What specifically do these students have at their fingertips?
What specifically do these students have at their fingertips?
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They have faculty who are at the top of their fields with labs that churn out research and are willing to take students.
Fellows and residents who are producing quality research who don't mind having students tag along to write a case report or review article or help with lab work.
Opportunities to learn about cutting edge techniques that are going to transform clinical practice before the guidelines have changed.
Exposure to a broad range of clinical cases at a quarternary center that would otherwise difficult to come by.
High level collaborations outside of the medical center with the university that may translate into device/tech development or novel research angles, etc.
This is the stuff that makes an applicant impressive to highly selective residencies. If someone doesn't want to pursue a field that is competitive, or doesn't want to pursue a competitive program in less selective specialty... or wants to be a private practice clinician, then I agree that these are not necessary.
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But the question is did you have a chance to go to a top tier place to begin with? If not, then it’s moot to say that going to a top tier place wouldn’t have made a difference.
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Not necessarily. Just getting into a top tier place doesn't mean you actually understand anything about the opportunities it provides you. I would actually expect this perspective to be more useful, to be honest.
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200+ for the opportunity to tag along and write a case report? lol. ill pass.
also med students who don't know basic medicine learning cutting edge techniques? lol. ill pass.
the only thing harvard gets you above other schools is a decent sized edge when it comes to getting into residency. after that no one cares about med school. residency and fellowship are where you become a doctor not med school.
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While I generally agree with you, my aspirations are a little different. I would like to enter private practice as either a dermatologist or plastic surgeon, and school name tends to be very important there for branding purposes.
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deleted1100659
If i had to choose between a 300k price tag at harvard or 100k price tag at a state school that was low-mid tier, I would pick the low-mid tier school without any hesitation.
What you do while you're in med school matters more than the name of the school. If you demonstrate an obvious dedication to the field that will help tremendously. Also people often change mindsets of what they want to do when they start medical school. I wanted to be a neurologist before I started. I realized when I started I definitely do not want to be a neurologist and now im a psychiatrist.
Everyone starts medical school with shining confidence and pride, which quickly gets demolished by the realities of medical school.
What you do while you're in med school matters more than the name of the school. If you demonstrate an obvious dedication to the field that will help tremendously. Also people often change mindsets of what they want to do when they start medical school. I wanted to be a neurologist before I started. I realized when I started I definitely do not want to be a neurologist and now im a psychiatrist.
Everyone starts medical school with shining confidence and pride, which quickly gets demolished by the realities of medical school.
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I'm glad I chose a cheaper school and I think I'd still choose it over a T5 (not that I'm qualified). Sure, it'd be nice to have the brand name and the connections, but as a M2 in their 30s, $$$ is always on my mind and I'm glad I'll leave with less debt.
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Until you hear program directors tell you, “yeah you’re application looks great, definitely top fifth of applicants… what’s going to hurt you though is going to XYZ COM… I mean we get applicants from Harvard Hopkins and Penn those are big names.”
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Don’t think people look up where there dermatologist or plastic surgeon went to school. Normally marketing you do that attracts people via private practice
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If you think you want to do something competitive don’t take advice from people in non-competitive fields. It’s really not a comparable match experience. Even for people gunning for top IM programs, at the end of the day they’re faced with just matching at a less prestigious program. If you want to do plastics or ENT, you’re faced with not matching at all. Ive been asked by people involved in admissions, “if you wanted to do this speciality, why did you go to this school”. One mentor, who also went to a low tier school based on cost, told me to say that “I made a mistake, I chose based on cost and at the time I didn’t realize I wanted to do X specialty before med school”
you can’t make this stuff up.
I’m not saying you won’t/can’t match but it’s seriously an unmodifiable dark cloud over you and a ball and chain on your application that you don’t want.
At a school without your choice of residency program, you’ll also see how the process of getting LoRs on away rotations is patently absurd.
you can’t make this stuff up.
I’m not saying you won’t/can’t match but it’s seriously an unmodifiable dark cloud over you and a ball and chain on your application that you don’t want.
