OMM happens to also be merely manipulative therapies like what a PT might do so those specific things are not quackery, however the process by which they were arrived at is and thus it is a reflection of luck that some aspects are legitimate rather than a validation of OMM in principle.
- Joined
- Apr 15, 2012
- Messages
- 393
- Reaction score
- 196
Wow this thread blew up in the past few weeks. We got Kaplan and First Aid. We also get the Kaplan Qbank and UWorld (which is stupid expensive). There is also talk of us possibly getting a Kaplan prep class next year paid for as well as the paid tutors.
- Joined
- Apr 15, 2012
- Messages
- 393
- Reaction score
- 196
I also want to put this out there, this program is not for everyone. Medicine is what you make it. I can tell you from talking to other med students that there isn't a better place to go to if you value your ability to set your own schedule for learning. I like having my time to do things how I want to do them. Literally they give you the barebones in lectures and reading material to supplement. Take what they give you, watch/read the lectures on your own time, and study for the Step 1 and you will be fine. Also as far as the clinical skills go, it's great being able to start with them in the first year. We have covered GIT, Respiratory, CV, and are now working through MSK physical examinations.
According to the MedEdPath website, the 2016 entering class will be paying $64,240 in tuition. For those of you in the program, how much would you add as a cost of living + other expenses?
I'm just trying to do the math to see how different it would be from PCOM, for example, which has its CoA here:
http://lgdata.s3-website-us-east-1.amazonaws.com/docs/1091/1370976/COA-DO-Phila-1516.pdf
I'm just trying to do the math to see how different it would be from PCOM, for example, which has its CoA here:
http://lgdata.s3-website-us-east-1.amazonaws.com/docs/1091/1370976/COA-DO-Phila-1516.pdf
Last edited:
Thanks! I saw that earlier but just wanted to know how much those numbers compare and/or deviate from what students actually end up spending.
Seems about right to me. I was also part of trying to get additional cost of living expenses added on in order to cover the added cost of USMLE exams so I was pretty familiar with the costs associated and across the board all those estimates are pretty well in agreement.
As for the cost of tuition... as I've said before that is pretty hefty. I would still pay it, knowing what I know now and all things said and done, but I have to admit that the cost is daunting. I've been tongue-in-cheek with saying though that once the US economy collapses (which, IMHO, is a near inevitability) being able to at least have the potential to earn AUD to pay back loans in USD would be a boon for us. Of course, that's not something to bank on and given these consistent increases in tuition it is harder and harder for me to recommend UQ-O over a DO or state school that is significantly less expensive (with significantly less cost of living as well).
All that said, yes there are plenty of stories of physicians getting crushed under their loans but those are the exception not the rule. And I have this strange notion that if an entire generation of physicians gets pushed to the point where loans are making them unable to sustain a practice there will be some sort of solution figured out. Obviously it would be better to have this sort of asinine system figured out ahead of time, but the simple reality is that there is no way a country can tolerate a large loss of a physician workforce which may be the direction things are headed with how incredibly onerous the costs and repayment of loans has becoming (and its only getting worse). So either something like IBR and PSLF will pan out, or the bottom will fall out. It will always be unfortunate for those stuck in the lurch, but they will be the minority and you shouldn't give up on a dream for fear of that. Conversely, if that does worry you enough to strongly consider giving it up, then maybe you really shouldn't be a physician. There are lots of other great ways to make good money, have minimal loans, and still use bench and clinical sciences to help people.
@nybgrus Thank you! While I definitely include cost when considering a program like UQ-O, my number one priority is residency placements. I understand that it is more difficult for IMGs to match and I'm certainly willing to put the effort for it. There are some allopathic schools in the US that charge 70K for out of state students BUT there's sort of "peace of mind" with respect to residency. I thought about SGU initially (and I still do) but UQ-Ochsner seems to fit my aspirations better.
I can absolutely understand the peace of mind aspect. Believe me, as the second class going through I was extremely nervous about the whole proposition. In fact I almost quit midway through M1 year (I am very glad that I did not).
What will really be informative is the next 2-3 graduating classes. Up till now we have only had around 25 people max attempting the match. The fact that we've had good match success thus far is heartening, but not truly representative. I personally think that as the graduating class grows we will have a small drop in the match stats but that overall the vast majority of our graduates will match. But, of course, only time will tell.
