Why high tuition hurts Osteopathic Medicine

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drusso

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This recent piece from CNN on student loan indebtedness has direct ramifications for the future of osteopathic medicine.

The trend to open more private, tuition-driven COMs will likely have a significant negative impact on the long-term viability of the profession. Graduating DO's will continue to seek professional opportunities where they can maximize their incomes (private practice, sub-specialty medicine, etc) and steer away from academic osteopathic medicine, rural medicine, and primary care. Fewer DO's in osteopathic academic medicine will impede the development of a research culture and "culture of discovery" already absent in most COM's. The AOA, through its Commission on Osteopathic College Accreditation (COCA), need to promote the development and expansion of publicly funded osteopathic medical schools or private osteopathic medical schools with direct feduciary attachment to large, established, and well-endowed private universities. They need to also revamp their accreditation standards to specify that new COM's have brokered and bonded academic affiliation agreements with teaching hospitals and clearly developed plans for residency training and biomedical scientist training programs before they can get full accreditation.

If you agree, then contact your local SOMA and Council of Osteopathic Student Government Presidents (COSGP) representatives and ask them to introduce AOA House of Delegates resolutions supporting these concepts.


http://money.cnn.com/2006/05/01/pf/college/reverse_dowry/index.htm

Student loans - a life sentence

Forget about getting married and buying a home. This generation is thinking about next month's payment.

By Christian Zappone, CNNMoney.com staff writer

May 1, 2006: 4:25 PM EDT


NEW YORK (CNNMoney.com) - Mayrose Wegmann, 25, should have been starting on her dream career as a political consultant by now. And saving toward her first home.

Instead, Wegmann, who graduated with a degree in political science and journalism from the University of Iowa in 2004 and moved to Washington, D.C., is working at a non-profit because it pays significantly more than entry-level politics work. And she won't even consider buying a home for several more years.

In fact, she won't consider much except how to meet the $300 a month she owes on her $34,000 student loan balance.

"The school debt makes you decide [about your career] based on the money factor. Not based on what you want to do," said Wegmann.

The Class of 2006, set to graduate this month, will soon be in the same boat.

Approximately two-thirds of all students use loans to pay for their higher education, according to the Center for Economic and Policy Research. The average debt is $15,500 for public schools and $24,600 for private – many students rack up even more on their credit cards.

Call it a reverse dowry: college debt diverts careers and delays or impedes graduates' plans to get married, buy a home or even to start a family. The effects can last years.

A 22-year old student graduating this year who consolidates their $40,000 loan at 6.125 percent will need to pay $243 a month...until they're 52. By that time, they will have paid $47,494 in interest alone.

A reverse dowry
"My student loan debt is my biggest source of stress in my life at the moment," said Steve Desroches, a 2002 graduate from Columbia University's Graduate School of Journalism. "I live paycheck to paycheck."

The degree left Desroches, who works for a newspaper on Cape Cod, $50,000 in debt with no savings. He's unable to buy a needed car or to even think about entering Massachusetts's "out of control" real estate market.

The repayments were so financially restrictive he briefly considered declaring bankruptcy, until he learned it wouldn't affect his student loans because they're federally guaranteed.

"My feelings about my degree now? My graduate education was invaluable [to my career], but it wasn't worth $50,000, or more accurately, it isn't worth the debt. My options are definitely limited."

Christine Moellenberndt of Sacramento, California has given up on the idea of owning a home, at least anytime in the next 10-15 years. She graduated last June from the University of California, Santa Cruz with a degree in anthropology, and moved back in with her mother when she realized not doing so would mean living paycheck to paycheck with no chance of paying down her debts.

"That $675 I could be spending in rent could also be a good chunk of a credit card payment, or a huge payment for my student loans. I see that as a bit of a better investment than living on my own and struggling paycheck to paycheck."

Moellenberndt says at least half her monthly income working at a state regulatory agency goes to pay off her $18k in federal student loans. And although the debt is daunting, her plans to become a community college professor call for an advanced degree...hiking her debt in the future.

