Wife cried last night...

GasDreams · Jun 27, 2013

I broke the news to my wife about 2 months ago that after I graduated in December with my associates degree in nursing I was going to start taking physics and orgo1 and try to beat the 2015 mcat. All I lack is physics and organic parts of prereqs so I assume I can knock those 4 classes out between the spring and summer semesters then study for the mcat for a few months and take it in november/december. 😎

When I got home last night from night classes, she was crying and had been crying :scared:

...she looked at the price of the handful of schools i'm considering applying to. She said that amount of debt was incomprehensible. She started having an anxiety attack and it took her a while to calm down.

I tried to explain to her the typical responses about student loans, deferment, and general salaries and that so long as we didn't live like idiots, lived well under our means for a few years, we could pay that off no problem......didn't seem to phase her.

She grew up poor, lower class, and was taught to save every penny she ever made. I grew up, upper middle with a dad who was a big computer programmer guy that worked for IBM and was taught that educational loans was part of life and that so long as you got a degree worth a hoot that paid well it was okay to take out those loans.

my favorite quote of his is, " Don't sacrifice tomorrow for today".

I don't know how to go about this with my wife, it seems i've exhausted all resources in trying to comfort her.

Is it just going to take time?

I tell myself that i'm doing this with or without her, but of course I want her support through it and have a REALLY BIG feeling i'll need it.

any suggestions?

deleted480308 · Jun 27, 2013

GasDreams said:
I broke the news to my wife about 2 months ago that after I graduated in December with my associates degree in nursing I was going to start taking physics and orgo1 and try to beat the 2015 mcat. All I lack is physics and organic parts of prereqs so I assume I can knock those 4 classes out between the spring and summer semesters then study for the mcat for a few months and take it in november/december. 😎

When I got home last night from night classes, she was crying and had been crying ...she looked at the price of the handful of schools i'm considering applying to. She said that amount of debt was incomprehensible. She started having an anxiety attack and it took her a while to calm down.

I tried to explain to her the typical responses about student loans, deferment, and general salaries and that so long as we didn't live like idiots, lived well under our means for a few years, we could pay that off no problem......didn't seem to phase her.

She grew up poor, lower class, and was taught to save every penny she ever made. I grew up, upper middle with a dad who was a big computer programmer guy that worked for IBM and was taught that educational loans was part of life and that so long as you got a degree worth a hoot that paid well it was okay to take out those loans.

my favorite quote of his is, " Don't sacrifice tomorrow for today".

I don't know how to go about this with my wife, it seems i've exhausted all resources in trying to comfort her.

Is it just going to take time?

I tell myself that i'm doing this with or without her, but of course I want her support through it and have a REALLY BIG feeling i'll need it.

any suggestions?

#1 medical school is not worth a good marriage
#2 ask her to come meet with you and the financial aid team from a local medical school. it is hard for people in the 15% tax bracket to comprehend $300k in debt in the same manner that it is hard to be aware of all the loan repayment options available to physicians before you even talk about $200k/yr incomes
#3 if #2 fails, reference #1

docelh · Jun 27, 2013

GasDreams said:
I tried to explain to her the typical responses about student loans, deferment, and general salaries and that so long as we didn't live like idiots, lived well under our means for a few years, we could pay that off no problem......didn't seem to phase her.

First, I'd recommend going over to the Residents and Specialties boards. You will see that many there are painting a picture of a changing landscape that contradicts the automatic assumption that an M.D. degree will pay for itself. There are stories of people in peds and family medicine who cannot service their loans. So at the end of this rainbow, if you get stuck in family medicine with a $100,000 salary and $400,000 loans at the end of residency, would your wife be right? And if you're right, what if living below your means for a few years ends up being say 15 years instead of four years as planned.

GasDreams said:
She grew up poor, lower class, and was taught to save every penny she ever made. I grew up, upper middle with a dad who was a big computer programmer guy that worked for IBM and was taught that educational loans was part of life and that so long as you got a degree worth a hoot that paid well it was okay to take out those loans.

The common wisdom not-so-long-ago was that education loans was a part of life independent of the type of degree you got. I remember many saying that a liberal arts education was even more valuable than say an engineering degree because it taught you how to think and to be a life-long student. Many bought it into hook, line, and sinker... until the economy tanked.

And that same stuff is going on with medical school loans until there is a medical school student loan crisis well after all the horses have left the barn.

GasDreams said:
Is it just going to take time?

You know your wife better than anyone here.

deleted551990 · Jun 27, 2013

I know that one of the things that makes my wife much more comfortable with med school debt is the fact that I'm planning on using a military scholarship to pay for it. Instead of tons of debt, it's a paycheck while in school. Maybe look into that?

GasDreams · Jun 27, 2013

usmctodoc said:
I know that one of the things that makes my wife much more comfortable with med school debt is the fact that I'm planning on using a military scholarship to pay for it. Instead of tons of debt, it's a paycheck while in school. Maybe look into that?

If you mean by serving for x-amount of of years after I graduate I actually have looked into that. Unfortunately I've also heard not to do the military for these reasons alone.