At a school without your choice of residency program, you’ll also see how the process of getting LoRs on away rotations is patently absurd.
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A huge part of the marketing is going to an institution with perceived prestige…
There are entire admin departments at hospitals dedicated to helping people from outside of a ration get second opinions or treatment at prestigious places. I had a family flew up to a hospital to get their sons ear tubes put in by someone at one of these places. Ear tubes…
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It's kind of absurd for them to ask you why you didn't go to a top tier school, when the whole admissions to med school is random and unpredictable. Most people ended up with only one A anyway, so I would presume that your choice of school was not up to you.
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Think some of you might enjoy reading this by someone (@CC_alumnus) who graduated from a school known for offering full-tuition. I think it’s sums up well that you should make the decision you think will make you happiest (both considering short and long -term happiness).
“I am a Cleveland Clinic Lerner College of Medicine alumnus.
Getting Google alerts about the school occasionally sends me to this forum (which was very helpful for me during my medical school application process many years ago) and I'll skim the threads that pertain to CCLCM. What I'm always surprised by is the emphasis that applicants place on the full merit scholarship that accompanies acceptance.
Hopefully I don’t come off as patronizing when I offer some unrequited advice on choosing a medical school, particularly as it pertains to CCLCM.
First, there is way too much focus on money. As a resident, I completely understand the crunch of finances and also am wholly familiar with loan interest capitalization. But, the idea that you should choose a medical school based on financial incentives is foolish. If you are equally torn between schools, it can be very helpful. Or, if your goals are very distinct and directed toward quick completion with minimal turbulence. In that case, the lower the tuition the better. But otherwise? Choose where you will be happiest. Life is too short, residency is too hard, and your happiness is too important.
Medical school occurs during a formative period in your life and where you go to medical school sets off a cascade of life events that will determine (for many people) the specialty you choose, the career you desire, and your lifelong friends. Do NOT make a decision based on a few hundred thousand dollars if it means you will be any measure less happy once you make that more frugal or “safe” decision. Also, an extra year in earning potential does not matter. Not an iota, as it compares to the rest of your life- or at least that’s what it feels like now. The concept of weighing a hypothetical year of income against a year of experiential unknowns is both as unromantic and unappealing as it sounds when you consider the length of the average physician career. You’re never going to look back and think “I wish I had netted another year of salary”- life just does not work that way. You should be interested in an extra academic year because it affords you the chance for the first time in a long time (and what will be a long time thereafter) to intellectually explore an academic or personal pursuit without other pressing obligations or the relentless regiment of a ticking clock. As I tell incoming residency applicants, you need to find the place you will be happiest every day, not the most prestigious or where your faculty advisor thinks is the most flattering. Very few people can function at a high level when they are unhappy.
There are a lot of components of medical schools that applicants focus on that again, from my perspective are inconsequential when taken out of context. Learning styles, lecture vs. PBL, parking, etc. These are only important in aggregate, when you debate whether or not the general educational focus of the school fits your personality and goals.
To that end, do not attend the Cleveland Clinic Lerner College of Medicine because it is less expensive. Furthermore, do not attend the Cleveland Clinic Lerner College of Medicine unless you truly have a sense that academic medicine is somehow in your future. It is otherwise a waste of your time, the school’s time, and your classmate’s time. There is no way that you’re going to be happy when you’re just trying to learn the cardiac cycle and instead of answering questions that prepare you for boards (like at other schools) you are being asked to prepare a mock three-armed randomized trial that builds on the results from a Cell 2008 paper on cardiac myosin, or whatever. Going through these academic exercises without the desire to be a functioning physician-investigator in the future will not endear you to research, it will drive you away.
Many of my classmates had to make the decision between places like CCLCM and JHH, HMS, etc and I don’t know exactly how each of them felt at the end of the 5 years. What I do know is that people who started out interested in academics were on the whole happier during their time than those who were on the fence about it.