An important thing to remember when thinking about comparing UQ-O to SGU or other caribs is that they are not quite apples to apples comparisons. Firstly, there is a rather high attrition rate in the Carib (though SGU is by far the least with a reported 10% rate). Secondly, SGU has had an average of 29% of their graduates sign contracts outside the match... which is no longer an option based on new NRMP rules (not sure how this is affecting SGU and the other Caribs' stats at this point). Thirdly, SGU and a few other Carib schools have a rather unique contracted relationship with the state of NY.
In fact it is that contracted relationship that is the root cause of the current hindrance to UQ-O grads being eligible to apply to NY. Essentially the Carib schools, being high volume for-profit entities flooded the NY UGME and GME markets with their grads and began effectively paying for spots. This led to NY state grads being displaced and so a rule was put into place that the school needed to be on a "list" (makes me think of the NOC list from Mission Impossible, LOL) in order for its grads to be eligible for NY residency. This basically was a compromise between all parties involved and, if you'll notice, the vast majority of Carib grads do residency in NY. In a lot of community programs that aren't particularly desirable, both in NY and elsewhere. So the "peace of mind" and proven track record of SGU is indeed legitimate and nice, but is also something that somewhat pigeonholes you. That is where I believe UQ-O will demonstrate its superiority in the coming few matches: our grads are indeed stigmatized for being IMG, but not pigeonholed the way that Carib grads are. To be clear, that is my prediction based on past evidence and knowledge, which could easily be proven wrong when the rubber meets the road. But I have plenty of reasons to think it won't be.
As for the UQ-O New York thing... that is just a bureaucratic pain in the derriere. The application is in, there is no reason to think it won't be approved, and it is quite literally just the process of getting large pencil pushing organizations to push some pencils (electronically and metaphorically, of course).
As for the USMLE... I'd say we are doing pretty darned well in that regard. Particularly with the Step 2. As for those who didn't pass the first time, I can actually speak rather confidently for the first 3-4 classes about why that is and I can tell you the overwhelming reason for it is personal issues relating to study habits. In some cases it had to do with personal circumstances outside the individual's control and for some people not having a highly restrictive and structured curriculum specifically geared to the USMLE was probably not compatible with that person's study habits. But at the end of the day I am fairly confident in saying that 95% of the fails fall squarely on the shoulders of the individual. The resources are available, the importance of the test is stressed from day 1, I and many others had been (and are) actively engaged in doing more to support everyone for the USMLE, but at the end of the day the structure and format of UQ (plus or minus the O) med is one that gives you plenty of rope to hang yourself with. If you are not self motivating and are like some of my classmates that found the lackadaisical Aussie lifestyle too alluring... well, let's just say I was only genuinely surprised about a USMLE outcome thrice (and as one of the founding members of OMSA, Academic Officer twice and President once, I was in the know more than most).
By far and away the biggest and most common mistake people made (and still make, despite quite literally every relevant organization and individual continually admonishing otherwise) is delaying preparation for the Step 1 until sometime after M2 year starts and then delaying taking the exam until after M3 year starts. People start taking diagnostic tests at the end of M2 year and when they are only scoring in the 210's and 220's and realize that their dreams of orthopedics or oculoplastics are in jeopardy they defer the test (since even though it is strongly encouraged and Ochsner does remove certain privileges if you haven't taken the Step 1 there is no means by which to force you to take it) thinking that they will study for it during clerkships and then take it later for a better score. Quite literally not one single person has realized this pipe dream. At best people tread water. More often their score suffers more as do their clerkships. In a handful of cases people have been scared enough to delay the exam into M4 year and then things really begin to unravel.
The Step 1 is designed to test your first 2 years of med school knowledge. If you could do well on that only studying for a few months, then we could compress the first 2 years of med school into just a few months. Sadly, the Step 1 is also not designed to actually be a valid metric by which to stratify applicants. It was designed as merely a competency test to ensure you knew a minimum amount to continue on to your clinical years. Obviously, that is not how it has come to be used, much to the detriment of some people who are smart and excellent physicians-to-be yet poor at standardized tests. The simple reality is that if you have not studied/learned enough to score into the 230's and 240's by the end of M2 year, then you simply aren't going to accomplish that during your M3 year. Period.
In case it hasn't been obvious from my ramblings, it has been true that every class there are some (around 15%) of the class that simply cannot (or willfully do not) understand this. Yes, it is true that this is the most important test you will take and it is important to score as high as possible. However, it is not true that you need to crush the exam to get any residency as an IMG. I can assure you that plenty of people have gotten quite good residencies with 210's and 220's. And there have been people who failed the exam (even one who failed both the Step 1 and 2) who still managed to find a residency spot. Obviously you don't want to be that person, but a fail does not mean all hope is lost, even for an IMG.