A growing issue for the economy and society
The cumulative effect of such student debt on graduates is unclear, although few would argue that its impact will be positive for the graduates, the economy or society.

"We've never done this to a generation of young people before," said Dr. Heather Boushey, Senior Economist at the progressive Center for Economic and Policy Research. "We've never put a generation in their 20s in debt they can't get out of before they started their work life."

"The normal approach in any healthy society is to help young married couples get started in life through marital gifts, dowries, and the like," Allan Carlson of the socially-conservative Howard Center for Family, Religion, and Society said.

"We now burden many young adults with student debt, sometimes massive in nature; the price being paid includes marriages delayed or foregone and fewer children. This is foolish public policy."

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drusso said:
The AOA, through its Commission on Osteopathic College Accreditation (COCA), need to promote the development and expansion of publicly funded osteopathic medical schools or private osteopathic medical schools with direct feduciary attachment to large, established, and well-endowed private universities. They need to also revamp their accreditation standards to specify that new COM's have brokered and bonded academic affiliation agreements with teaching hospitals and clearly developed plans for residency training and biomedical scientist training programs before they can get full accreditation.

If you agree, then contact your local SOMA and Council of Osteopathic Student Government Presidents (COSGP) representatives and ask them to introduce AOA House of Delegates resolutions supporting these concepts.
Agreed. The dual benefits of lowering student debt and alignment of COMs w/established programs as you describe should be the prime aim of the AOA's educational mission.

But, as an outsider who is one of the thousands of students mortgaging my future to be a DO, I have grown increasingly discouraged about the judgement and ethical compass of our HOD.
I have shared meals with AOA presidents, have badgered my reps, emailed and signed petitions, spent what I now think are wasted hours perusing osteopathic history and direction, raised a courteous voice to the powers...for what exactly?
There is no discernible, progressive inertia in the AOA. Between the combined match smack-down, the metastasis of "branch programs" with no clinical support, and the utter lack of media savvy in our leadership, I am looking to get into the most lucrative practice possible. Following this plan I will quickly pay down my alarming debt and then cut the cord to my governing body.

Sorry for the downer, but I have really had enough. I just hope the imminent implosion of this profession does not destroy my career because I am stuck with a title that has a vowel.
 
I just hope the imminent implosion of this profession does not destroy my career because I am stuck with a title that has a vowel.

A bit dramatic don't you think?
 
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chris7b said:
A bit dramatic don't you think?
It was supposed to be. I sweat this stuff in a pretty big way.
So let's say this was a little hysterical. With which part do you take exception?
A. The implosion that is a certainty if significant changes are not made. (realistic accreditation requirements, the guarantee of quality post-grad training, student debt that does not put 3 COMs in the top 10 highest debt load schools)
B. Having a DO degree will once again become a mark of dubious prestige due to variability in candidate ability and training.
 
drusso - A great topic, and undoubtedly a very relevant one, but I am extremely skeptical of the AOA responding to any initiatives brought before it that involve a change to the status quo. As an MS2 (no, not an 'OMS2' - I refuse to use that term) I have listened to 2 AOA presidents come to my school and blather on for 45 minutes about how much the AOA cares about us. So far I have seen no evidence of this at all. Schools continue to open at a ridiculous pace, and tuition increases every year. This year has even seen the birth of the first "for-profit" osteopathic medical school. Simply put, there is absolutely no reason whatsoever to motivate the AOA to make any changes at all - the current system suits them just fine, and there certainly is no lack of applicants willing to indebt themselves for the next 30 years.

As of today, I am staring down the barrel of close to 200K in loans, and I'm halfway done with medical school. Thus far in my osteopathic career, I have seen nothing, nothing at all, that makes me feel that the AOA will ever address this issue as long as each COM fills its class.

I read your posts with respect and interest, and I appreciate the fact that you encourage those with complaints about the politics of the AOA to get involved to make a change. I guess I've just become so frustrated with the AOA that I just want nothing to do with the organization. I honestly feel that the only way we will see change is a mass exodus.
 
