Welp, see ya later medical school

[PL198]

Don't ever use average indebtedness figures because they figure in kids with rich parents. Per the AAMC, the average and median indebtedness for private US MD schools in 2013 was $181,058 and $190,000, respectively. The average tuition and fees alone for private schools in 2013 was $50,476/yr, so figure an average COA in the $70k/yr range. The numbers are total bull****.

In terms of raw earnings the physician will earn more.

Yes but using raw earnings as a metric is pretty silly in my opinion.

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[PL198]

Care to show some evidence of only a small minority receiving any kind of aid or scholarships?

Lol ask however many med students you know if they get any financial aid. Hint : it's probably 0 or very close to 0

 

[Fabio Lanzoni]

I think the average indebtedness is the evidence. amirite?

Actually the avg indebtedness proves the opposite. They're all in the 100K-200K range, yet school tuition alone is almost 180-200K at non-state schools. Where's the cost of living? We all know the averages are brought down by rich people paying their tuition without loans. The vast majority of people will be lucky to be under 150K

 

[masaraksh]

Actually the avg indebtedness proves the opposite. They're all in the 100K-200K range, yet school tuition alone is almost 180-200K at non-state schools. Where's the cost of living? We all know the averages are brought down by rich people paying their tuition without loans. The vast majority of people will be lucky to be under 150K

No, my point was that if a much larger amount of students got fin aid, then the avg debt would be lower.

 

[motz]

Doctor's salaries will go down. NPs and PAs are doing a great job at providing primary care. It's getting harder to justify the salary of physicians as time goes on. Nobody cares how much debt and training you take on unless you can justify it with improved patient outcomes.

 

[Fabio Lanzoni]

No, my point was that if a much larger amount of students got fin aid, then the avg debt would be lower.

The full COA for 4 years for most schools will be between 240-280K (45K tuition + 15K living expenses on the conservative end). Average indebtedness is almost always under 200K. If you look at that, you would think most people get aid, which is false. Therefore: avg debt is already lower than full COA while most people are not getting aid = you shouldn't look at avg debt estimates.

 

[masaraksh]

Doctor's salaries will go down. NPs and PAs are doing a great job at providing primary care. It's getting harder to justify the salary of physicians as time goes on. Nobody cares how much debt and training you take on unless you can justify it with improved patient outcomes.

Salaries will go down in other fields as well, as the forces of globalization bring on a period of convergence. This will bring rise and wealth to the poorer/less developed countries but the relative wealth of the US will drop. Not just in medicine but across the board.

 

[masaraksh]

The full COA for 4 years for most schools will be between 240-280K (45K tuition + 15K living expenses on the conservative end). Average indebtedness is almost always under 200K. If you look at that, you would think most people get aid, which is false. Therefore: avg debt is already lower than full COA while most people are not getting aid = you shouldn't look at avg debt estimates.

Your COA and Avg Indebt figures are correct. You're wrong in that I wouldn't draw that conclusion

 

[lmn]

I think the average indebtedness is the evidence. amirite?

No... Most schools are around $70-80k a year COA, that would be $280k-$320k without interest, how many schools on MSAR reflect that? Most schools are somewhere around ~$150k-ish which would mean in order for there to be no scholarships/aid for students that half off the class or more would need to pay for (or their parents/etc) their entire COA while the other half is taking out loans to pay that entire amount.

Lol ask however many med students you know if they get any financial aid. Hint : it's probably 0 or very close to 0

A very sizable amount of people I know, including myself (although mine is very substantially less than some other friends'), are receiving at least some amount of scholarship money from our different schools. A much smaller amount of people I know are receiving things such as institutional loans that have low rates and don't accrue interest during school or residency. Now I don't know any statistics, and so far I haven't seen anyone else produce any, but I have very clearly seen the majority of people I know in schools receiving at least some money to help with the COA.

 

[WhippleWhileWeWork]

Doctor's salaries will go down. NPs and PAs are doing a great job at providing primary care. It's getting harder to justify the salary of physicians as time goes on. Nobody cares how much debt and training you take on unless you can justify it with improved patient outcomes.

Do you mean it's getting hard to justify the salary of primary care physicians? What happens when NPs demand the same reimbursements and then the same pay for those "similar outcomes"?

 

[Medstart108]

If you can be happy doing something else, do something else. Medicine is "worth it" only if you can't fathom doing anything else.

Tons of people who are happy in medicine can fathom doing something else. I can fathom doing a crap ton of things including being a garbage man, doesn't mean i want to be a garbage man. I'm so tired of the "only be a doctor if u couldn't imagine doing anything else" bull****. If i took everything you had away i'd bet you'd quickly start fathoming a career other than medicine.

 

[circulus vitios]

Yes but using raw earnings as a metric is pretty silly in my opinion.