In terms of loan repayment... I just learned a pretty sweet fact because I am literally right now going through re-certifying my IBR/PSLF stuff.
Firstly, as I have said before, when you do IBR/PSLF what happens is you take 10% of your income based on the previous year's W-2 form, divide that by 12, and that's your monthly payment. From there, once you make 120 qualifying payments (which is defined as whatever the IBR payment is whilst employed at a qualifying institution as described a few comments up in this thread) then whatever you have left on your loan will be forgiven.
So what is pretty cool is that as a student you make $0. So your qualifying monthly payment is... $0. So for your first 12 payments you have paid nothing. Then, when you start making money as an intern, your next set of 12 payments will be based on half a year's income which in my case is $20k (because I have a few deductions that will be commonly available to anyone like my retirement plan and health insurance). And then the next year will be your full year's income at double that (so roughly $40k). Now, if you do the math on that for my 13th-24th payments I should be paying $167/month. Which is indeed pretty affordable. But I was just on the phone with the FedLoan people and it turns out that isn't actually correct. They take not from your gross reportable income but from your discretionary income which is based on the gross minus their standardized cost of living data. But it gets even better. When you report your household size, you don't have to be married or have kids to have the household be bigger than just you. If you have a roommate that you split costs with, that counts and you can increase your household size to 2. In my case, since I am not legally married to my fiance yet, I had listed my household as 1. But the FedLoan officer told me I can list it as 2. Why does this matter? Because then they take even more off of what my IBR payment is.
She did a quick estimate of the numbers for me and for my next 12 months of payments if I had listed only myself in the household, it would have been around $30/month for a qualifying PSLF payment. But since I can list my fiance it will be $0 again.
Now the unfortunate reason why I have come to realize this (which was truly worth me being a screw up) is that I managed to forget to re-certify my IBR status on time. Which meant that I had a $4,300 loan payment due today. Which is why I got on the phone with them to figure all this out. What I had to do was put my loan on an immediate forbearance, which means I won't owe any money right now, but also means that I lose a month of qualifying loan payment for the PSLF. The nice thing though is that I will be faxing in my IBR recert today, and once that goes into effect the forbearance will automatically end, it will immediately re-start me ona $0 IBR payment plan, which will then count towards my PSLF. So overall a small price to pay to figure that stuff out.
Now the rub is that once you make attending money, your IBR payment will go up significantly and you will pay more towards your loan. But so long as you are not in private practice (or if you are, that you make yourself a 501(c)3 somehow) then you will still save a lot of money on your loans by having them discharged after 120 payments. Of course, now that I know it is discretionary income it would actually make sense to pad your retirement plan(s), HSA, mortgage, literally anything that is pre-tax deductible (maybe a Roth IRA counts? I'll have to figure that one out) as much as possible to keep those payments down as much as possible. And for folks like me, it is great since I am currently planning on doing a PGY-8 year and this sort of thing really incentivizes training longer. You don't need to get out and make attending money super fast because by training longer you have vastly lower monthly payments and are that much closer to having a larger portion of your loans written off. Who knows, maybe I'll find a reason to do a PGY-10 year and be done! (I actually know two guys at Ochsner who are PGY-10's).
So TL;DR: The IBR/PSLF is an even better deal than I had previously known and it looks like I'll get 24 qualifying payments of $0 with the subsequent years of payments while still in training of somewhere around the couple hundred dollars per month range. And if you have kids, then it can easily go back down to $0.
In any event, I figured this sort of info may be interesting to those on this thread and I thought I would share.
@Maruko you might find this particularly interesting and helpful in some of your decision making right now
Firstly, as I have said before, when you do IBR/PSLF what happens is you take 10% of your income based on the previous year's W-2 form, divide that by 12, and that's your monthly payment. From there, once you make 120 qualifying payments (which is defined as whatever the IBR payment is whilst employed at a qualifying institution as described a few comments up in this thread) then whatever you have left on your loan will be forgiven.