As someone who is now glimpsing the end of a long residency, I’m going to continue being a researcher and a surgeon. And in that regard I am exceptionally happy with the education I received at Cleveland Clinic. I look back incredibly fondly and I have no doubt that I received world-class training. But I don’t know what my path would have been at a different school, and no really has that capability. What I do know is that I attended the school I thought would make me the happiest, and luckily I was right. I encourage you to do the same.
I wish you the best of luck.”
“I am a Cleveland Clinic Lerner College of Medicine alumnus.
Getting Google alerts about the school occasionally sends me to this forum (which was very helpful for me during my medical school application process many years ago) and I'll skim the threads that pertain to CCLCM. What I'm always surprised by is the emphasis that applicants place on the full merit scholarship that accompanies acceptance.
Hopefully I don’t come off as patronizing when I offer some unrequited advice on choosing a medical school, particularly as it pertains to CCLCM.
First, there is way too much focus on money. As a resident, I completely understand the crunch of finances and also am wholly familiar with loan interest capitalization. But, the idea that you should choose a medical school based on financial incentives is foolish. If you are equally torn between schools, it can be very helpful. Or, if your goals are very distinct and directed toward quick completion with minimal turbulence. In that case, the lower the tuition the better. But otherwise? Choose where you will be happiest. Life is too short, residency is too hard, and your happiness is too important.
Medical school occurs during a formative period in your life and where you go to medical school sets off a cascade of life events that will determine (for many people) the specialty you choose, the career you desire, and your lifelong friends. Do NOT make a decision based on a few hundred thousand dollars if it means you will be any measure less happy once you make that more frugal or “safe” decision. Also, an extra year in earning potential does not matter. Not an iota, as it compares to the rest of your life- or at least that’s what it feels like now. The concept of weighing a hypothetical year of income against a year of experiential unknowns is both as unromantic and unappealing as it sounds when you consider the length of the average physician career. You’re never going to look back and think “I wish I had netted another year of salary”- life just does not work that way. You should be interested in an extra academic year because it affords you the chance for the first time in a long time (and what will be a long time thereafter) to intellectually explore an academic or personal pursuit without other pressing obligations or the relentless regiment of a ticking clock. As I tell incoming residency applicants, you need to find the place you will be happiest every day, not the most prestigious or where your faculty advisor thinks is the most flattering. Very few people can function at a high level when they are unhappy.
There are a lot of components of medical schools that applicants focus on that again, from my perspective are inconsequential when taken out of context. Learning styles, lecture vs. PBL, parking, etc. These are only important in aggregate, when you debate whether or not the general educational focus of the school fits your personality and goals.
To that end, do not attend the Cleveland Clinic Lerner College of Medicine because it is less expensive. Furthermore, do not attend the Cleveland Clinic Lerner College of Medicine unless you truly have a sense that academic medicine is somehow in your future. It is otherwise a waste of your time, the school’s time, and your classmate’s time. There is no way that you’re going to be happy when you’re just trying to learn the cardiac cycle and instead of answering questions that prepare you for boards (like at other schools) you are being asked to prepare a mock three-armed randomized trial that builds on the results from a Cell 2008 paper on cardiac myosin, or whatever. Going through these academic exercises without the desire to be a functioning physician-investigator in the future will not endear you to research, it will drive you away.
Many of my classmates had to make the decision between places like CCLCM and JHH, HMS, etc and I don’t know exactly how each of them felt at the end of the 5 years. What I do know is that people who started out interested in academics were on the whole happier during their time than those who were on the fence about it.
As someone who is now glimpsing the end of a long residency, I’m going to continue being a researcher and a surgeon. And in that regard I am exceptionally happy with the education I received at Cleveland Clinic. I look back incredibly fondly and I have no doubt that I received world-class training. But I don’t know what my path would have been at a different school, and no really has that capability. What I do know is that I attended the school I thought would make me the happiest, and luckily I was right. I encourage you to do the same.
I wish you the best of luck.”