Match into something that's conducive to a humane lifestyle. $200k/yr 9-6 in outpatient FM/IM, psych, derm, or PM&R. >$125/hour in EM. People who go into fields like surgery or any of the inpatient medical specialties without wanting to work 60+ hours a week for the rest of their life are dumb.

 

[motz]

Do you mean it's getting hard to justify the salary of primary care physicians? What happens when NPs demand the same reimbursements and then the same pay for those "similar outcomes"?

Yup. But there are CRNAs, and PAs who specialize, too. Frankly, I see medical schools and students becoming more tiered and hierarchical, as competition for residencies in high-paying fields increases. DOs focusing on primary care, state schools focusing on rural medicine, while Harvard and UCSF take up all of the radiology spots!

 

[motz]

Match into something that's conducive to a humane lifestyle. $200k/yr 9-6 in outpatient FM/IM, psych, derm, or PM&R. >$125/hour in EM. People who go into fields like surgery or any of the inpatient medical specialties without wanting to work 60+ hours a week for the rest of their life are dumb.

Yup. $$$ per hour is a better way to look at it. I think psychiatrists have their earning power a bit underrepresented because people cite salaries and not $$$ per hour worked.

 

[PL198]

Doctor's salaries will go down. NPs and PAs are doing a great job at providing primary care. It's getting harder to justify the salary of physicians as time goes on. Nobody cares how much debt and training you take on unless you can justify it with improved patient outcomes.

No. How can you possibly say that? Currently the care they provide is overseen by a licensed physician. Therefore when they write up an order for something that would kill a patient, but the doctor goes " no no no, you can't do that," we don't have an outcome of death marked down. There is literally no data yet on them practicing independently and when there is, it's not going to be doing a "great job." Do you understand what NP school entails? If you think that gives someone the knowledge to practice as a PCP on their own, then I'm scared sh*tless. Online classes and joke clinical experiences FTW. MS3s have more clinical experience than a newly minted NP.

 

[tmn]

No. How can you possibly say that? Currently the care they provide is overseen by a licensed physician. Therefore when they write up an order for something that would kill a patient, but the doctor goes " no no no, you can't do that," we don't have an outcome of death marked down. There is literally no data yet on them practicing independently and when there is, it's not going to be doing a "great job." Do you understand what NP school entails? If you think that gives someone the knowledge to practice as a PCP on their own, then I'm scared sh*tless. Online classes and joke clinical experiences FTW. MS3s have more clinical experience than a newly minted NP.

This thread took longer to arrive here than I would have guessed. Nice work SDN.

 

[motz]

No. How can you possibly say that? Currently the care they provide is overseen by a licensed physician. Therefore when they write up an order for something that would kill a patient, but the doctor goes " no no no, you can't do that," we don't have an outcome of death marked down. There is literally no data yet on them practicing independently and when there is, it's not going to be doing a "great job." Do you understand what NP school entails? If you think that gives someone the knowledge to practice as a PCP on their own, then I'm scared sh*tless. Online classes and joke clinical experiences FTW. MS3s have more clinical experience than a newly minted NP.

I certainly don't want to see more NPs and PAs encroach on physician's roles, but that's the way things are going. Medical school tuition is increasing at an almost logarithmic rate, so medical students are less willing to do primary care. Salaries are going down across the board, and some are barely higher than NPs and PAs, not even enough to cover training time and tuition costs. The difference in the day to day duties of a psychiatric NP and ID NP vs. a psychiatrist and ID doctor isn't that much, though the training and expertise is obviously different. We're seeing a larger gap between the knowledge training between physicians that specialize and do long fellowships, and a shrinking gap between NPs and PAs (particularly NPs who have great people lobbying for them) and PCPs. NPs and PAs are getting better trained (yeah, online classes aren't great, but how many medical students attend lectures and just livestream lectures now?) and doing the job our country needs right now.

Hell, I work in a clinic and volunteer at a few, and most patients see primary care clinicians in the following manner: Old, experienced MD/DO >>> young MD/DO >> NP. Look up nurse practitioner on Google. You'll find a very easy to read website that the public will read and love. "NPs are holistic, they treat the whole person, they have conversations with you, they take extra time with you. If they don't know something, they'll consult with other NPs and their physician *partners.*" NPs see themselves as partners, not physician's underlings. And from working in the clinic, that's how they operate.

Just my two cents.

 

[PL198]

I certainly don't want to see more NPs and PAs encroach on physician's roles, but that's the way things are going. Medical school tuition is increasing at an almost logarithmic rate, so medical students are less willing to do primary care. Salaries are going down across the board, and some are barely higher than NPs and PAs, not even enough to cover training time and tuition costs. The difference in the day to day duties of a psychiatric NP and ID NP vs. a psychiatrist and ID doctor isn't that much, though the training and expertise is obviously different. We're seeing a larger gap between the knowledge training between physicians that specialize and do long fellowships, and a shrinking gap between NPs and PAs (particularly NPs who have great people lobbying for them) and PCPs. NPs and PAs are getting better trained (yeah, online classes aren't great, but how many medical students attend lectures and just livestream lectures now?) and doing the job our country needs right now.