And to be quit honest it's really not about the money. So long as I could provide for my family and help with income that's enough for me. Being a physician means so much more than that. If money was the driving force id become a CRNA.

Making 100k/year sounds good to me 🙂

Fortunately she is matriculating into a NP program next June so that should help if the loans are unbearable

Shjanzey · Jun 27, 2013

You may want to consider the various rural doctor programs that are out there as well. Some schools will pay your tuition if you do your residency in a rural location. Of course the residencies are limited to a smaller set of specialties, but it is well worth considering. It would definitely put your wife at ease too.

You also mention that you aren't doing it for the money, but this isn't about you it is about your wife. For her, money is a huge huge deal, so you need to keep that in mind.

rodmichael82 · Jun 27, 2013

GasDreams said:
I broke the news to my wife about 2 months ago that after I graduated in December with my associates degree in nursing I was going to start taking physics and orgo1 and try to beat the 2015 mcat. All I lack is physics and organic parts of prereqs so I assume I can knock those 4 classes out between the spring and summer semesters then study for the mcat for a few months and take it in november/december. 😎

When I got home last night from night classes, she was crying and had been crying ...she looked at the price of the handful of schools i'm considering applying to. She said that amount of debt was incomprehensible. She started having an anxiety attack and it took her a while to calm down.

I tried to explain to her the typical responses about student loans, deferment, and general salaries and that so long as we didn't live like idiots, lived well under our means for a few years, we could pay that off no problem......didn't seem to phase her.

She grew up poor, lower class, and was taught to save every penny she ever made. I grew up, upper middle with a dad who was a big computer programmer guy that worked for IBM and was taught that educational loans was part of life and that so long as you got a degree worth a hoot that paid well it was okay to take out those loans.

my favorite quote of his is, " Don't sacrifice tomorrow for today".

I don't know how to go about this with my wife, it seems i've exhausted all resources in trying to comfort her.

Is it just going to take time?

I tell myself that i'm doing this with or without her, but of course I want her support through it and have a REALLY BIG feeling i'll need it.

any suggestions?

OP your wife sounds like my mother. She too was raised in lower class and focuses on saving money. She complains about loans and all the interest rate yet she understands the value of a medical education. I want to explain a couple points to you so you can show this to your wife.

1) A medical degree (MD or DO) will provide you with a reliable job. Businesses and the economy can go up or down but the need for medical doctors will always remain. You will NEVER have the risk of losing your job based on the economy. My father worked a high paying bank job for 20 years and he randomly got laid off due to the economy a few years ago.

2) I understand the loan is a lot but crying over it come on now. A medical doctor especially a specialist makes about 200-300k+ a year. Radiologist make around 450-500k a year. The interest rate of 7.9 % might take the 200k loan to 300k in the end but check this out. Even if you pay $3k a month you could pay that loan off in about 8 years. You save money from paying taxes due to the educational loans that you can commit towards the loan. For a physician to be making 20k-40k a month do you think paying 3k is a big deal? stop with the tears already it's embarrassing.

3) Education is something that you should never ever stray away from due to money. Money comes and goes but education stays with you forever.
My father always told me, "You could lose money in a heart beat but knowledge can never be taken away from you".

4) If you love your husband you will stand by him especially if he wants to achieve a quality education. Not only can he change the life of his family by providing financial stability but he can also make a difference in the lives of others. Stop with the tears and stand by your man, he only lives his life once so don't take this away from him.

GasDreams · Jun 27, 2013

rodmichael82 said:
OP your wife sounds like my mother. She too was raised in lower class and focuses on saving money. She complains about loans and all the interest rate yet she understands the value of a medical education. I want to explain a couple points to you so you can show this to your wife.

1) A medical degree (MD or DO) will provide you with a reliable job. Businesses and the economy can go up or down but the need for medical doctors will always remain. You will NEVER have the risk of losing your job based on the economy. My father worked a high paying bank job for 20 years and he randomly got laid off due to the economy a few years ago.

2) I understand the loan is a lot but crying over it come on now. A medical doctor especially a specialist makes about 200-300k+ a year. Radiologist make around 450-500k a year. The interest rate of 7.9 % might take the 200k loan to 300k in the end but check this out. Even if you pay $3k a month you could pay that loan off in about 8 years. You save money from paying taxes due to the educational loans that you can commit towards the loan. For a physician to be making 20k-40k a month do you think paying 3k is a big deal? stop with the tears already it's embarrassing.

3) Education is something that you should never ever stray away from due to money. Money comes and goes but education stays with you forever.
My father always told me, "You could lose money in a heart beat but knowledge can never be taken away from you".

4) If you love your husband you will stand by him especially if he wants to achieve a quality education. Not only can he change the life of his family by providing financial stability but he can also make a difference in the lives of others. Stop with the tears and stand by your man, he only lives his life once so don't take this away from him.