This is such a sad situation. No one but us-- the current generation of medical school students or recent graduates-- knows what it's like to take out and pay back such huge student loans. I can't even ask a physcian on his/her perspective on paying back student loans because no one before this generation has had the burden of this magnitude of student debt.

Those people in the article have less than a quarter of that +200K figure we'll be taking out and they're struggling like crazy. It's insane!
 
These are all very relevant points.

About the AOA... just from seeing threads on here... I get the impression that it is a bunch of old white-hair foagies running it. Life comes around full circle, to put it nicely. A newer generation of DO's will eventually have to take the reigns of the AOA. Hopefully they'll be more attentive to the concerns of our new generation. The climate has changed much since they went through medical school.

I think DO schools are still making progress towards research and academia. Touro-NV, being a new school, already has a research building. NSU has just recently announced plans to put up a research facility as well. I'm sure these aren't the only two schools getting in on this. It seems as if the AOA is the biggest factor threatening the long-term viability of osteopathic profession... not neccessarily research.

I also believe this will affect our friends the other letters as well. I've heard WVCOM is insanely expensive for out of state. However, a lot of the other osteo schools seem to have tuition in the 30's. Many allos are in the upper 30's and even low 40's. I have heard many M3's and M4's of both MD and DO say things along the line of "well, its not that I'm completely against something like Pedes or Family Practice, its just that with all these loans I can't afford to do it." I know competition for residency goes in cycles. However, until we have a serious change in our reimbursement system, I forecast there will be continued strong interest in cash-cow fields.

Just my .02
 
My personal choice of ways to get around this; take a military HPSP scholarship.

They pay all your tuition regardless of how much it costs, pay your health insurance, reimburse you for all books and mandatory equipment, and they give you $1200+ a month for living expenses (which is a great deal in Des Moines).

Additionally, you will make more during residency, you're guaranteed a residency, and if you go Navy you're guaranteed to live on the ocean!


Obviously there are drawbacks mainly being the year for year commitment not counting residency or internship time, and the chance of being deployed, but I personally think the risk of spending 6-12 months in exchange for $160,000 of education isn't that bad of a deal.


One of the best parts for me is that there are good odds I will be eligible to leave the Navy debt free with money in the bank before many of my classmates have paid off their loans.

Obviously this choice isn't for everyone, but a nice thing about the military is you're in the medical corps of your respective branch and you are Lieutenant Smith or Captain Smith or whatever, not Dr. Smith DO or Dr. Smith MD. MD's and DO's are on completely equal footing, in fact the #2 in command of the Navy Medical Corps is a DO from Iowa.

Also not having to worry about malpractice is a nice touch!
 
FutureNavyDOc said:
and the chance of being deployed ....QUOTE]

And subsequently dying........Ummm, I'll take the debt.
 
The_Sensei said:
FutureNavyDOc said:
and the chance of being deployed ....QUOTE]

And subsequently dying........Ummm, I'll take the debt.


The NHSC is a good alternative to the chance of being deployed. You just work in underserved medicine in this country for 4 years. Of course, growing up in an area that qualifies as rural underserved, I think that this is a great oppertunity. But for someone who likes city life... Maybe urban underserved medicine? They still pay for school and books and give you a stipend...
 
The_Sensei said:
FutureNavyDOc said:
and the chance of being deployed ....QUOTE]

And subsequently dying........Ummm, I'll take the debt.

I doubt a Navy doctor is going to be put in a place where he/she can be killed.
 
The AOA, through its Commission on Osteopathic College Accreditation (COCA), need to promote the development and expansion of publicly funded osteopathic medical schools or private osteopathic medical schools with direct fiduciary attachment to large, established, and well-endowed private universities
that would take actual work...an effort...to improve the profession. This alone is the reason the AOA would never even think of doing something like this! Instead, they'll write postcards to TV shows asking them to talk about how hard debt is for students and maybe someone else will do something about THEIR problem.