Hell, I work in a clinic and volunteer at a few, and most patients see primary care clinicians in the following manner: Old, experienced MD/DO >>> young MD/DO >> NP. Look up nurse practitioner on Google. You'll find a very easy to read website that the public will read and love. "NPs are holistic, they treat the whole person, they have conversations with you, they take extra time with you. If they don't know something, they'll consult with other NPs and their physician *partners.*" NPs see themselves as partners, not physician's underlings. And from working in the clinic, that's how they operate.

Just my two cents.

They are underlings. If a doctor(a physician) says, " no you don't do this," they don't get to do this. By definition, that's an underling. A shrinking gap? In what? Knowledge or perception of knowledge? They're getting better trained? Have you seen the classes they take? Someone broke it down and literally 60-70 percent of it was pure BS and wasn't even science related. Every statement you make is based on the perception of NPs, not their actual efficacy. This isn't a game. We aren't advocating for people that are improperly trained to have complete and full control over a patient's care. They have very limited training compared to a physician, this is why physician oversight was required for so long. If you can truly look over their curriculum and tell me you'd feel confident listening to their medical advice, which had no oversight from a physician, then I'd say you're on some good stuff. Primary care isn't as simple as you make it out to be. Online classes vs watching lectures online and having in-person exams and still tons of activities at the school are completely different.

Nothing you've said is based on fact. If we want to debate perception, sure, yet perception doesn't stop someone from dying. Knowledge and proper judgement does. What is your status? There is literally 0 data to show that the outcomes are similar, seeing as it's impossible for that data to exist since they haven't been able to practice solo. If you had your math teacher and you could ask them if your work was right for every problem, you'd get a 100 too.

 

[Psai]

I certainly don't want to see more NPs and PAs encroach on physician's roles, but that's the way things are going. Medical school tuition is increasing at an almost logarithmic rate, so medical students are less willing to do primary care. Salaries are going down across the board, and some are barely higher than NPs and PAs, not even enough to cover training time and tuition costs. The difference in the day to day duties of a psychiatric NP and ID NP vs. a psychiatrist and ID doctor isn't that much, though the training and expertise is obviously different. We're seeing a larger gap between the knowledge training between physicians that specialize and do long fellowships, and a shrinking gap between NPs and PAs (particularly NPs who have great people lobbying for them) and PCPs. NPs and PAs are getting better trained (yeah, online classes aren't great, but how many medical students attend lectures and just livestream lectures now?) and doing the job our country needs right now.

Hell, I work in a clinic and volunteer at a few, and most patients see primary care clinicians in the following manner: Old, experienced MD/DO >>> young MD/DO >> NP. Look up nurse practitioner on Google. You'll find a very easy to read website that the public will read and love. "NPs are holistic, they treat the whole person, they have conversations with you, they take extra time with you. If they don't know something, they'll consult with other NPs and their physician *partners.*" NPs see themselves as partners, not physician's underlings. And from working in the clinic, that's how they operate.

Just my two cents.

You have no idea what you're talking about so it's obvious that you're a premed. You have zero experience as a doctor or an np so you don't have any way to compare the two careers. Being a volunteer gives you no insight into their work. There's a huge difference between an online class and a class where you stream a lecture (by the way, it's not a livestream, it's a recording). Also, it's not "if they don't know something" but "when". You can't pack in a proper medical education in a shorter period of time through a less rigorous program with lower quality teachers and fluffy topics. Doctors go through a ridiculous amount of quality control and no amount of talk about "holistic" care will make any difference in the quality of an education.

 

[PL198]

Not to mention the whole " you don't know what you don't know. " Fresh NPs haven't been exposed to 1/10th the medicine an MD has, thus when there is something they don't know, they literally don't know that they don't know.

 

[motz]

You have no idea what you're talking about so it's obvious that you're a premed. You have zero experience as a doctor or an np so you don't have any way to compare the two careers. Being a volunteer gives you no insight into their work. There's a huge difference between an online class and a class where you stream a lecture (by the way, it's not a livestream, it's a recording). Also, it's not "if they don't know something" but "when". You can't pack in a proper medical education in a shorter period of time through a less rigorous program with lower quality teachers and fluffy topics. Doctors go through a ridiculous amount of quality control and no amount of talk about "holistic" care will make any difference in the quality of an education.