A lot of truth in this, thanks

RockDoc7 · Jun 27, 2013

sb247 said:
#1 medical school is not worth a good marriage
#2 ask her to come meet with you and the financial aid team from a local medical school. it is hard for people in the 15% tax bracket to comprehend $300k in debt in the same manner that it is hard to be aware of all the loan repayment options available to physicians before you even talk about $200k/yr incomes
#3 if #2 fails, reference #1

Couldn't have conveyed a more wise response myself. 👍

Goro · Jun 27, 2013

Maybe some counseling will help? It's one thing to be frugal, but when it's used to block your career plans (which are entirely practical...you're not planning on being a rock 'n roll star), my sense is that she's crossing a line.

Keep pushing the six figure salaries that doctors make once they finish residency. That, and moonlighting and locum tenums payouts.

GasDreams said:
I broke the news to my wife about 2 months ago that after I graduated in December with my associates degree in nursing I was going to start taking physics and orgo1 and try to beat the 2015 mcat. All I lack is physics and organic parts of prereqs so I assume I can knock those 4 classes out between the spring and summer semesters then study for the mcat for a few months and take it in november/december. 😎

When I got home last night from night classes, she was crying and had been crying ...she looked at the price of the handful of schools i'm considering applying to. She said that amount of debt was incomprehensible. She started having an anxiety attack and it took her a while to calm down.

I tried to explain to her the typical responses about student loans, deferment, and general salaries and that so long as we didn't live like idiots, lived well under our means for a few years, we could pay that off no problem......didn't seem to phase her.

She grew up poor, lower class, and was taught to save every penny she ever made. I grew up, upper middle with a dad who was a big computer programmer guy that worked for IBM and was taught that educational loans was part of life and that so long as you got a degree worth a hoot that paid well it was okay to take out those loans.

my favorite quote of his is, " Don't sacrifice tomorrow for today".

I don't know how to go about this with my wife, it seems i've exhausted all resources in trying to comfort her.

Is it just going to take time?

I tell myself that i'm doing this with or without her, but of course I want her support through it and have a REALLY BIG feeling i'll need it.

any suggestions?

deleted307836 · Jun 27, 2013

docelh said:
First, I'd recommend going over to the Residents and Specialties boards. You will see that many there are painting a picture of a changing landscape that contradicts the automatic assumption that an M.D. degree will pay for itself. There are stories of people in peds and family medicine who cannot service their loans. So at the end of this rainbow, if you get stuck in family medicine with a $100,000 salary and $400,000 loans at the end of residency, would your wife be right? And if you're right, what if living below your means for a few years ends up being say 15 years instead of four years as planned.

Of course 400k debt and a 100k salary would be extraordinarily oppressive. However, the most recent MGMA data showed average FM compensation is 200k; 100k doesn't sound too realistic at this point (average FM compensation has been rising in recent years). I know you're mentioning a changing landscape of medicine in this post, but that would be an extremely drastic change. Midlevels in primary care often make more than 100k. I don't mean to be splitting hairs but I think it's important for the OP to work this out with his wife in a more realistic way.

deleted551990 · Jun 27, 2013

GasDreams said:
If you mean by serving for x-amount of of years after I graduate I actually have looked into that. Unfortunately I've also heard not to do the military for these reasons alone.

So why is it that you aren't considering this, then? I mean I don't blame you either way. I'm just curious. There are definitely drawbacks, but to my understanding, one of the big drawbacks is that you don't get paid quite as much when you are an attending in the military. If money isn't what you care about, it seems like one of these scholarships would be a big help to your family situation.

docelh · Jun 27, 2013

CityLights said:
Of course 400k debt and a 100k salary would be extraordinarily oppressive. However, the most recent MGMA data showed average FM compensation is 200k; 100k doesn't sound too realistic at this point (average FM compensation has been rising in recent years). I know you're mentioning a changing landscape of medicine in this post, but that would be an extremely drastic change. Midlevels in primary care often make more than 100k. I don't mean to be splitting hairs but I think it's important for the OP to work this out with his wife in a more realistic way.

God, I hope you're right. Reading some of those threads over there were pretty depressing. The Pathology thread is downright miserable, and the termination of those Radiology residents in NY was shocking to say the least.

deleted307836 · Jun 27, 2013

docelh said:
God, I hope you're right. Reading some of those threads over there were pretty depressing. The Pathology thread is downright miserable, and the termination of those Radiology residents in NY was shocking to say the least.

Yeah, pathology and radiology are definitely facing big problems. I don't think FM is the "last resort" that it's often portrayed to be on SDN though.

GasDreams · Jun 27, 2013

usmctodoc said:
So why is it that you aren't considering this, then? I mean I don't blame you either way. I'm just curious. There are definitely drawbacks, but to my understanding, one of the big drawbacks is that you don't get paid quite as much when you are an attending in the military. If money isn't what you care about, it seems like one of these scholarships would be a big help to your family situation.

She wants a stable family that doesn't move from around her parents. It's already going to be 4 years plus residency, can't imagine asking much more from her

GasDreams · Jun 27, 2013

Also about the mid level thing, I really did consider this. This is one of the major issues she has with this idea. She says I'm throwing my entire nursing career away by not pursuing advanced practice nursing.

Here's the thing:

Compare the two curriculum. NP vs. MD/DO

It's almost UNETHICAL to allow Np's to do 90% of what a physician does. I understand NP's have their place in rural health care but where I'm from they're rampant even in the big city. This is because they're viewed as cheap labor and because "studies" have shown favorable outcomes.