So what is pretty cool is that as a student you make $0. So your qualifying monthly payment is... $0. So for your first 12 payments you have paid nothing. Then, when you start making money as an intern, your next set of 12 payments will be based on half a year's income which in my case is $20k (because I have a few deductions that will be commonly available to anyone like my retirement plan and health insurance). And then the next year will be your full year's income at double that (so roughly $40k). Now, if you do the math on that for my 13th-24th payments I should be paying $167/month. Which is indeed pretty affordable. But I was just on the phone with the FedLoan people and it turns out that isn't actually correct. They take not from your gross reportable income but from your discretionary income which is based on the gross minus their standardized cost of living data. But it gets even better. When you report your household size, you don't have to be married or have kids to have the household be bigger than just you. If you have a roommate that you split costs with, that counts and you can increase your household size to 2. In my case, since I am not legally married to my fiance yet, I had listed my household as 1. But the FedLoan officer told me I can list it as 2. Why does this matter? Because then they take even more off of what my IBR payment is.
She did a quick estimate of the numbers for me and for my next 12 months of payments if I had listed only myself in the household, it would have been around $30/month for a qualifying PSLF payment. But since I can list my fiance it will be $0 again.
Now the unfortunate reason why I have come to realize this (which was truly worth me being a screw up) is that I managed to forget to re-certify my IBR status on time. Which meant that I had a $4,300 loan payment due today. Which is why I got on the phone with them to figure all this out. What I had to do was put my loan on an immediate forbearance, which means I won't owe any money right now, but also means that I lose a month of qualifying loan payment for the PSLF. The nice thing though is that I will be faxing in my IBR recert today, and once that goes into effect the forbearance will automatically end, it will immediately re-start me ona $0 IBR payment plan, which will then count towards my PSLF. So overall a small price to pay to figure that stuff out.
Now the rub is that once you make attending money, your IBR payment will go up significantly and you will pay more towards your loan. But so long as you are not in private practice (or if you are, that you make yourself a 501(c)3 somehow) then you will still save a lot of money on your loans by having them discharged after 120 payments. Of course, now that I know it is discretionary income it would actually make sense to pad your retirement plan(s), HSA, mortgage, literally anything that is pre-tax deductible (maybe a Roth IRA counts? I'll have to figure that one out) as much as possible to keep those payments down as much as possible. And for folks like me, it is great since I am currently planning on doing a PGY-8 year and this sort of thing really incentivizes training longer. You don't need to get out and make attending money super fast because by training longer you have vastly lower monthly payments and are that much closer to having a larger portion of your loans written off. Who knows, maybe I'll find a reason to do a PGY-10 year and be done! (I actually know two guys at Ochsner who are PGY-10's).
So TL;DR: The IBR/PSLF is an even better deal than I had previously known and it looks like I'll get 24 qualifying payments of $0 with the subsequent years of payments while still in training of somewhere around the couple hundred dollars per month range. And if you have kids, then it can easily go back down to $0.
In any event, I figured this sort of info may be interesting to those on this thread and I thought I would share.
@Maruko you might find this particularly interesting and helpful in some of your decision making right now
Glad folks found it useful.
I was hoping there'd be more to say since I am killing time in clinic waiting for a stat lab to come back and see if I need to send my patient to the ER or not. So here I sit twiddling my thumbs.
But yeah, the loan stuff is important. Mine are up at <eep!> $420k now. For funsies, let's try running some numbers back-of-the-envelope style.
Since my salary will stay effectively the same for the first 3 years of residency I can basically count on paying roughly $0 for 48 qualifying payments. Why 48? Because the year after residency will still be based on my PGY-3 salary just like my first year of residency was based on my M4 salary.
From there I am planning a year off between residency and fellowship to work and save up money, pay off a few smaller debts, and then travel with my better half for a while. I'm anticipating making around $175k for the year. Now, I'm not sure how that will all suss out with the discretionary income aspect so lets pretend it all counts, minus the deductions I can probably count on. So I'll have to pay 10% of $150k which is $15k. The tricky part here will be figuring out how to make them qualifying payments since the work I plan to do will be locum stuff, but I think it should be possible somehow.
Then I'll have another 5 years of fellowship salary which will be a little more and probably end up making me pay something towards my loans (especially since I'm not planning on having kids and I'll probably moonlight as staff from time to time). So let's say that works out to $3600 per year ($300/mo). By the end of my first year of fellowship I'll have made 60 qualifying payments totaling $15k. So then I'll have another 5 years of fellowship level pay (with the final year being my first year as a full fledged attending, but still based on that previous last year of fellowship income) which comes out to $18k total.
Which means I could be paying as little as $33k towards my loans and have the rest forgiven. Given some fudge factors and some extra income along the way call it $50k. That almost sounds too good to be true, but it really seems to be the case. And certainly motivates me to make sure and stay on top of my IBR and PSLF and work at only 501(c)3 (or otherwise qualifying) jobs. Now, to the best of my knowledge, there is no "tax bomb" at the end of this though I'll admit it is indeed nebulous. So let's say there is a tax bomb and I have to pay tax on that $380k I'll be saving. Well, that would come out to roughly a total of $200k paid towards the loans which is still a heck of a lot better than the $420k I have right now (which will be even more because interest accrues).