Yeah, I'm just talking about my impression as a clueless pre-med, but you should realize that my impression is similar to the general public. And I think I do have basic knowledge to compare the two careers, namely reading the Resident's Forum where psychiatrists talk about the career differences, and by personal experience talking with doctors and NPs. The NP at the clinic I work at sees her own patients, just like the doctors, see the same # of patients with the same diseases and co-morbidities, and do lumbar punctures, too. It's cognitive work, not procedural, and very routine. Even a psychiatrist I talked to said that there's so much we don't know about psychiatry, and that it's often subjective, so NPs are very likely to take over an increasing share of the market.

Again, anyone with a 5th grade reading level can figure out the level of training is much different. But how does that difference translate to in terms of ability and care when it comes to a good chunk of healthcare? If it's small enough, people in need of primary care clinicians may just choose to go to an NP/PA when there aren't enough primary care physicians. If it's small enough, their lower cost will make them more attractive to hospitals/clinics/whatever. I don't disagree with you that training is a virtue and a good thing, but aside from surgery and a few other specialties, which specialties are immune from mid-levels?

Can someone give me an answer that's not 90% condescension and 10% information? We're not arguing whether or not physicians and mid-levels are equivalent in effectiveness (despite their training), but whether or not mid-levels will take a larger and larger portion of doctors patients due to shortages, costs, lobbying, and marketing.

 

[mvenus929]

The NP at the clinic I work at sees her own patients, just like the doctors, see the same # of patients with the same diseases and co-morbidities, and do lumbar punctures, too. It's cognitive work, not procedural, and very routine.

Are you sure the NPs are managing the same patients? Typically, the physician is taking on the patients with more comorbidities. Then again, I may be biased because I'm in peds, and the post-NICU babies, CP kids, etc, etc, are seen by multiple physicians, while the NPs generally manage the more routine kids within whatever specialty they do (the well child checks, the fast track in the ED, the 'typical' diabetes, etc).

 

[motz]

They are underlings. If a doctor(a physician) says, " no you don't do this," they don't get to do this. By definition, that's an underling. A shrinking gap? In what? Knowledge or perception of knowledge? They're getting better trained? Have you seen the classes they take? Someone broke it down and literally 60-70 percent of it was pure BS and wasn't even science related. Every statement you make is based on the perception of NPs, not their actual efficacy. This isn't a game. We aren't advocating for people that are improperly trained to have complete and full control over a patient's care. They have very limited training compared to a physician, this is why physician oversight was required for so long. If you can truly look over their curriculum and tell me you'd feel confident listening to their medical advice, which had no oversight from a physician, then I'd say you're on some good stuff. Primary care isn't as simple as you make it out to be. Online classes vs watching lectures online and having in-person exams and still tons of activities at the school are completely different.

Nothing you've said is based on fact. If we want to debate perception, sure, yet perception doesn't stop someone from dying. Knowledge and proper judgement does. What is your status? There is literally 0 data to show that the outcomes are similar, seeing as it's impossible for that data to exist since they haven't been able to practice solo. If you had your math teacher and you could ask them if your work was right for every problem, you'd get a 100 too.

Yeah, it's based mostly on perception, but there are a few facts, that NPs have been getting increasing autonomy in the past years, many practice under a physician only technically (just getting an MD to sign off on stuff), and they're trained to do a limited portion to do what doctors do at the same level. There is a huge need for primary care, and since physicians don't want their numbers to go up (we've seen in law and pharmacy a decrease in salaries, prestige, and employment) NPs and PAs are lobbying for more practice rights. As far as perception, you realize that most of the public rely on it when they make decisions like when they choose who they go to for primary care. NPs can't tout superior training, but they can convince people they are "holistic" and "more caring." If patients believe that, they'll go to NPs, or feel less hesitant about trying out an NP for their primary care. That's another patient that MDs/DOs have lost.

Facts matter, but impressions and perception is important when it comes to politics and the general public. I wish physicians would stop being so self-centered and focused on their credentials and their own medical knowledge and take a more broad view when it comes to the mid-level debate. An article from Forbes: "With hospitals and clinics scrambling to find enough primary care doctors ahead of the Affordable Care Act, a new report shows they are increasingly turning to the already short supply of physician assistants and nurse practitioners."

People need primary care providers. There are not enough physicians. So NPs are filling in for them. It's not an ideal situation, but would you recommend more medical schools? As they get more practice rights, it becomes easier for them to justify more practice rights. Physicians responding with, "They're not as highly trained as us!" is not a good response because it doesn't address the needs of the public. People need immunizations, routine check-ups, and preventive care. NPs can totally do that just fine.

Some of these arguments (that are weak, IMHO) against NPs can be used against PCPs, too. A cardiologist can cry out that the internal medicine doctor isn't as well trained as he is, and the cardiologist had more years in a fellowship. And PCPs often refer patients to other specialists when patients are out of their scope of practice. My ophthalmologist referred my mom to a retinal specialist when he didn't have the skills to treat her problem, for instance. I got referred to a cardiologist because my PCP couldn't do a stress test (and he later told me he couldn't read a EKG, which was bull**** and out of laziness).