Simply put, I do NOT want to be a nurse playing doctor. I want to be a doctor playing doctor.

rodmichael82 · Jun 27, 2013

GasDreams said:
She wants a stable family that doesn't move from around her parents. It's already going to be 4 years plus residency, can't imagine asking much more from her

Do well in medical school and apply to residencies close by?
There's a way to make this work out. I don't think you should question your dream over minor things like this. I'm sorry if I'm coming off harsh but your wife is looking at this in the sense of short-term / instant gratification. She needs to open her mind to the long-term benefits.
If you like to calculate risks on every major action like I do then I tell you that the long-term benefits far exceed the short term "suffering".

GasDreams · Jun 27, 2013

rodmichael82 said:
Do well in medical school and apply to residencies close by?
There's a way to make this work out. I don't think you should question your dream over minor things like this. I'm sorry if I'm coming off harsh but your wife is looking at this in the sense of short-term / instant gratification. She needs to open her mind to the long-term benefits.
If you like to calculate risks on every major action like I do then I tell you that the long-term benefits far exceed the short term "suffering".

Bro she can't see past the end of her nose. I realized this a while back and have tried to point this out. Still working on it...

ChE04 · Jun 27, 2013

rodmichael82 said:
Do well in medical school and apply to residencies close by?
There's a way to make this work out. I don't think you should question your dream over minor things like this. I'm sorry if I'm coming off harsh but your wife is looking at this in the sense of short-term / instant gratification. She needs to open her mind to the long-term benefits.
If you like to calculate risks on every major action like I do then I tell you that the long-term benefits far exceed the short term "suffering".

7 years of no/low income, uncertainty over where you'll be during that timeframe, and having her husband enter a time consuming and grueling training process in addition to the debt load isn't exactly minor. From her perspective, the "terms and conditions" of the relationship have changed since she signed on for it, and she is struggling to come to grips with that. Sure, long term will probably be worth it and if she works as an NP that will help minimize the financial strain, but I think some people are less resilient when their lives are turned upside down (which is what the OP did when he switched from nursing to medicine) than you or I.

Darth Doc · Jun 27, 2013

GasDreams said:
Also about the mid level thing, I really did consider this. This is one of the major issues she has with this idea. She says I'm throwing my entire nursing career away by not pursuing advanced practice nursing.

It's almost UNETHICAL to allow Np's to do 90% of what a physician does. I understand NP's have their place in rural health care but where I'm from they're rampant even in the big city. This is because they're viewed as cheap labor and because "studies" have shown favorable outcomes.

Simply put, I do NOT want to be a nurse playing doctor. I want to be a doctor playing doctor.

As a physician assistant, I completely agree with this. I know what midlevels can and can't do. My husband is about to start NP school now and plans to create a stink about NPs trying to become independent practice once he graduates. We don't have the pathophysiological or biochemical background or residency experience to give us that knowledge for those circumstances when something out of the ordinary is going on.

I'm applying to medical school because I don't want to be limited to what someone else will let me do. I want to maximize my own capabilities and become the best provider possible.

Perhaps if she thinks of it as you two being able to practice together (as my husband and I plan to do in the future) the idea will be more palatable.

Someone else mentioned the military. USUHS is the only school I'm applying to. We have 6 kids, and there's no way we will be able to support everyone without that full-time salary. No one would give us enough loans, and we're too far into our lives to live like college students. (Koodos to you who do.) I'm already national guard and my husband is prior service, so we know what we are in for. I really think it's a great option for us.

I've worked in a small family practice where it was just me and the doc. She made less than $130k a year and I made about half that. It was not enough money for the work. Now I'm working in a prison which is easy work, and I make close to $100k. What you make as a physician or mid-level is based on experience but also what kind of work you are able to do. There's a job opening near me in urgent care where I could make $120k a year - about as much as the doc I used to work for. The docs I work with at the prison make $110 an hour as family practice/ internal medicine.

I agree with your wife about the loan issue, but disagree with her about you being a NP. You will never be happy as an NP and will just end up going back to school for MD at some future time because it will eat at you until you do.

Talk with her. Look at all the possibilities. Look at cheaper medical schools. Consider the National Service Corp (loans repaid to work in underserved area) which some doctors are using here on the eastern shore of Maryland. Maryland also has loan repayments for family practice providers whose practices meet certain qualifications. Texas has some nice offers if you're willing to work rural. See what your state offers.

You two can work it out together and make the best decision for your family. Just talk.

GasDreams · Jun 27, 2013

Darth Doc said:
As a physician assistant, I completely agree with this. I know what midlevels can and can't do. My husband is about to start NP school now and plans to create a stink about NPs trying to become independent practice once he graduates. We don't have the pathophysiological or biochemical background or residency experience to give us that knowledge for those circumstances when something out of the ordinary is going on.

I'm applying to medical school because I don't want to be limited to what someone else will let me do. I want to maximize my own capabilities and become the best provider possible.