So if we run the numbers without training forever....
The first 48 payments will be the same - $0. (unless you do surgery and then it will be your first 60)
After that you'll be making attending money and from there whether it is "financial hardship" qualifying you for IBR will depend. If you are a pediatrician making $150k gross, paying $4,300/mo towards your loans would certainly be a hardship. If you are an orthopedist making $650k maybe not so much. But let's assume you'd have to pay the full amount at $4,300 for 72 payments = $309k. If you went into some surgical speciality then it would be $4,300 for 48 payments = $206k.
So it seems that even with a tax bomb, there is an incentive to do at least 5 years of GME training to break even. And certainly the longer you train the better.
Anyways, if I learn more information or if someone notices something wrong with my calculations and thoughts, let me know.
I was hoping there'd be more to say since I am killing time in clinic waiting for a stat lab to come back and see if I need to send my patient to the ER or not. So here I sit twiddling my thumbs.
But yeah, the loan stuff is important. Mine are up at <eep!> $420k now. For funsies, let's try running some numbers back-of-the-envelope style.
Since my salary will stay effectively the same for the first 3 years of residency I can basically count on paying roughly $0 for 48 qualifying payments. Why 48? Because the year after residency will still be based on my PGY-3 salary just like my first year of residency was based on my M4 salary.
From there I am planning a year off between residency and fellowship to work and save up money, pay off a few smaller debts, and then travel with my better half for a while. I'm anticipating making around $175k for the year. Now, I'm not sure how that will all suss out with the discretionary income aspect so lets pretend it all counts, minus the deductions I can probably count on. So I'll have to pay 10% of $150k which is $15k. The tricky part here will be figuring out how to make them qualifying payments since the work I plan to do will be locum stuff, but I think it should be possible somehow.
Then I'll have another 5 years of fellowship salary which will be a little more and probably end up making me pay something towards my loans (especially since I'm not planning on having kids and I'll probably moonlight as staff from time to time). So let's say that works out to $3600 per year ($300/mo). By the end of my first year of fellowship I'll have made 60 qualifying payments totaling $15k. So then I'll have another 5 years of fellowship level pay (with the final year being my first year as a full fledged attending, but still based on that previous last year of fellowship income) which comes out to $18k total.
Which means I could be paying as little as $33k towards my loans and have the rest forgiven. Given some fudge factors and some extra income along the way call it $50k. That almost sounds too good to be true, but it really seems to be the case. And certainly motivates me to make sure and stay on top of my IBR and PSLF and work at only 501(c)3 (or otherwise qualifying) jobs. Now, to the best of my knowledge, there is no "tax bomb" at the end of this though I'll admit it is indeed nebulous. So let's say there is a tax bomb and I have to pay tax on that $380k I'll be saving. Well, that would come out to roughly a total of $200k paid towards the loans which is still a heck of a lot better than the $420k I have right now (which will be even more because interest accrues).
So if we run the numbers without training forever....
The first 48 payments will be the same - $0. (unless you do surgery and then it will be your first 60)
After that you'll be making attending money and from there whether it is "financial hardship" qualifying you for IBR will depend. If you are a pediatrician making $150k gross, paying $4,300/mo towards your loans would certainly be a hardship. If you are an orthopedist making $650k maybe not so much. But let's assume you'd have to pay the full amount at $4,300 for 72 payments = $309k. If you went into some surgical speciality then it would be $4,300 for 48 payments = $206k.
So it seems that even with a tax bomb, there is an incentive to do at least 5 years of GME training to break even. And certainly the longer you train the better.
Anyways, if I learn more information or if someone notices something wrong with my calculations and thoughts, let me know.
@nybgrus You mentioned that being married means you can increase our household size to 2 and qualify for extra deductions when it comes to IBR. Suppose someone were to get married during medical school or right after graduating. When he starts residency and applies for IBR, would his monthly payment amount be calculated as 10% of his income alone or would it be 10% of the combined income of the married couple (assuming his wife also has a job)
Also, how would you manage to pay $0 for the first 48 payments when you are actually making an income as a resident?
Last edited:
- Joined
- Apr 15, 2012
- Messages
- 393
- Reaction score
- 196
I think it's household income. When my wife was doing IBR for her student loans they needed my information as well.