 

[motz]

Are you sure the NPs are managing the same patients? Typically, the physician is taking on the patients with more comorbidities. Then again, I may be biased because I'm in peds, and the post-NICU babies, CP kids, etc, etc, are seen by multiple physicians, while the NPs generally manage the more routine kids within whatever specialty they do (the well child checks, the fast track in the ED, the 'typical' diabetes, etc).

No, not 100% the same patients, actually. But there's overlap and when the doctors take a day off the NP absorbs some of their patients, and the NP does many of the same patients but different types of appointments. In the HIV clinic (where you have to be pretty bad in the first place to go), the NP usually sees on average younger patients (who naturally have fewer co-morbidities), but she also sees older people on a regular basis. I'm not sure how patients are divided, but a PA "sorts out" new patients and determines which doctor they'll get. But there's two physicians, an NP, and two PAs. I do the appointments, and usually the NP takes the doctor's patients when the patient needs a certain type of appointment like a follow-up or something. The doctor would rather focus on seeing new patients or doing more in-depth appointments. About 20% of patients who get told their follow-up will be with the NP refuse the NP and want to see any of the two doctors. But it's just my impression NPs' work is overlapping a great deal with physicians, and it kind of blew my mind. I just wondered how an NP could get such a great job in a very nice clinic in a very nice city, working independently much like an MD, and why a MD or DO wasn't there in her place.

 

[StBernardsRule]

Just curious, OP what did you decide to do?

 

[darklabel]

Not to mention the whole " you don't know what you don't know. " Fresh NPs haven't been exposed to 1/10th the medicine an MD has, thus when there is something they don't know, they literally don't know that they don't know.

The whole statistic that most NPs can't even pass a watered down version of Step 3 scares me. I mean most residents, attendings and such say that minor things like a cold can be handled by NPs, but aren't there subtle symptoms that physicians would be able to catch over an NP because as you said, NPs haven't been exposed to 1/10th the stuff an MD has? Sounds like letting NPs encroach with inferior knowledge is more dangerous for the patient than anything else.

 

[PL198]

The whole statistic that most NPs can't even pass a watered down version of Step 3 scares me. I mean most residents, attendings and such say that minor things like a cold can be handled by NPs, but aren't there subtle symptoms that physicians would be able to catch over an NP because as you said, NPs haven't been exposed to 1/10th the stuff an MD has? Sounds like letting NPs encroach with inferior knowledge is more dangerous for the patient than anything else.

Yes. There's this idea that somehow NPs could adequately manage in primary care. They definitely couldn't. Primary care isn't 100 % colds and ear infections, and those cases that aren't are the ones that are serious and there would be a HUGE difference between an MD/DO and a NP.

 

[shockazulu]

It cracks me up when I log on it SDN and people are complaining about "only" making 250K a year (Not directed at you OP, as you have other reservations about med school, which is fine). Even after paying taxes, loans, and a mortage you still come out with 100,000K. You're not eating Oodles and noodles and you would live better than 99.99999% of the human population. If its money that you're after play the lottery. This is just stupid.

 

[Iatrike]

and, like a dying star, this thread is finally imploding on itself

/thread

TL;DR for this 7 paged thread, but responding to your original post: Point #1: I think you've made a grave error in your calculations. If you live well below your means for the first 3-4 years out of medical school on yearly expenses of less than 25,000 per year you can have all of it paid off in less than 4 years even on the $250,000 salary rate you mentioned. You just have find a comfortable way to live on a lower rate of monthly living allowance. Live like a student into residency and for a few years after. That would solve the dilemma.
Point #2: There are other ways to make money besides through your work in medicine and having a higher salary rate would make that easier. There's no need to give up your position for a little bit of debt. Mentors have told me that most physicians they know are not relying on medicine as their primary source of income. They make wise investments, they start businesses, they own property, and they see a greater return because that higher salary rate allows them to put more into it. A good career goal I'm aware of is to build up your assets to the point where you're making more through those assets than you are from simply working.
Point #3: Have the global picture in mind -- the average career length of a physician is 41 years. To consider financial matters when pursuing a medical career is wise. To do medicine for the money is unwise. Likewise, if given the opportunity to do medicine, to not do it because of the debt is also unwise -- as you pay it off the debt really won't impose upon your lifestyle as much as it did at the beginning. Which is worth more -- a career in medicine or the money from that career? Since no amount of money can buy your way into medical school and becoming a doctor I would reason that the opportunity to become a physician is more valuable.

I'm still in the medical student stage but these are things that I've heard from mentors and have researched that have helped me. Hopefully they'll help you to make a wiser decision. I hope that helps.