Echinoidea said it best...the AOA doesn't care about us or the future of osteopathy. Simply looking at recent issues tackled by our brave leaders on our behalf you can see that...DO's on TV??? OMS??? We don't really want a joint match???
Two facts really hurt...MORE DO's participate in the ACGME match than our own AOA match...and MORE DO's applied to allo FM residencies than MD's did!!! If this whole "philosophy" makes us unique, how do you justify a difference when the majority of us are allo trained?
If the AOA really cares, why are they allowing malignant growth of over-priced schools and doing NOTHING to correct the inadequate quality and geographic disparity of postgraduate education?
 
navydoc said:
One of the best parts for me is that there are good odds I will be eligible to leave the Navy debt free with money in the bank before many of my classmates have paid off their loans.

If it's about the money, I had a conversation on this very topic with one of the docs I shadowed before medschool. He told me that the non-military ones end up making more money owing to their ability to jump into private practice. Now, I have no idea if that's true or not; I'm just repeating what he told me. Maybe those wiser than I on this forum know a little more about that.

I used to be enticed by the absence of monetary debt that the military provides. Until my wife pointed out that not all debts are monetary.

I'm not saying the military is a bad way to go, no way! Good for you for finding the right choice for yourself. We decided against it mainly because we already had a small family and didn't want to be beholden to someone telling us where to go, when to go, that sort of thing. It simply wasn't the best fit for us, personally.

Does anybody know anything about those programs that offer to pay your debt if you agree to practice in an underserved area? Here's an example. I honestly don't know much about this sort of thing yet but I've heard of it and it's intriguing.
 
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A little on the military angle. I took a scholarship w/ the ARMY. As a single guy who doesnt mind being in the military and traveling all over the place, being deployed, it really works out for me. I am attending NYCOM in the fall where tuition/books/fees/ and health insurance puts things in the 50K a year range quickly, and thats not counting living expenses. I figured out that on the scholarship at NYCOM, they will be throwing about 70K a year at me in total compensation, for the 4 years of internship and residency I get about 58K salary, and the during the 4-5 year payback period ill make a little under 100K, breaking the 6 figure barrier before my comittment is up. Now I am looking to go into Peds (as of now) so for a primary care doctor this will be a pretty good route. If you are financing your entire medical education with staffords over 6% and private loans hovering near 10%, i would like to see the math showing a primary care doctor coming out of a similarly expensive school as NYCOM coming out ahead, b/c i dont think it exists. As for an HPSP doctor getting killed on deployment, anything is possible but you have to figure if the military has spent 400-500K and 4+ years to train you they are going to expend some effort in keeping you a few feet away from the bullets/bombs. I agree that the cost of osteopathic school and medical school in general is getting outrageous. And the sight of a for profit osteopathic school is deplorable.
 
jhug said:
that would take actual work...an effort...to improve the profession. This alone is the reason the AOA would never even think of doing something like this! Instead, they'll write postcards to TV shows asking them to talk about how hard debt is for students and maybe someone else will do something about THEIR problem.

Echinoidea said it best...the AOA doesn't care about us or the future of osteopathy. Simply looking at recent issues tackled by our brave leaders on our behalf you can see that...DO's on TV??? OMS??? We don't really want a joint match???
Two facts really hurt...MORE DO's participate in the ACGME match than our own AOA match...and MORE DO's applied to allo FM residencies than MD's did!!! If this whole "philosophy" makes us unique, how do you justify a difference when the majority of us are allo trained?
If the AOA really cares, why are they allowing malignant growth of over-priced schools and doing NOTHING to correct the inadequate quality and geographic disparity of postgraduate education?


I wonder if they will not allow DOs to match allo in the future, that may be a scary thought

also do most students walk into DO school or MD with substancial amounts of loans already, meaning like 60G or so.

