RichardH2024
Full Member
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Good morning and hope you’re doing well. Have you ever thought about the military as an option to help with your debt? Also many options for career opportunities.
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Think of it like this. The benefit of coming from a background where you're already used to living conservatively is that you will continue to be comfortable living somewhat conservatively. I don't think you need to sacrifice your career interests when you can simply make the decision based on where to live.
Given the need to pay down such high loans, you will need to prioritize what the income-based repayment amount will be—and it's going to be quite big—over your cost of living choices. So to be quite frank, you should probably just forget about moving to SF, NYC, DC, or Honolulu. All of these cities will offer you a high salary, but you're going to funnel most of it into living expenses if you want to live in anything more than a small box going forward.
Think about where you can still get that high salary and also find suitable living arrangements.
Do you want to live in a city and sacrifice apartment size and/or luxury and have a short commute? Think Chicago, Philadelphia, Boston, Pittsburgh, Cincinnati, Minneapolis.
Do you want to rent or immediately buy a home? Think Midwest and South with commutes, or maybe parts of Northeast. But then that's a guaranteed need for two cars for you and your partner. Think Texas, Georgia, Florida, Utah, Michigan, Ohio, Wisconsin, Iowa, Minnesota. Does your partner's life move to those places easily? I have friends who worked at the Mayo Clinic in Rochester, MN and bought a huge home, but they had to live in a rural McMansion subdivision where the only thing for delivery was pizza from Domino's and the nearest store was a 15-minute drive. It's very give and take.
You can also sacrifice higher salary and go more rural, lots of need for peds in rural Oregon, and you'll find very inexpensive housing. But your earning potential will be reduced by location.
Of course, a lot of this also depends on how much money you can spend to interview far away from where you currently are. It's going to be a lot easier to look local to where you're living after residency.
Good luck! Stay the course!
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Practicing pediatrics in NYC with 600k in debt as an older medical student...I admire your love for peds because that's literally doing your medical career on hard mode.
RichardH2024
Full Member
The Reserve provides part time options with various incentives. Time commitment is mostly up to you.
I personally think you’ll be fine. You’re highly intelligent, hard working and you live within your means in the most expensive city in the US. It’s worth exploring all specialties to find the right fit, but people get too hung up on debt burden; you’re smart enough to figure it out. With your stats and work ethic, you’ll match a great residency program in whatever field you choose. This will open doors to academic positions or private practice gigs that aren’t advertised. If you stay academics, do PSLF but plan to continue to live like a resident and save on the side for any tax bombs / program implosion. Make certain to qualify for PSLF every year as a resident/fellow. Yes, pay off the private loans. Continue tutoring, and once a resident look into moonlighting opportunities. Don’t forget that even starting your attending career at 40, if you work until 65 that is 25 years of making a minimum of $150k and probably more like $200k+ ...that’s $3.75-5M total lifetime earnings (minus taxes of course). People wringing their hands about $300k of debt vs $600k of debt should be more worried about savings rate, lifestyle creep and avoiding dumb investments. You can still save for retirement and pay off big debt as a doctor — most attendings in any specialty can afford to pay down $50-100k/year of debt while maxing out pretax 401k etc. If you choose a higher paying speciality or rise to a leadership position in your group/department, your salary will go up. And if you continue to reflect on all these things as you go along in training, you’ll come out better than many colleagues who start out with no debt, but do stupid **** like buying a Tesla or a “doctor house” during residency or otherwise living way outside their means. I guess I fall into the “don’t blindly do what you love without considering the bigger picture including financial and lifestyle, but definitely do something that genuinely interests you, and work hard” camp.
Superkatev
New Member
There are underserved areas that need service, and loan repayment programs vary by state. If public health interests you, the Commissioned Corps offers options.
Not at all relevant to the thread. Just read the title and the geico commerical immediately came to mind.