Perhaps if she thinks of it as you two being able to practice together (as my husband and I plan to do in the future) the idea will be more palatable.

Someone else mentioned the military. USUHS is the only school I'm applying to. We have 6 kids, and there's no way we will be able to support everyone without that full-time salary. No one would give us enough loans, and we're too far into our lives to live like college students. (Koodos to you who do.) I'm already national guard and my husband is prior service, so we know what we are in for. I really think it's a great option for us.

I've worked in a small family practice where it was just me and the doc. She made less than $130k a year and I made about half that. It was not enough money for the work. Now I'm working in a prison which is easy work, and I make close to $100k. What you make as a physician or mid-level is based on experience but also what kind of work you are able to do. There's a job opening near me in urgent care where I could make $120k a year - about as much as the doc I used to work for. The docs I work with at the prison make $110 an hour as family practice/ internal medicine.

I agree with your wife about the loan issue, but disagree with her about you being a NP. You will never be happy as an NP and will just end up going back to school for MD at some future time because it will eat at you until you do.

Talk with her. Look at all the possibilities. Look at cheaper medical schools. Consider the National Service Corp (loans repaid to work in underserved area) which some doctors are using here on the eastern shore of Maryland. Maryland also has loan repayments for family practice providers whose practices meet certain qualifications. Texas has some nice offers if you're willing to work rural. See what your state offers.

You two can work it out together and make the best decision for your family. Just talk.

I was unaware of the repayment services for working rural. I currently live in a suburb of Memphis in Mississippi and any direction other than north is considered rural. I probably wouldn't even have to move, 20-30 min commute Interesting....

I'm glad someone agrees with me about the mid-level debate. One of my fears of becoming one is just what you said In reference to med school eating at me.

GasDreams · Jun 27, 2013

ChE04 said:
7 years of no/low income, uncertainty over where you'll be during that timeframe, and having her husband enter a time consuming and grueling training process in addition to the debt load isn't exactly minor. From her perspective, the "terms and conditions" of the relationship have changed since she signed on for it, and she is struggling to come to grips with that. Sure, long term will probably be worth it and if she works as an NP that will help minimize the financial strain, but I think some people are less resilient when their lives are turned upside down (which is what the OP did when he switched from nursing to medicine) than you or I.

Nailed it.

She is having a hard time trying to grasp the idea of me pursuing this loooong road. Funny what u said about " the terms and conditions". I had never considered that but looking back I can see that in her eyes when we discuss it.

jl lin · Jun 27, 2013

GasDreams said:
If you mean by serving for x-amount of of years after I graduate I actually have looked into that. Unfortunately I've also heard not to do the military for these reasons alone.

And to be quit honest it's really not about the money. So long as I could provide for my family and help with income that's enough for me. Being a physician means so much more than that. If money was the driving force id become a CRNA.

Making 100k/year sounds good to me 🙂

Fortunately she is matriculating into a NP program next June so that should help if the loans are unbearable

I see your moniker is gas dreams. Does this mean you are interested in anesthesiology; b/c if so, eventually, you will make 3X's as much as a CRNA--well, at least at most places I know around where I live.

I think there definitely will continue to be an issue for primary care providers. I see a LOT of support for moving to NPs for primary care with the move toward ACA. Financially, from their perspective, it makes sense. I am not saying I agree. I am looking at their bottom line. I mean there is HUGE support politically for utilizing NPs in a much more dominant way. My gut tells me that this will makes things a lot more challenging financially and otherwise for physicians. People can poo poo it all the want to. At the end of the day, trying to implement this massive machine called ACA will require undercutting primary care physicians and using NPs and more PAs.

I'm sure some docs or residents may reply with "Ah nah. We will always have our roles, etc." Thing is, there just won't have as much of the lion's share b/c of the push to use other providers--and this is an issue given what it costs to educate a physician.

Things are only going to get tougher, and I think anyone that doesn't see it is caught up in some level of delusion.

You can say it will test who will want to become physicians for the right reasons, but that may be a bit naïve, given the GIANORMOUS financial burden from the educational process required to become a physician. You can love what you do and be good at it--but it's not easy to go through all the education, work, and expense to end up being a glorified wage-slave.

If primary care is the thing of interest, I say it behooves those interested to talk directly--I mean face-to-face, not just on a message board--with dozens or more of those physicians actively practices in primary care--if not more. I mean, even though it's not face-to-face, talk with primary care physicians from various areas throughout the country--although, nothing beats speaking directly with someone face-to-face, and picking up on all the non-verbal communication.

OK, so here is an example of what I am getting at:

" I found Mr. Busko's argument interesting, but flawed for several reasons:

First, the predicted shortage of doctors is not the problem. The problem is the unequal access to health care. The anticipated primary care shortage can be eliminated if the growing trend of physician substitutes (like physician assistants and nurse practitioners) continues, and if solo practitioners pool resources to form small group practices.

Second, hiring more doctors may not be cost-effective. The mean internist salary ($191,000) is double that of a nurse practitioner ($91,000). By hiring two nurse practitioners instead of one general internist, a medical group could theoretically double access to care and allow doctors to care for more complicated patients at a similar cost.