I consider myself luckey, I graduated from a private UG (30G a year)where my parents worked hard to put me through, (i do have i believe 10G in fed loans) Went to grad school at a private school (where i was on full scholarship)

The loans i aquire in med school luckely will be the only ones i have
 
Mike2010 said:
As for an HPSP doctor getting killed on deployment, anything is possible but you have to figure if the military has spent 400-500K and 4+ years to train you they are going to expend some effort in keeping you a few feet away from the bullets/bombs.

In a war like Iraq, it isn't going to matter what rank you are or how much you are worth. Roadside bombs...suicide bombers... Many wars in the future could be like this. That is a fact you have to accept when you sign for contract.
 
After the residency is done, you must still be making enough money to well support yourself. If we're talking around 150k/yr range. At that salary, your talking about a net of around 7k a month. Even if the loan payment is 1k a month, that's still a lot of money. If $350 was a too much than they're not making a lot of money.
 
Its going to be more like 2K - 3K per month for loans!
 
Let us not forget that thanks to the wonderful boom of the recent past housing will NEVER be as affordable as it once was...Especially if you plan to live somewhere remotely desirable. So, as one could have had a nice "family"size house for around 1500/month that same house round these parts is like double that now...I am in the market right now and I am on the verge of committing some kind of major felony I am so pissed off!
So lets not forget that not everyone is single and families themselves are expensive. And to have a nice house, not great house, with God forbid a FREAKIN' YARD! (sorry, more of my angst of house shopping coming through) your gonna be shelling out the $$. Put the 1500-2K in loans as a little cherry on top and you have made yourself a little problem...if you have any thoughts of saving for a decent retirement.

Granted that is still not putting anyone in the red, but for the love of all that is holy, after this much schooling and dedication that should be a non issue.
 
Echinoidea,

I am curious as to which school has been classified as for-profit.
 
Echinoidea,

I am curious as to which school has been classified as for-profit.
The newly formed Rocky Vista in Colorado .... state site and DO-online reference

Rocky Vista University has requested authorization as a private, for-profit college or university offering a program in Osteopathic Medicine granting a degree of Doctor of Osteopathy or Doctor of Osteopathic Medicine. Staff has conducted the required review of the institution's application materials and finds that the institution meets the requirements for preliminary state authorization.
 
For profit medical school?

How much is their tution going to be per year?

I'd say in this market a med school could push for $100,000 in annual tution and they'd still get 5,000 applications for 100 seats.

I bet we see $100,000 mark within 5 years.

.02
 
Just a thought on the military thing:

The last Navy doctor that I personally knew, who was killed while serving, was CAPT David Brown. He was aboard Space Shuttle Columbia when it broke up over Texas.
 
The_Sensei said:
The NHSC is a good alternative to the chance of being deployed. You just work in underserved medicine in this country for 4 years. Of course, growing up in an area that qualifies as rural underserved, I think that this is a great oppertunity. But for someone who likes city life... Maybe urban underserved medicine? They still pay for school and books and give you a stipend...

That's only if you can get it. Last year they interviewed 14 people for evry 1 scholarship awarded. In the past it was closer to 1:1 or 2:1. Just another great bush policy to cut funding for NHSC, the most recent budget he submitted has another 10 million dollar cut to NHSC. Not to mention a 10% cut across the board in medicare reimbursement and 0 dollars for gme! What the powers that be can't seem to grasp is that students would go into primary care, if they could afford it. Just look at the # of people applying for NHSC.

I'm at a top ten tuition school :laugh: and when I asked the dean how he could bring down tuition, he said "I agree that it's a big problem, especially as it relates to our mission of training primary care providers, but I have no ideas on how I can address the tuition rates." Maybe this is part of the problem.
 
Just a thought on the military thing:

The last Navy doctor that I personally knew, who was killed while serving, was CAPT David Brown. He was aboard Space Shuttle Columbia when it broke up over Texas.

Heck, the last soldier I personally knew who died in Iraq or Afganistan was...wait I didn't personally know anyone who died in this war. So does that mean that all those people are not really dead?