D
deleted158872
Curiously though, this repayment plan sounds very sweet and it lookd like most hospitals out there qualify as part of the plan, so how come there aren't more people/doctors taking advantage of it? Is there any downside to this?
As Sean pointed out, I do believe it is household income. Which means if I were actually legally married to my fiance they would probably take that income into consideration. So depending on how much your spouse makes that could be detrimental or beneficial to you. It has certainly given me a little pause in whether I want to actually get legally married now! But you do not need to be married to count as part of the household, so as of right now I get to claim 2 people in the house but only my own income which seems to be the best option for now.
As for how the first 48 payments are zero... as I said above. Apparently they consider your discretionary income, not net taxable income. At least this is what the FedLoan officer I spoke with told me over the phone. Which is why if I claimed only myself she said I would pay around $30/mo rather than the $167/mo it should be if it was my entire income.
Now that you raise the point and I am thinking about it more, working backwards that seems to mean that they figure on around $16k as non-discretionary. So when my reported salary goes to the full year of ~$40k, then if I was filing it as solo that would be $40k-$16= $24k which means the payments would go to ~$200 per month. So my numbers above should be amended so that solo my first 12 payments would be $0, next 12 around $30, and then the subsequent 24 ~$200. Not sure how the addition of another household member would factor in exactly, but it would obviously bring it lower though I doubt to zero.
So it seems I was over-exuberant in my back-of-the-envelope and really should tack on an extra $5k total over those first 48 payments and probably another $10k over the remaining ones. That's why I gave myself a generous fudge factor by saying that even though my numbers are coming out to $33k, it is probably more like $50k at least and possibly more than that. And it seems I was in range. In any case, it could be $100k and that would still be great.
Last edited:
As for why more people aren't doing this... I don't know. Perhaps lots of people are? I really have no idea.
As for the downside... the downside is not making 120 qualifying payments. Because if you manage to somehow only make 119 payments then you are still on the hook for the entire rest of the loan plus all the interest that has accrued on it. And since you are (ostensibly at least) not paying additional money towards the interest as it is accruing or towards the principle (ha! as if you could) then your recapitalization on principle will be much higher than it hypothetically could have been.
For example, my very good friend did not know about IBR/PSLF and when he went through he opted to get private loans to cover everything beyond the Stafford subsidized loans (so a little over 2/3). Right now he is doing IBR for his loans (his private loans allow a version of that as well as the federal loans). He is currently paying $500/mo as a PGY-3 and that is almost entirely paying the interest that is accruing on his loans. He hasn't touched the principle at all. But at the end of the day, he'll be better off for it because otherwise that interest ultimately gets tacked on to the principle once full loan repayment begins (i.e. when he is an attending). So the ~$80k he will be spending over the course of his training is basically just to let him tread water on the loan amount he had on graduating medical school. Otherwise that $80k would have been added back into the principle and then interest would start over on the new recapitalized amount. There was somewhere I saw sample numbers showing examples of this but off the top of my head, for loans our size, having interest recapitalize on principle can easily add upwards of $125-150k to the total of the loans over their lifetime of repayment.
So if you do try and pull off IBR/PSLF and don't pay anything at all towards interest and then can't (for whatever reason) manage to complete the 120 qualifying payments, you could be on the hook for an extra $100k+. Also, if your training program is short, it makes much less of a difference (as I roughly estimated earlier). It seems you need to train for at least 5 years to make it particularly worthwhile. And if you, say, get a job offer at a private non-501(c)3 place for gobs of money, you'd have to weigh the balance of your loans in context of the money you'd be making.
In other words, let's say you are 5 years out and have been doing IBR/PSLF only. Now some pharma company or whatever comes along and says they'd like to hire you as a whatever and pay you some exorbitant amount like $750k. Sounds like a great salary, but since you've only paid around ~$15-20k towards your loans with interest accruing, now that $420k loan I have is more like $480k (because don't forget the IBR/PSLF thing is great but the interest rate on our loans sucks, which is why my friend went with private loans instead) which I will then be on the hook for in total. So you'd have to pay it all of ASAP because the vig is running. If you are making $750k, then roughly half will go to taxes and whatnot so your take home will be $375k at best. Which means you'd still need at least a couple of years of paying basically all of your take home pay in order to be done with it. So you'd have a job paying you $750k a year and still have barely more spending cash left over than you did as a fellow and not have the ability to invest or pay towards your retirement. Alternately you take longer to pay it off, have more cash in your pocket, maybe buy a house/car, and put away for retirement, but take a few extra years to pay off the loans and tack on another extra $50-100k because of interest.