Third, the quality of international medical graduates is unpredictable. Foreign students often score very well on written tests. However, as any residency program director can attest, good board scores do not consistently translate into good clinical performance. Residency may be our only opportunity to ensure a standard level of training.

Lastly, adding more foreign doctors may not improve rural access to health care. Foreign doctors often gravitate to metropolitan areas with high concentrations of similar immigrants.

We need to formulate a comprehensive national health policy to improve access, improve outcomes and ensure cost-effectiveness."

CALVIN HWANG
Bronx, June 19, 2013

The writer, a pulmonary care specialist, is an assistant professor of medicine at Albert Einstein College of Medicine.

http://www.nytimes.com/2013/06/23/o...-improve-health-care.html?pagewanted=all&_r=0

That's the writing on the wall. Extending access to the current administration and others means using MORE NPs.

deleted307836 · Jun 27, 2013

jl lin, I find it interesting that you say he will "eventually make 3x as much as a CRNA" as an anesthesiologist but then go on to illustrate the threat that midlevels may pose in other specialties such as primary care. Do you have reason to think anesthesia is particularly immune?

(sidenote - I think too many SDN threads devolve into midlevel disputes, but I am genuinely curious about your thoughts since anesthesia is an interest of mine)

GasDreams · Jun 27, 2013

There are 5 CRNA schools within 100miles of Memphis. Saturation and market forces will drive the wages down of crna's around here. I saw a single listing on gaswork for Memphis metro at 110k for CRNA. The lowest on that board I'm sure. I believe this is just an example of how market saturation is going to be death of CRNA practice. MOST students go to CRNA school for the money( whether they admit it or not) and when they realize that they can complete their DNP online with half the stress for the same income those money seekers will likely change their mind...

I originally had my sights aimed at anesthesiology but I'm sure that will change 20x before I graduate med school( assuming I can get in one!!)

Probably should have gone with more of a generic handle lol

deleted307836 · Jun 27, 2013

GasDreams said:
There are 5 CRNA schools within 100miles of Memphis. Saturation and market forces will drive the wages down of crna's around here. I saw a single listing on gaswork for Memphis metro at 110k for CRNA. The lowest on that board I'm sure. I believe this is just an example of how market saturation is going to be death of CRNA practice. MOST students go to CRNA school for the money( whether they admit it or not) and when they realize that they can complete their DNP online with half the stress for the same income those money seekers will likely change their mind...

I originally had my sights aimed at anesthesiology but I'm sure that will change 20x before I graduate med school( assuming I can get in one!!)

Probably should have gone with more of a generic handle lol

While of course that isn't good for CRNA's, that also seems like a bad situation for anesthesiologists in the long term. If their "competition" is so cheap due to high supply, it seems as if the downward pressure on what they can command would only decrease as hospitals seek to utilize these cheaper services.

Sorry for going off-topic...

GasDreams · Jun 27, 2013

No worries, you make a valid point. I've heard advice regarding fellowships and whatnot for practicing anesthesiologists to maintain marketability.

shezadeh · Jun 27, 2013

I haven't broken the news directly to my wife yet...I indirectly asked, as in asked about quitting my job in a few years and going to school full time, she said ok as long as we plan it and save some money now... we'll see how this goes..

GasDreams · Jun 27, 2013

shezadeh said:
I haven't broken the news directly to my wife yet...I indirectly asked, as in asked about quitting my job in a few years and going to school full time, she said ok as long as we plan it and save some money now... we'll see how this goes..

Good luck friend. Hope it mulls over better than it did with my wife lol

jl lin · Jun 28, 2013

CityLights said:
jl lin, I find it interesting that you say he will "eventually make 3x as much as a CRNA" as an anesthesiologist but then go on to illustrate the threat that midlevels may pose in other specialties such as primary care. Do you have reason to think anesthesia is particularly immune?

(sidenote - I think too many SDN threads devolve into midlevel disputes, but I am genuinely curious about your thoughts since anesthesia is an interest of mine)

I'm not saying it is or isn't, although the concerns regarding pts in an OR and liabilities related to them would be a factor. For example, the real position from the hospitals is that docs bring in the money, b/c people come to see them for the procedure in said hospital. Now if a mostly CRNA staff ends up creating unsafe OR environments or recovery environments, the surgeons aren't going to practice at said hospital--b/c the ultimate outcomes are associated with mortality and morbidity for x amount of days after the OR experience. These numbers can affect the surgeons numbers. So there are liability issues that can be viewed as more critical--given the area--and there is the issue of mortality and morbidity in close proximity with the surgeon and the surgical procedure. Surgeons start leaving, well, then the hospitals lose money.

tartesos · Jun 28, 2013

docelh said:
First, I'd recommend going over to the Residents and Specialties boards. You will see that many there are painting a picture of a changing landscape that contradicts the automatic assumption that an M.D. degree will pay for itself. There are stories of people in peds and family medicine who cannot service their loans. So at the end of this rainbow, if you get stuck in family medicine with a $100,000 salary and $400,000 loans at the end of residency, would your wife be right? And if you're right, what if living below your means for a few years ends up being say 15 years instead of four years as planned.