 

[Iatrike]

Exhibit A:

(New account, numbered school names to keep anonymous).
School 1 -
...
Any thoughts on this comparison would be very much appreciated, especially from those farther down the road (medical students, residents) with a better perspective on these parameters. How important would you weigh happiness versus this extent of debt? Crude calculations show that in a standard 10 yr repayment plan I'd be paying at least 6k per month which seems completely crippling. But I also know that I'll never have these years back, and so happiness may in this sense out weigh the price I'd have to pay.

One primary point of reflection that I've gleaned from your comments would be that you view debt as unhappiness. Being able to be in-debt up to your eyeballs is what makes the U.S. a great country. In other countries such options simply are not available. In some countries you are born into a social stratum and income level that you will remain in until you die. It's because you can come from nothing, have nothing, and still do great things. It's a means to an end. I think that you should adjust the way that you see the debt. Rather than something that encroaches upon your happiness see it as an opportunity. 'I get to become a doctor.' I say this as one already seeing at a lot of debt from the initial part of medical school. You may live a long time. You may rather want to say that you spent the strength of your youth getting into the career you love than that you turned down a great opportunity to follow frivolous things that didn't give you the same sense of fulfillment you imagined you would get from medicine (as I've heard from several retired people, including an engineer).

 

[Fedaykin]

And 20 years from now, you will realize you made a horrible mistake. IBR, PAYE and win.

You can also count on inflation to help out with debt. My Dad spent an enormous amount of money in the 1950s to go to college- $15,000. He retired 50 years later bringing in around $95k/yr.

 

[Fedaykin]

TL;DR for this 7 paged thread, but responding to your original post: Point #1: I think you've made a grave error in your calculations. If you live well below your means for the first 3-4 years out of medical school on yearly expenses of less than 25,000 per year you can have all of it paid off in less than 4 years even on the $250,000 salary rate you mentioned. You just have find a comfortable way to live on a lower rate of monthly living allowance. Live like a student into residency and for a few years after. That would solve the dilemma.

I think this is a point lost on most people- cost of living doesn't scale to salary unless you have a complete lack of self-control. I'm living on about $24k per year. I don't eat filet mignon but I have an ok lifestyle. NetFlix and HuluPlus go a long way and once a year or so I find a way to take a modest vacation. If I had the opportunity to raise my annual cost of living to $50k, I would feel like a king. Say you get into a good specialty and pull in $250k after a few (5-10) years of experience. That's going to be about $180k after taxes, and I could live what's for me a comfortable life ($50k per year) and throw $130k per year at my loans. Taking the scariest number in OP's post- $750k, that's no more educational debt after six years. Six. Say that his specialty is less lucrative and he pulls in $150k/yr. That's still going to be around $110,000 per year in take home pay and allows him to throw $60,000 a year at his debt. Reasonably comfortable lifestyle unless you're in San Francisco, out of debt in 13 years. That's using an extremely high overestimation for total debt cost and assuming a low-paying career path after medical school.

*Note: data in this post was acquired by googling "tax burden estimator" and running round numbers through a calculator. The numbers aren't publication-quality but the underlying point remains.

 

[Fedaykin]

PAYE = %10 of income, remaining balance forgiven after 20 years,

Sort of, not really. Your remaining balance is forgiven after 20 years but you need to declare the amount forgiven on your taxes as income. That certainly works out to be a lot less money that continuing to pay the principal while it's still accruing interest, but it's also not the free lunch that the phrase "loan forgiveness" can sound like.

 

[BestDoctorEver]

I think this is a point lost on most people- cost of living doesn't scale to salary unless you have a complete lack of self-control. I'm living on about $24k per year. I don't eat filet mignon but I have an ok lifestyle. NetFlix and HuluPlus go a long way and once a year or so I find a way to take a modest vacation. If I had the opportunity to raise my annual cost of living to $50k, I would feel like a king. Say you get into a good specialty and pull in $250k after a few (5-10) years of experience. That's going to be about $180k after taxes, and I could live what's for me a comfortable life ($50k per year) and throw $130k per year at my loans. Taking the scariest number in OP's post- $750k, that's no more educational debt after six years. Six. Say that his specialty is less lucrative and he pulls in $150k/yr. That's still going to be around $110,000 per year in take home pay and allows him to throw $60,000 a year at his debt. Reasonably comfortable lifestyle unless you're in San Francisco, out of debt in 13 years. That's using an extremely high overestimation for total debt cost and assuming a low-paying career path after medical school.

You won't take home 110k with a 150k salary... Reasonable take home pay might be in the 80k-85k after tax/SS/medicare, health insurance deductions and 5% 401k contribution into your retirement...

 

[Fedaykin]

You won't take home 110k with a 150k salary... Reasonable take home pay might be in the 80k-85k after tax/SS/medicare, health insurance deductions and 5% 401k contribution into your retirement...