It's a "hopeful thought" but don't forget about PSLF. I know every budget season this is on the rocks. Don't forget about IBR. PSLF is IBR ran so repayment is DIRECTLY tied to your salary (10-15%). It makes it much more manageable for the lower paying specialties like FM (me) for example.
Depending on the 11/3 outcome, several things could happen:
1) PSLF gets dissolved in a repeat Trump administration (ugh).
2) PSLF participants who are already "enrolled" get grandfathered in.
3) Biden's student loan legislation comes to fruition and even if PSLF goes away, your IBR after 20-25 years ends and all remaining debt is forgiven tax-free.
4) The world ends and it doesn't matter.
Having only about 4 years of payments left I hope 2 or 3 happens.
The money will fall into place. You won't be poor. As a lowly-paid FM doc who is single, I have about $6000 worth of payments for the mortgage and loans monthly and I was entertaining adding a second luxury vehicle because I have the cash to do so, haha. Not smart so I won't be doing it, but the pauper lifestyle won't happen. You'll be fine.
Caveat to my post: I only read the OP.
Do what you like. If you like a lot of things do what pays the most and has best job market
Step 1: Figure out what lifestyle you want. This includes pay, hours/month, days off, weekends, call, holidays, clinic vs hospital, etc. Once you figure that out, find the specialty you hate the least that matches that lifestyle.
Step 2: Enjoy your life!
Step 2: Enjoy your life!
Ahhh. Yeah, I mean, I'm not shocked you found a place where presumably two of you made it work at $700 each. It totally can be done. And if you're willing to continue living there while working as a peds doc, then you're doing no worse than people living in many other major cities. Sharing a place is better than being on your own!Unfortunately, my life is in NYC🙁
Which, tbf, I lived in NYC my whole life and my rent was never higher than $700 haha. Outside of loans, I spent maybe 15k/yr at most living there. It's cheaper for us natives hahaha
But thank you for the advice <3
The question is if you're hoping to give that up and upgrade, or how you would handle things if you were suddenly on your own.
I think the takeaway is you won't be buying some Long Island beach home anytime soon. That's all!
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If you find yourself interested in procedures: You're competitive for ENT, but you'll need some research to get in.
Pediatric ophtho is also an option, you'll pull >$300k/year and it's I think a 5 year commitment. Better hours too.
Pediatric ophtho is also an option, you'll pull >$300k/year and it's I think a 5 year commitment. Better hours too.
I think if you're not 100% planning on doing PSLF you'd be making a horrible mistake no matter how much you love Peds.
Edit: NYC?? It's one thing if you wanted to practice in some rural place and make (relative) bank, but NYC is going to be a horrible market for nearly any job. Please don't do Peds in NYC with 600k debt!
Edit: NYC?? It's one thing if you wanted to practice in some rural place and make (relative) bank, but NYC is going to be a horrible market for nearly any job. Please don't do Peds in NYC with 600k debt!
At your debt level I’d seriously consider looking at fields that pay better. You’re debt is ~2x others and you’re already ~10 years older.
FYI peds specialties don’t usually pay multiples more like IM specialties do, so keep that in mind.
I wouldn’t bet my future on government debt forgiveness for someone making 4-5 times the average US family income when our debt is spiraling out of control. That’s very easy fat to trim that 99% of the public would support without hesitation . They don’t care about the bad debt decisions made by rich doctors. They can phase it out by income or something like so many other deductions and programs and leave you holding the bag.
FYI peds specialties don’t usually pay multiples more like IM specialties do, so keep that in mind.
I wouldn’t bet my future on government debt forgiveness for someone making 4-5 times the average US family income when our debt is spiraling out of control. That’s very easy fat to trim that 99% of the public would support without hesitation . They don’t care about the bad debt decisions made by rich doctors. They can phase it out by income or something like so many other deductions and programs and leave you holding the bag.
Didn't realize youre 10 years older - also a great reason Peds is a bad idea.