Overall it may be in your better interest to take that lower paying job at a 501(c)3 than the kush $750k job with AstraZeneca in that context. Still though, it strikes me as a plenty great option, but it will be more or less great depending on exactly who you are, what your plans are, and where you anticipate yourself working. If you are thinking of a long training path and at least some sort of quasi-academic career then it is a no-brainer. If you want to be out and done ASAP and work some business angles and start making the biggest money you can the fastest, may not be in your best interest. At at least not quite as attractive.
Thanks a lot! This is really interesting. From what you described in several posts above, it seems that the maximal benefit of IBR/PSLF will depend on getting the following things right from the beginning to the end:
1. Get the max federal student loans to cover the cost. Is it possible to get all the UQ-Ochsner costs covered by eligible fed student loans? If not, what percentage of the cost can be covered by the eligible fed student loans?
2. Get the residency/fellowship pay that is eligible for IBR/PSLF for all PGY1 to PGY10. Can one assume that all pays from residency/fellowship are IBR/PSLF eligible? If not, how can one make sure it is? What's the rough percentage of residency/fellowship out there that is eligible for IBR/PSLF?
3. Get PGY1-10 residency/fellowship, and live poorly for at least 10 years. I know that getting a residency is not easy in the first place. Then getting PGY10 must be even harder. Which hard tests are there when moving from PGY1 all the way through to PGY10? How much can we bet on getting it all the way through? As you said, the downside is that if one can't get far enough to make 120 eligible payments, then all the interests piled up plus the principal of the loans will be a big problem down the road.
4. How likely will the policy be changed in future after new president enters the White House?
1: All of my loans are eligible Federal loans
2: I don't have hard numbers, but I do know that ~80% of all GME occurs in county/state hospitals which are by definition eligible. Of the remaining 20% I would aver that nearly all are 501(c)3. Only smaller community or other "outside the match" type programs would be ineligible.
3: Getting residency is tough, but highly variable. Psych residency is not the same as ortho. So it is with fellowships. ID fellowship is basically one where if you apply you will get a spot somewhere. There were unfilled spots in Louisiana for this year's intake. Cardiology and GI fellowship are much more difficult to get in. Critical care is middle of the road but getting more competitive. You don't really need more tests at that point though. For IM subspecialties your Step scores play a factor, but your research and letters of rec are vastly more important. It also becomes vastly less important (if a factor at all) if you are IMG or not, assuming you completed residency in the US. Getting out past your first fellowship becomes much easier. Mostly because there is much less competition at that point. There is also a lot of flexibility in being able to make your own fellowships depending on exactly what you want to do.
For example one of the guys I worked with my last couple of weeks in the ICU did an IM residency, then a heart failure fellowship before it was an official ABMS specialty as a foot in the door to cardiology fellowship. Then he finished his cards fellowship and is now doing just a single year of critical care fellowship in order to be able to be boarded in: Internal Medicine (3 years), heart failure (1 year), cardiology (3 years), and critical care (1 year). So that's already 8. If he decided to do interventional cardiology that would add another year.
Furthermore, you do not need to be in residency/fellowship to get this deal. You just need to work at a 501(c)3. You could be a staff physician at Ochsner making attending money and still qualify with the payments. It is just that your payments will be more and you will pay more towards your loan. Conceivably you could even strike up a contract with a hospital or other organization that qualifies and agree to a lower salary with more of your pre-tax income put into retirement funds or other means that the IBR does not "see" in order to knock out your payments. Point being, is that getting the qualifying payments is not that hard. It is merely a question of how much you will end up paying based on the salary you get at the time.
4: There has been significant pressure and attempts to really screw us in this regard. Thankfully some major legislation that would have been very bad did not pass last year. Of course, who knows how the landscape will play out. That said, the ability to use IBR and PSLF is part of the MPN you sign upon receiving the loans. So as long as you never re-negotiate those loans (e.g. consolidation) then the government is bound by the terms. They can change exactly what is meant by IBR/PSLF and make things tougher and end up costing more, they could make the "tax bomb" a reality, and so forth, but at least in principle, assuming you signed the MPN with IBR/PSLF still in effect it cannot be taken away sometime down the road.