The common wisdom not-so-long-ago was that education loans was a part of life independent of the type of degree you got. I remember many saying that a liberal arts education was even more valuable than say an engineering degree because it taught you how to think and to be a life-long student. Many bought it into hook, line, and sinker... until the economy tanked.

And that same stuff is going on with medical school loans until there is a medical school student loan crisis well after all the horses have left the barn.

You know your wife better than anyone here.

Family med making 100k a year? Not even part time!! You really shrieked these numbers there. As long as you are willing to skip the big cities for a few years you can get some loan repayment assistance.
Money should jot be an excuse for him not to go to med school if he really wants to.

Law2Doc · Jun 28, 2013

CityLights said:
Of course 400k debt and a 100k salary would be extraordinarily oppressive. However, the most recent MGMA data showed average FM compensation is 200k; 100k doesn't sound too realistic at this point (average FM compensation has been rising in recent years). I know you're mentioning a changing landscape of medicine in this post, but that would be an extremely drastic change. Midlevels in primary care often make more than 100k. I don't mean to be splitting hairs but I think it's important for the OP to work this out with his wife in a more realistic way.

First, the fact that the average compensation is $200k means that potentially more than half of all FM physicians or pediatricians earn less than that -- for every guy you hear about who is way above the mean, it means several are probably below. So i think you shouldnt go into this with the expectation that you will be earning an above average or necessarily even average salary. However, most of the time debt isn't close to 400k either. You can probably service $200k in debt on a $100k salary -- it just takes time and means you are living a very meager existence longer. But if it's what you want to do, maybe that's a win. There really aren't that many doctors out there who can't service their student loans. There are plenty who aren't living the good life because of them though.

sengineer · Jun 28, 2013

I know from experience that if your spouse is unhappy now then medical school will be extremely hard because she will hate you even more then. It is stressful for the spouse who will have to be the soul bread winner and take care of kids and over and above that, you will be too busy/exhausted to spend much time with them. Give it some thought... money is always going to be an issue...loans will be hard to pay off regardless of your salary since you are in a different situation than young graduates without a family. I still hear it day in and out about why I made the mistake of not doing medicine in the first place and opting for engineering...even though I changed because of the whining and high expectations from the rest of the family about me not supporting the family. So good luck.

cabinbuilder · Jun 28, 2013

tartesos said:
Family med making 100k a year? Not even part time!! You really shrieked these numbers there. As long as you are willing to skip the big cities for a few years you can get some loan repayment assistance.
Money should jot be an excuse for him not to go to med school if he really wants to.

Totally agree here. I understand the thought of 200K in loans is daunting when you only bring home $400/wk. Heck I remember surviving on $200/wk.

However, as family medicine doctor working 3/4 time, I clear 200K/yr without even trying. So my student loan payment of $1125/month is NOTHING. I make that in 1-2 days. Think about it.

When you become a doctor you will always have money, you will always have a job. It's up to you to make the choice to work in an area that pays you the income to cover your debt.

deleted307836 · Jun 28, 2013

Law2Doc said:
First, the fact that the average compensation is $200k means that potentially more than half of all FM physicians or pediatricians earn less than that -- for every guy you hear about who is way above the mean, it means several are probably below. So i think you shouldnt go into this with the expectation that you will be earning an above average or necessarily even average salary. However, most of the time debt isn't close to 400k either. You can probably service $200k in debt on a $100k salary -- it just takes time and means you are living a very meager existence longer. But if it's what you want to do, maybe that's a win. There really aren't that many doctors out there who can't service their student loans. There are plenty who aren't living the good life because of them though.

Of course it means half make less than that - but many live in large cities and may work part time. To me, if the average is 200k, that suggests that it is VERY possible to make that if you are open to locations with a particular need and working more than 40 hours/wk on average. And if I were in a position with that much debt, that's exactly what I would be doing.

localmotion24 · Jun 28, 2013

Really great info here, everyone!

For me and my girlfriend, it's kind of switched as I am the one who freaks about the debt I will incur and my girlfriend doesn't really acknowledge that issue. I often go back and forth between becoming an NP or becoming a physician mostly because I don't know how I will get by financially for that 7 years or more of school and residency and if I will be able to pay off my debt.

However, like someone said, that shouldn't deter me from pursuing what I want to do with my life. If I did go to NP school, would I regret not going to med school? Would I go later anyway?

I'll find a way to get through this as I always have since my mom died and I had to support myself through undergrad through now!

sengineer · Jun 28, 2013

I think one big question or concern for some is not the big debt afterwards...really I don't think much about it. For me and if anyone else agrees, please add, my main concern is taking care of my family and bills while in med school. We both worked for the last 4 years and still lived paycheck to paycheck.

GasDreams · Jun 28, 2013

I think the income will be fine to pay off the loans. And my wife is an NP so she will be supporting me through it lol

localmotion24 · Jun 28, 2013

Haha, I'm also hoping my girlfriend finishes nursing school and finds a stable job by the time I start med school.

But as for the matter of supporting oneself and others while in med school, I know the military offers stipends if you sign up with them. That's one route, and I guess another is to just pull out some big loans and live frugally for a while. Anyone else know of other alternatives?