Death really sucks but I think the odds are slim because you're pretty valuable to the military since they invested all those $$$s in you. I think the bigger issue you may face in the military is the unending paperwork, antiquated systems, and being told what to do for about 6 years.
 
Heck, the last soldier I personally knew who died in Iraq or Afganistan was...wait I didn't personally know anyone who died in this war. So does that mean that all those people are not really dead?

You missed my point. Unfortunately, I know several heros that have made the ultimate sacrific.

What I was refering to are the opportunities available to military, having inherently higher risks, that civilian physicians could never do...

On the other hand, at a lesser degree, there are organizations such as Doctors without Boarders....
 
you know that dems voted for the medicare cuts right?
And the reason the gov isn't funding more GME is because they are trying to get out of GME all together. That would mean that we would have to help fund our continued eduation as residents (sounds crazy but i promise you this has come up). Dems are set on gov. funded health care...while covering everyone makes us all feel warm and fuzzy inside, the reality is where will the money come from? When we are already paying 50% in taxes are you going to want to give more? Have you ever experienced the efficiency of the gov by registering your car (or any thing else that is gov. managed)? Do we really want our government calling the shots for us as physicians?
and cats...i'd be interested to know if your school decreases tuition now they have more funding...
 
With the BILLIONS going towards military technology, overseas prisons, and explicit and implicit military missions in other countries, I think we can afford universal health care.
 
.... the reality is where will the money come from? When we are already paying 50% in taxes are you going to want to give more? ....

If the US ever were to have universal coverage, I hope that this would allow a better emphasis on primary care. The money for UC could then come from savings in treating the 5 costly, chronic diseases that affect the population: diabetes, CAD, CHF, asthma & depression.
 
Have you ever experienced the efficiency of the gov by registering your car (or any thing else that is gov. managed)? Do we really want our government calling the shots for us as physicians? ...

Universal coverage doesn't have to mean "government provided" healthcare. It just means there's a sustainable system for everyone to have complete healthcare.

I agree that the government being the provider of healthcare for everyone would probably be a nightmare. But universal coverage could mean something as simple as requiring everyone to have some form of basic health insurance--kind of like many states require auto insurance if you drive a car.

Having some form of insurance could then take the load off the EMs and into the PCPs where more affordable and prospective care can be delivered.
 
As bad as the debt may be...and it is bad...there are programs that can obviously help with the burden. I could see more and more D.O.'s filling Federal based tuition reinbursement programs as a result of the rising cost of tuition.

This probably explains why tuition keeps increasing without any lack of takers...people matriculating will usually find a way to pay for the costs one way or the other. So until demand slows, tuition will continue to increase. Bad news for anyone in med school/starting med school is that demand will not slow down, but maybe continue to increase. I am glad I beat that Grey's Anatomy rush I foresee in a year or 2.
 
Dude, like what Gekko said...."...the illusion becomes real...". Kids will always want to be doctors, even if it paid $50,000 and tuition was $100,000 per year.
 
i don't get it what's going on???
- High cost of education forcing many traditionally altruistic docs like DOs into higher paying gigs
- Discussion of differing methods to pay for medical school
- Various, irrelevant tangents
 
so if u make osteopathic med school cheaper, more docs will go for internal med? hah
 
Sure, why not? You don't believe income influences career paths in medicine at all? Why do you think many FP and IM residency spots go unfilled every year? Why is there such a shortage of primary care physicians?
 
I don't see how osteopathic will witness any reduction in tuition.

The for profits will only continue to inflate...
 
I was under the impression there are no for-profit MDs in the U.S. I don't know what Stewart University is though.
 
Let us not forget that thanks to the wonderful boom of the recent past housing will NEVER be as affordable as it once was...

Not so sure about that anymore, but I guess hindsight is 20/20
 
What about adding some mandatory business classes or talking with a financal avisor during our training so we don't feel overwhelmed by all the upcoming expenses coming our way. I know that they have to give us our mandatory exit interview for financial aid borrowers, so why not add something in addition?
 