Added a postscript.

 

[mvenus929]

One primary point of reflection that I've gleaned from your comments would be that you view debt as unhappiness. Being able to be in-debt up to your eyeballs is what makes the U.S. a great country. In other countries such options simply are not available. In some countries you are born into a social stratum and income level that you will remain in until you die. It's because you can come from nothing, have nothing, and still do great things. It's a means to an end. I think that you should adjust the way that you see the debt. Rather than something that encroaches upon your happiness see it as an opportunity. 'I get to become a doctor.' I say this as one already seeing at a lot of debt from the initial part of medical school. You may live a long time. You may rather want to say that you spent the strength of your youth getting into the career you love than that you turned down a great opportunity to follow frivolous things that didn't give you the same sense of fulfillment you imagined you would get from medicine (as I've heard from several retired people, including an engineer).

Other countries will pay for your education if you demonstrate that you are smart enough.

The US doesn't not have a good system for moving out of social classes. It's the great American dream, but most people end up staying in the class that they were born in, because it's very difficult to move out of it.

Considering how much pay has changed in the last 20 years, and the fact that people 20, heck even 10 years ago were paying a fraction of what current students are paying for medical school, it's absolutely appropriate to consider the debt burden. And the mentality that debt is good for you isn't such a great one.

 

[Psai]

It cracks me up when I log on it SDN and people are complaining about "only" making 250K a year (Not directed at you OP, as you have other reservations about med school, which is fine). Even after paying taxes, loans, and a mortage you still come out with 100,000K. You're not eating Oodles and noodles and you would live better than 99.99999% of the human population. If its money that you're after play the lottery. This is just stupid.

Most tired argument in preallo. It's not about living well, it's that debt is an anchor and sitting on 500k will seriously limit your options. Maybe you'll take that crappy job in the middle of nowhere where you can't practice how you want to because the administrators without an inkling of what patient care entails makes all these stupid decisions like purchasing an emr with a horrible interface tells you what to do. You have a bunch of bills to pay and aunt sally mae is knocking at your door with 7% interest rates. It's also not about how much you get paid in number amounts but how much you're worth for the time you spend and your expertise. If you're working 80 hours a week and generating a million in billing but some company takes half of it without adding anything of value because obamacare prevents you from owning your own center you'll probably be pissed. I'm guessing that you've never had a job before so I don't blame you for making the classic premed mistake of just looking at the numbers without any idea of what goes into it. Money is only as good as how you can use it. You'll find out if you get into medical school

 

[TheWeeIceMan]

Point #3: Have the global picture in mind -- the average career length of a physician is 41 years. To consider financial matters when pursuing a medical career is wise. To do medicine for the money is unwise. Likewise, if given the opportunity to do medicine, to not do it because of the debt is also unwise -- as you pay it off the debt really won't impose upon your lifestyle as much as it did at the beginning. Which is worth more -- a career in medicine or the money from that career? Since no amount of money can buy your way into medical school and becoming a doctor I would reason that the opportunity to become a physician is more valuable.

I'm still in the medical student stage but these are things that I've heard from mentors and have researched that have helped me. Hopefully they'll help you to make a wiser decision. I hope that helps.

The average physician works to 71 at the earliest? That seems way high.

 

[Fedaykin]

The average physician works to 71 at the earliest? That seems way high.

Could depend on how you quantify "works." It's not uncommon to still be working at a later age but in a diminished capacity.

 

[kyamh]

The average physician works to 71 at the earliest? That seems way high.

Also, I would argue that residency is "working". If you're in med school at 22, graduate at 26, then you retire at 67 on average. Also, what @Fedaykin said.

 

[Iatrike]

Other countries will pay for your education if you demonstrate that you are smart enough.

The US doesn't not have a good system for moving out of social classes. It's the great American dream, but most people end up staying in the class that they were born in, because it's very difficult to move out of it.

Considering how much pay has changed in the last 20 years, and the fact that people 20, heck even 10 years ago were paying a fraction of what current students are paying for medical school, it's absolutely appropriate to consider the debt burden. And the mentality that debt is good for you isn't such a great one.

Yes, as stated previously, it is wise to consider the debt that you're taking on when you are going in. But it would be unwise to make the decision that the original poster made of having gotten in and then rejecting such a great opportunity simply because of the amount of debt necessary to take on initially. I, like the original poster, don't have parents who are willing to pay for things. They cannot. They're broke. They're in different countries. I've been working since my early teens. I used scholarships and worked part- and sometimes full-time to get through my undergraduate years with just a little debt in comparison to what debt I have now -- and by the grace of God alone. If taking on that debt were not available I don't know how I would have made it thus far or to be able to go into medical school. I didn't intend to state all countries, mind you -- during undergrad I had friends that came from countries where straight A's didn't matter to get into college -- rather than by merit it was based on what your parents did or who you know, a frank question to be admitted. One of my friends in medical school even has parents that are deceased. Some others didn't come from wealth. But where they lacked in financial 'bequeathment' by lineage they were able to overcome through taking advantage of timely opportunities rather than to be at the mercy of 'class' or social status/their financial situation. My conclusion: debt isn't something inviting or to be loved but one can appreciate the opportunity to be able to take it on when left with no other options where situations such as graduate or professional school education would otherwise be a closed door. It's an opportunity.