Greedo · Jun 28, 2013

GasDreams said:
Bro she can't see past the end of her nose. I realized this a while back and have tried to point this out. Still working on it...

I think that if this is really how you feel about your wife, you should do her a favor and split up now. She can have a nice career as a NP without having to support you through med school. It sounds like you're making all the decisions about your finances without her, and if that's what you want to do, support yourself through school.
It's not about her realizing that you're making a good decision, it's about her being part of the decision.

AnnoyedByFreud · Jun 28, 2013

I feel bad for the OP's wife.

deleted307836 · Jun 28, 2013

Greedo said:
I think that if this is really how you feel about your wife, you should do her a favor and split up now. She can have a nice career as a NP without having to support you through med school. It sounds like you're making all the decisions about your finances without her, and if that's what you want to do, support yourself through school.
It's not about her realizing that you're making a good decision, it's about her being part of the decision.

I think there's a lot of truth to this, and that's a great point that it's not so much about "convincing" her about this but making her a partner in the decision. We don't know the full story but there is undoubtedly more than the financial impact of the decision at play here.

jl lin · Jun 29, 2013

AnnoyedByFreud said:
I feel bad for the OP's wife.

I honestly don't know what to say OP, except listen to your wife and see if you can give her support. If she doesn't feel committed to the endeavor, however, I think you are up for some serious added stress on top of an enormously stressful process. I think it might help to talk with a reputable counselor. Plus, financial issues are the number one thing that seem to be a factor in divorce.

shezadeh · Jun 30, 2013

Don't married students fall under a different category for student loans? Don't you get more because you have more dependents, etc? Furthermore, though it doesn't come to people's minds always, there are scholarships in med school. When it comes to scholarships, I am a firm believe it the "give it a shot" view. If you apply, the probability of getting it is >0. If you don't apply, probability = 0. Also, if you have kids, many states have some sort of medical program (medicaid) for kids + family, but I do not know the specifics on these things.

Arkangeloid · Jun 30, 2013

First, I'd recommend going over to the Residents and Specialties boards. You will see that many there are painting a picture of a changing landscape that contradicts the automatic assumption that an M.D. degree will pay for itself. There are stories of people in peds and family medicine who cannot service their loans. So at the end of this rainbow, if you get stuck in family medicine with a $100,000 salary and $400,000 loans at the end of residency, would your wife be right? And if you're right, what if living below your means for a few years ends up being say 15 years instead of four years as planned.

Yeah, uh, this dude is right. Remember that reimbursements and salaries for physician have been declining for several years now, and the future of medicine for physicians is bleak. Depending on your specialty, medicine may or may not be worth it.

I mean, I'd do it anyways, but financial concerns should be front-and-center in your specialty choice and future plans.

Perhaps I'm wrong, and someone more experienced than I can shed more light on this, but gloom and doom is the general attitude I've seen on this matter.

thepoopologist · Jun 30, 2013

Of course she cried. You broke the news that instead of taking the practical route of advanced practice nursing you'd rather go through an incredibly stressful, poverty-stricken road which will be entirely focused on your ultimate success. And she's going to pay for it with her NP salary.

Go do what you need to do, but keep the above in mind.

GasDreams · Jun 30, 2013

thepoopologist said:
Of course she cried. You broke the news that instead of taking the practical route of advanced practice nursing you'd rather go through an incredibly stressful, poverty-stricken road which will be entirely focused on your ultimate success. And she's going to pay for it with her NP salary.

Go do what you need to do, but keep the above in mind.

Damn.....

Dbate · Jun 30, 2013

usmctodoc said:
I know that one of the things that makes my wife much more comfortable with med school debt is the fact that I'm planning on using a military scholarship to pay for it. Instead of tons of debt, it's a paycheck while in school. Maybe look into that?

OP, I would strongly suggest that you pursue the military scholarship route.

It IS unfair that your wife will have to sacrifice so much so you can pursue your "dream" career. Especially since you already have a nursing degree, which offers significant clinical work and a stable income.

The only responsible financial option is for you to commit to a military scholarship.

Dbate · Jun 30, 2013

GasDreams said:
I think the income will be fine to pay off the loans. And my wife is an NP so she will be supporting me through it lol

So not only do your expect her to take on a huge loan burden, she also has to support you as well?

OP, this sounds like a recipe for divorce. If you pursue this route without taking out the military scholarship, that would be incredibly selfish.

You have a nursing degree, which offers a high paying job and stability. Then you are going to throw that away AND force your wife to support you?

I doubt you will be married by the end of residency. Look at it from her perspective, but it sounds like you are being incredibly selfish on your part. There is no reason she should have to sacrifice like this. You should just go work as a nurse.

GasDreams · Jun 30, 2013

She IS supportive of me chasing my dreams. She is also having a hard time coming to terms with the loans. Well to be honest, I wouldn't mind pursuing the military education loan idea. Chance to serve and get my degree. However, the thought of deployment would be worse to my wife than loans ( I'm assuming that's how it would work)

Wife cried last night...

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