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Wait what? PDs actually say that? That's pretty elitist and absurd tbh
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It is a little extreme to say that $$$ should not be a factor. Unfortunately, no matter what you read online or who you talk, you won't know whether you will be happy until you matriculate and by then it's too late. But I think most people will agree that having less debt = generally will be happier.
My spouse went to a fully funded MD/PhD program and it's great that she has no debt, that I can take out less loans for my own schooling, that we can eat out a little more frequently/enjoy life and she doesn't have to live "like a resident". She can even see her savings grow! Should it be the only factor? No. Is it understandable that people place a high emphasis on it? Yes.
My spouse went to a fully funded MD/PhD program and it's great that she has no debt, that I can take out less loans for my own schooling, that we can eat out a little more frequently/enjoy life and she doesn't have to live "like a resident". She can even see her savings grow! Should it be the only factor? No. Is it understandable that people place a high emphasis on it? Yes.
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Spoken like a true med student.
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deleted1100659
I dunno about you guys, but a few hundred thousand is definitely a big deal to me.
You may not think its a big deal now, but when you're paying >$40,000 a year off your salary, after losing 1/3 of your salary in taxes, I would count that as a big deal. You're essentially giving the government a mercedes a year
Ultimately what gets someone into a competitive specialty isnt necessarily the school, probably more so the applicant.
You may not think its a big deal now, but when you're paying >$40,000 a year off your salary, after losing 1/3 of your salary in taxes, I would count that as a big deal. You're essentially giving the government a mercedes a year
Ultimately what gets someone into a competitive specialty isnt necessarily the school, probably more so the applicant.
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This thread is the exact reason why docs get themselves in horrible financial situations. They are numb to debt and prestige chase themselves into hundreds of thousands in debt. And then make bad financial sections going forward in life.
D
deleted1100659
Well I dont think people understand how a paycheck works. Most physicians probably pay 30-40% of their salary in taxes. Not to mention, most medical students are starting to save for retirment late (because we obviously have no had the chance to). So now its time to start thinking about an IRA and other retirement accounts. After finishing residency the realization that I was in my 30s and had zero dollars for retirement was kind of daunting, when you add that to the debt i incurred.
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Couldn't agree more. Someone is defending turning down a full ride at a mid or lower tier school to pay full tuition at a top tier school by referencing a hypothetical conversation a PD may have one day about someone's application to residency. It's absolute lunacy.
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I agree that this is not the best argument.
But every post you make write conveys the attitude that someone should NEVER do that.
It’s a case by case basis, depends on the individual, their short and long term goals, characteristics of the schools (eg is one closer to home), etc.
It’s not as black and white as you make it seem.
As someone mentioned earlier, finances should absolutely be taken into consideration when people have decisions like this (heck, most students only get into one school so it’s out of their hands!).
Let’s not devalue the decisions coming from those who made decisions to pay more or less for school. Plenty of success stories (success =happy) of people who have done both.
It seems there’s a consensus that at the end of the day, with enough drive, people can (for the most part) get where they want.
At the end of the day, time is something you can never get back. Money, you can always make more. I think it’s priceless to do what makes you happy.
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Money is a surrogate for time. The further your behind in debt actually is proven to limit your happiness and free time to do the things you want to do outside of work. Honestly this thread is why private equity groups and hospital admins run circles around us and take advantage of docs… We have our head in the sand as soon as money is brought up.
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if you pay 30 to 40%, that means you have a poor financial planning skill....
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There's no free lunch.... When you get a lot of money from a lower tier school, there's always a catch somewhere. Otherwise, top schools would have a much lower yield rate given that most of the class at a t5 has a full ride somewhere else.
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That's completely a stereotype. I, for one, have managed over several billion dollars before med school at one of the largest reinsurance companies in the world. The assertion that a doc is inherently bad with money perpetuates itself as more doctors resign to that notion. The key is that we can educate ourselves really quickly by reading a primer on investment. It's really a very very rudimentary thing, no more than algebra learned in middle school.
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It’s a stereotype for a reason. Majority of doctors don’t have that background and are completely chumps when it comes to being smart with money. But good for you, don’t see how it adds anything to the convo other than to flex.