I just got my letter stating my tuition has risen 5%. It kills me to say, but there is an inkling of regret in my decision to be a DO...
 
I just got my letter stating my tuition has risen 5%. It kills me to say, but there is an inkling of regret in my decision to be a DO...

Hardly specific to DO. MD schools are going up just as fast.

The DO-specific "tragedy" is the schools that claim a primary care focus with a tuition pricetag of $35k or more. Ridiculous.
 
Hardly specific to DO. MD schools are going up just as fast.

The DO-specific "tragedy" is the schools that claim a primary care focus with a tuition pricetag of $35k or more. Ridiculous.

"DO" the math...using CCOM as an example.

CCOM's tuition for out of state students, including fees, will be $45K in 2008. If tuition continues to rise at 5%, this means that for students matriculating in 2008, tuition will be 45K, 47.25K, 50K, and finally 52.5K. In principal alone, this adds up to $194.75K. But hold on...we haven't even talked about the rest of the money....

The average undergraduate debt is $20K.

For the people like me, who didn't have wealthy parents to contribute to my finances while I was in medical school, it can be challenging living on student loans alone...especially when the school is taking up SO MUCH in tuition...but for those, who like me, decide to do it...this is what will happen (except for the fact that you are matriculating later and consequently your loans will be even more ridiculous)....

There is a limit on the amount of Stafford loans that one can take out, so the school divides this into four years. If you have taken money out during undergraduate, this amount will be subtracted from the total amount you are allowed to borrow. Consequently, you are required to take more of the "other" loans. The "other" loans are either PLUS, with a current rate of 8.5% (FIXED), or private, which vary depending on your credit score, but typically run around the neighborhood of PLUS if you have decent credit.

Chicago (and its burbs) is relatively expensive in terms of cost of living. And even for the students, who like me, tried to spend carefully, it is difficult not to take out close to the upper limit of what the school allows. There are so many hidden costs...whether its the school's outrageously overpriced medical insurance, or buying your required medical equipment as a first year student, or buying books (even online), or spending more than $2000 to take the COMLEX I and II and PE...or if you think you need to take steps of the USMLE, add another $400 per shot...it adds up. Oh, and the fact that at CCOM, the rotating hospitals are insanely spread out, and even if you try to keep them close, you have little control over it, and you will end up driving 100+ miles roundtrip some days just to get to and from work. With gas at $3.50, this also adds up.

OK, so I've made my argument that it is expensive to survive, so what does it cost? I'll be conservative, and say 20K. However, most of the CCOMers that I know are taking the max every year, which is approximately 30K more than tuition during years 3 and 4. This means that the students on the conservative end have 80K in "living costs" (even though much of that is "school costs") and the students on the upper end have approximately $100K after four years. $20-$25K per year is not an extravagant lifestyle, especially when $3000 goes to health insurance (the school's policy) every year, when board exams can easily cost $3000 (between years two and four), when gas costs as much as it does and the rotating sites are often in INDIANA.

Back to my original point....the "average" medical student with no outside support will take 80-100K out over four years to live on. These loans are at a rate of 6.5-10%, depending on your credit, etc.

NOW, for the interest...because all of these loans aren't free. Current rate for unsubsidized loans is 6.8%. This makes up the majority of the tuition loans at CCOM (because subsidized, interest free loans are capped at $8500 per year). PLUS loans, which the university encourages, are currently at 8.5%. Because I'm a dork, and I feel like wasting my time this morning, I actually plugged all these values into a loan calculator (interest rates, increasing loan balances at what intervals). The bottom line is that by the end of med school, you will have between $25-31K in interest alone added to your principal depending on how conservative you are (back to the 80K-100K thing).

So, if you "DO" the math, you'll see

Undergrad debt $20K
CCOM tuition/fees $194.75K
Living/Other school expenses $80-100K
Accrued interest after 4 years $25.25-31K

TOTAL for out of state CCOM students matriculating in 2008 without significant outside financial support: $320,000 to $346,000.