However, I wouldn't assume PSLF wouldn't work. Believe Obama already tried to cap the PSLF and it didn't go through. Trump also wasnt able to pass anything. You already signed the MPN and you have a contractual agreement with the government - pretty simple as long as you follow all the rules and keep track of everything. For future borrowers I can see rule changes, but I don't believe the gov has ever retroactively done something as extreme as screwing someone out of 100s of thousands.
Also neither side of the aisle is actually concerned with the federal debt as you can see from deficit spending.
J
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If you want to do primary care or either adult or peds hospitalist, med/peds will find you jobs. There are certainly fellowships that work well with that too - allergy being the main one, or adult congenital cardiology.
I'm not sure about doing both peds and adult heme/onc. If that's what you want, I'd pick one of them.
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Keep in mind that you can do allergy from peds or IM, you don't need med/peds to do it.
It's really easy to get hung up on ensuring the gargantuan effort you've put in to achieve perfect grades and the amount you've dedicated financially does not get wasted. That said, 20 years from now, you will rather have chosen the field that you enjoy and tolerate the most. Your life for the next 30-40 years or however long you decide to practice will be far more important than an extra few years in training or debt you held onto now. I have outlined a few thoughts (some contradict each other, but I'm just thinking aloud here) to help you consider this difficult choice.
1.) If you do Med-Peds, going by your desire to pay off the debt you have, you're delaying that opportunity by 2 years.
2.) It seems like your passion is for pediatrics as even as you look for more lucrative options, you're still trying to hold onto that pediatrics path.
3.) One potential option is to ask yourself if you'd rather do IM-> Heme/Onc. It would be similar length, but more lucrative career path.
4.) If we are strictly discussing finance and career passion/aspiration, the ideal option for you would either be to do 3 yr EM-> locums as delaying your time to practice even if it to do further training to increase your salary is going to come at the opportunity cost of 150-300k yearly for the chance to make an additional 200k.
5.) I know this will not help significantly but there are tons of FB groups that discuss topics such as FIRE (Financial Independence, Retire Early) and Passive Income for Doctors and they may be able to give you some ideas to mitigate the financial issues.
6.) I do not know the logistics, but I imagine there are programs that offer you partial or complete loan repayment for choosing a less lucrative career path. Definitely something to explore further.
Hope some of that helps!
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According to the White Coat Investor, a debt-to-income ratio of >3 can be very burdensome. If there are any other specialties that you enjoy and pay more, he recommends going that route instead. Otherwise, do what you love doing, but just know that the debt burden will be putting you further away from building wealth and saving a nest egg for retirement.
Also, PSLF would be a great option for you if you qualify.
Also, PSLF would be a great option for you if you qualify.
Late to the party, but if you know this, it might help narrow your options a lot. This goal would be a good fit for a longitudinal primary care outpatient clinic combined with periodic inpatient work (easiest would be IM inpatient unless you want to do the new ped hospital medicine fellowship), or a med or peds subspecialty like allergy/heme-onc/cardiology where you have an outpatient clinic and also provide inpatient consult coverage. The specific subspecialty makes a difference - most hospitals don't have an inpatient allergy service. Inpatient heme/onc or inpatient ped cardiology would probably only be at a children's hospital.
If you want to work with underserved patients, that usually means a county hospital, a community hospital in an under-resourced setting, or an academic center if there is no county hospital nearby to take underserved patients.
It is a matter prioritization. People forget that rural pediatrics and primary care can have benefits that help compensate for debt (health service loans, cost of living, signon bonuses, etc... though clearly, learning to manage money should always be prioritized, otherwise no salary will adequately compensate for poor decisions).
www.nejmcareercenter.org
People always want to have their cake and eat it too though...
Demystifying Urban Versus Rural Physician Compensation
Salary Differences Are Minimal, but Incentives and Perks Might Make Rural Opportunities More Attractive
People always want to have their cake and eat it too though...
600k debt and going Peds. Yikes
And living in a high COL city. Not a great combination, but I guess it's OP's choice to not press the "easy" button.