 

[Iatrike]

I think this is a point lost on most people- cost of living doesn't scale to salary unless you have a complete lack of self-control. I'm living on about $24k per year. I don't eat filet mignon but I have an ok lifestyle. NetFlix and HuluPlus go a long way and once a year or so I find a way to take a modest vacation. If I had the opportunity to raise my annual cost of living to $50k, I would feel like a king. Say you get into a good specialty and pull in $250k after a few (5-10) years of experience. That's going to be about $180k after taxes, and I could live what's for me a comfortable life ($50k per year) and throw $130k per year at my loans. Taking the scariest number in OP's post- $750k, that's no more educational debt after six years. Six. Say that his specialty is less lucrative and he pulls in $150k/yr. That's still going to be around $110,000 per year in take home pay and allows him to throw $60,000 a year at his debt. Reasonably comfortable lifestyle unless you're in San Francisco, out of debt in 13 years. That's using an extremely high overestimation for total debt cost and assuming a low-paying career path after medical school.

*Note: data in this post was acquired by googling "tax burden estimator" and running round numbers through a calculator. The numbers aren't publication-quality but the underlying point remains.

Yes, I agree with everything you said and I think that was well-stated.

 

[TheWeeIceMan]

Also, I would argue that residency is "working". If you're in med school at 22, graduate at 26, then you retire at 67 on average. Also, what @Fedaykin said.

Well yes, but not when you consider that the implication was that it was 41 years of making 250k.

 

[Iatrike]

Well yes, but not when you consider that the implication was that it was 41 years of making 250k.

I did a research project during an internship I had before medical school that involved a lot of statistics about the workflow of physicians, and that statistic may have come from that period, but that statistic from what I remember comes from what I read rather recently. Though I'm not certain of an exact authoritative source to give you to make you feel more comfortable regarding that career length statistic, here's something I just Googled that seems to generally be in compliance with what I stated: http://work.chron.com/average-length-doctors-careers-13376.html Of course we're talking about averages, so there's bound to be a standard error of the mean of a few years and confidence intervals are not given in that source so it serves to give a rough estimation. Hope it helps to swallow the pill.

 

[TheWeeIceMan]

I did a research project during an internship I had before medical school that involved a lot of statistics about the workflow of physicians, and that statistic may have come from that period, but that statistic from what I remember comes from what I read rather recently. Though I'm not certain of an exact authoritative source to give you to make you feel more comfortable regarding that career length statistic, here's something I just Googled that seems to generally be in compliance with what I stated: http://work.chron.com/average-length-doctors-careers-13376.html Of course we're talking about averages, so there's bound to be a standard error of the mean of a few years and confidence intervals are not given in that source so it serves to give a rough estimation. Hope it helps to swallow the pill.

The article you quoted indicates that the average length of a career for a physician is about 35 years, which, imo, is a more accurate number.

Hope it helps to swallow the pill.

 

[shockazulu]

I'm guessing that you've never had a job before

You know, I can handle your disagreeing with me but personal attacks are petty and childish. I'm working a full time job as we speak and have been working in some capacity since I was 14.

 

[DokterMom]

@coldpheet -- What did you decide to do? Update?

 

[Iatrike]

The article you quoted indicates that the average length of a career for a physician is about 35 years, which, imo, is a more accurate number.

It also mentions a retirement age of 67 years which was in concordance with what a previous poster mentioned. The 41 years is also accurate. This isn't the end-all authority on the number. It doesn't come from me and my research. And there are different studies and different findings. This was my bottom line. I apologize if the final comment bothered you, there really was no attitude to what I posted. I type very quickly.

 

[MOHS_01]

I appreciate you taking the time to response and offering a different point of view. However, please refer to the original post where I estimate my salary to be less than $250,000. I sure would like to strike it rich, but not everyone can open cash only mohs practices. Half of us will end up in a primary care specialty. Ain't nobody making $400,000. Specialize within IM and you can have a much higher salary. But that also comes with years lost of potential income.

Replace physician's salary with $250,000, please.

No one does Mohs on a straight cash basis.

Kids these days.

 

[Drogo]

This whole thread left my head spinning! *vomits on himself* OP I hope you figured things out, that's a hell of a situation to be stuck in.