But I'm not finished yet. Now you need to ask yourself, "how much of this am I realistically going to pay down during residency?" If you decide to do something stupid...like start a family...probably not very much...if you continue to live like a student, you might pay a little. I've talked to a few residents who actually pay on their loans...but at least in my experience, most don't make any significant payments. At $40K per year, you aren't going to accomplish much.

So upon graduation from med school, you consolidate your $346,000 loan at a weighted, fixed rate of 7% (seems reasonable, even a little optimistic, since most of your loans were between 6.8% and 8.5%). This means that your first year of residency, you accrue $24,220, your second year, $25,915, your third year $27,729.

This means that your total after a minimum THREE YEAR residency has become $423,864. That is nearly one half of a million dollars, folks. Let's say you were extremely responsible with your cash during residency. You didn't do anything silly...like start a family, buy a condo...you know, stuff like that. You paid $10,000 per year on your loans. With interest saved, you have a total of $32000 less on your total amount....so more like $391,000...that is STILL nearly half a million dollars....

So, in summary, if you are one of those students, who like me, didn't come from wealth, lived below the poverty line during med school, and borrowed to make it through, you could end up with $423K in debt by the end of your experience. At a fixed rate of 7%, this will cost you $4,911 per month for ten years to pay off. Over 30 years, it will STILL cost you $2,814 per month. That will come to more than 1 million by the time it is paid off. Starting to sound a little like indentured servitude, don't you think??

If you are a highly motivated person, check my math. It is correct. And if you are a premed, and if you think like I did, you might look at these numbers and think "no big deal, i'll be a doctor." Look up what a primary care provider makes (because the odds are that if you become a DO, you will go into primary care). "DO" the math....

If you interview at CCOM, they will give you a BS line about the "average" debt upon graduation from CCOM...tell them you don't want to know the "average," you want to know the MEDIAN. That is where the truth lies. Tell them you want to know the MEDIAN debt of their graduates upon completion of residency...that is where the truth lies. The average means very little because there is always a handful of students whose wealthy parents pay for part or all of their school, not to mention that kids of faculty at CCOM get to go for free. These factors artificially decrease the "average" and make it appear as though most CCOM grads have reasonable debt. They don't. And it is my suspicion that graduates of many DO schools are in the same boat.
 
One of the professors at AZCOM called it the Caribbean medical school of the West, just "pay to play"... (CMS for short, ref: House of God)...
 
This is, IMO, a large reason osteopathic graduates are tending against primary care specialities (esp. at the more expensive schools)...

Let's say you go into FP, the average salary in my area is $130,000. After taxes, you are left with roughly $86,710/yr. Now you make you loan payments, lets say you want to pay them off before you retire so you do the 10 yr option.... Assuming the above, about $4911/month x 12 = $58,932. 86710-58932 = $27,778 or well less then you made in internship, most likely not an option.

Even if you spread it over the next 30 years... you are looking at about $50,000/yr take home. Not to mention the years of lost income, lost investment, to go to medical school,residency, etc.

So, even if you loved primary care to begin with, you may be forced to look into other fields just to pay back your loans.... (especially true if you had undergrad loans over 20k and/or master degree loans)... A friend of mine on graduation day owed more then $450,000 in undergrad, grad school, and med school loans...
 
Let's reverse the situation for a second. What would you do if you were able to make it through medical school with no debt and no time owed to the military? Refining it further, you have no income or money saved before, during, or immediately after graduation from medical school. How would that influence your choices on specialty, family, and location of practice?
 
Yes and no... only a few allopathic schools have tuitions that are more then AZCOM's (~42k/yr)... Tufts comes to mind at about ~46k/yr

But, there are also A LOT of allopathic schools with tuitions less then 50% of AZCOM's... many allopathic schools have tuitions of less then 10k/yr and even better, the UC schools have free tuition.
 
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