As for how likely any of that is to happen... I have no idea. I attempt to understand politics because it affects my life and the lives of those I love. But I am a scientist and a rationalist, and if there are two things politics are not (especially in the US) is evidence based and rational. But I have a feeling that given how much student debt is eclipsing all other debt in the US there will need to be some kind of reform and if that reform leads to huge numbers of people, particularly folks like doctors who hold esteem, authority, and respect in society (ahem, and probably - sadly - more importantly, money), getting royally screwed there will be some sort of backlash.
At the end of the day, I personally don't worry about it (well, maybe a little from time to time but not much). One thing they will never take away from me is my medical license because if they want money that's how they'll get it. And so long as I can practice medicine, I'll be happy. Plus I also happen to be an EU citizen and my fiancee really liked Australia so...
Just realized the link I provided earlier also answers a lot of important questions.
"A qualifying loan for PSLF is any loan you received under the William D. Ford Federal Direct Loan (Direct Loan) Program"
"Loans from these programs [Federal Family Education Loan (FFEL) Program or the Federal Perkins Loan (Perkins Loan) Program] do not qualify for PSLF, but they may become eligible if you consolidate them into a Direct Consolidation Loan. However, only qualifying payments that you make on the new Direct Consolidation Loan can be counted toward the 120 payments required for PSLF. Any payments you made on the FFEL Program loans or Perkins Loans before you consolidated them don’t count."
"If you make a monthly payment for more than the amount you are required to pay, you should keep in mind that you can receive credit for only one payment per month, no matter how much you pay. You can’t qualify for PSLF faster by making larger payments. However, if you do want to pay more than your required monthly payment amount, you should contact your servicer and ask that the extra amount not be applied to cover future payments. Otherwise, you may end up being paid ahead, and you can’t receive credit for a qualifying PSLF payment during a month when no payment is due."
"To help you determine if you are on the right track as early as possible, we have created an Employment Certification for Public Service Loan Forgiveness form (Employment Certification form) that you can submit periodically while you are working toward meeting the PSLF eligibility requirements."
"If you do not periodically submit the form, then at the time you apply for forgiveness you will be required to submit an Employment Certification form for each employer where you worked while making the required 120 qualifying monthly payments."
"After you make your 120th qualifying monthly payment, you will need to submit the PSLF application to receive loan forgiveness. The application is under development and will be available prior to October 2017, the date when the first borrowers will become eligible for PSLF"
and very importantly:
"Note that loan amounts forgiven under the PSLF Program are not considered income by the Internal Revenue Service. Therefore, you will not have to pay federal income tax on the amount of your Direct Loans that is forgiven after you have made the 120 qualifying payments."
So it also seems that more people aren't doing/talking about this also because it is rather new and not a single person has yet qualified for the forgiveness.
"A qualifying loan for PSLF is any loan you received under the William D. Ford Federal Direct Loan (Direct Loan) Program"
"Loans from these programs [Federal Family Education Loan (FFEL) Program or the Federal Perkins Loan (Perkins Loan) Program] do not qualify for PSLF, but they may become eligible if you consolidate them into a Direct Consolidation Loan. However, only qualifying payments that you make on the new Direct Consolidation Loan can be counted toward the 120 payments required for PSLF. Any payments you made on the FFEL Program loans or Perkins Loans before you consolidated them don’t count."
"If you make a monthly payment for more than the amount you are required to pay, you should keep in mind that you can receive credit for only one payment per month, no matter how much you pay. You can’t qualify for PSLF faster by making larger payments. However, if you do want to pay more than your required monthly payment amount, you should contact your servicer and ask that the extra amount not be applied to cover future payments. Otherwise, you may end up being paid ahead, and you can’t receive credit for a qualifying PSLF payment during a month when no payment is due."
"To help you determine if you are on the right track as early as possible, we have created an Employment Certification for Public Service Loan Forgiveness form (Employment Certification form) that you can submit periodically while you are working toward meeting the PSLF eligibility requirements."
"If you do not periodically submit the form, then at the time you apply for forgiveness you will be required to submit an Employment Certification form for each employer where you worked while making the required 120 qualifying monthly payments."
"After you make your 120th qualifying monthly payment, you will need to submit the PSLF application to receive loan forgiveness. The application is under development and will be available prior to October 2017, the date when the first borrowers will become eligible for PSLF"
and very importantly:
"Note that loan amounts forgiven under the PSLF Program are not considered income by the Internal Revenue Service. Therefore, you will not have to pay federal income tax on the amount of your Direct Loans that is forgiven after you have made the 120 qualifying payments."
So it also seems that more people aren't doing/talking about this also because it is rather new and not a single person has yet qualified for the forgiveness.