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At least you didn't go to DO school. You'd have the same hefty price tag but no prestige.
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Cool flex bro
hiiiiiiiiiii
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I mean you can’t really change federal and state tax laws...unless you’re referring to some loop hole...in which case, enlighten us
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Not loopholes, but deductions that can be taken advantage of, check schedule D and E, there are a lot of ways you can lower your effective tax rate. Rich people don’t pay 30%. Doctors are mostly rich.
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deleted1100659
Doctors are not rich CEOs. Rich CEOs avoid high taxes because they do not have a salary. They make money through other means that have a significantly lower tax. You will pay at least (or close to) 1/3 of your salary in taxes as a doctor unless you're comitting tax evasion or have a low salary.
Im telling you this because I am paying taxes, and working as an attending. I am living this life. You are likely not near the stage I am, so you dont see it quite yet but you will eventually. There is no magic way out of paying taxes the way that CEOs do. Its completely different, they are able to get paid in other ways. You will pay state tax, federal, FICA, medicare, etc. Oh and you have a house? Property tax of course.
Not trying to be mean/insulting but your view of doctors is a bit jaded. Doctors are upper class but most arent elite.
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When you put it like that it sounds silly, but its the addition of the other things that I mentioned. Beyond that, having your name on a single publication or two publications is only a small fraction of the important elements to that early mentoring relationship. Its being taught the scientific method, how to write manuscripts, getting a couple middle authorships to fill out your CV and learn how the review process works. Anyone can say that this stuff is learnable on your own. And thats true. I had to learn a lot of it on my own. But if you can have someone who has been through it before guide you through it, then maybe this next generation can be better than we were at the same stage of our training. You could ask why its more likely to happen at a "prestigious" university. Well its because these programs end up having residents and fellows who went through those same processes (writing a bunch of papers, etc.) to get to that fellowship as opposed to less academic institutions.
Beyond that, it's developing the connection with residents and fellows in your field of interest who soon will be faculty in your field of interest who you can call upon when you're moving onto the next phase of training.
With respect to learning cutting edge techniques without understanding basic medicine. This is the school of thought that would suggest that every medical school is the same. An MD is an MD, and I agree that at most levels this is mostly true. There's no secret cure for cancer that is only taught at one school. The argument being that cutting edge stuff is not necessarily at the clinical level yet, so whether a person is trained in clinical medicine doesn't have a serious impact on their ability to be exposed to novel therapies that are still in their earliest phases of development. Moreover, its exceedingly hard to think of things that you've never even heard of before. I for one think that getting exposed to breadth of clinical scenarios and being at a center that is participating in trials (even as a student) is beneficial. When TAVR was new, i was a student at a participating center. And people were constantly talking about it around the medical center. Being part of that milieu was beneficial.
If your only concern is doing okay on step 1, passing your classes, and getting the degree, then I absolutely agree that the $200,000 is not worth it.
D
deleted1100659
I understand that point of view- different people have different values. I just want premeds/med students to understand 200k is not a small number that is insigificant. Quite the opposite.
The reality is we don't even know what physician salaries will be in 5 years. Or 10. If we for some reason move towards single payer which many people are pushing then they will for sure drop significantly.
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$50k vs $250k is a tiny drop in the bucket of your career earnings even in a "low paying" speciality. That is the difference in maybe 2-3 extra years of paying off debt if you are aggressive about it. And that is if you are dead-set on pediatrics.
The vast majority of people in your situation are going to make back A LOT more than $200k by being able to easily match into derm, surgical subspeciality, internal medicine sub-speciality, etc. I mean...for example, ortho vs general surgery is $200-400k more per year as an attending. That is at least $6 million over a 30 year career as an attending. People from Stanford and Harvard match ortho with Step 1 of 220...not so much from Joe's state MD school.
And even more important than $$$ is the option to do a speciality you actually enjoy. You will make millions more, live longer, and have a better personal life getting to do something you like for 30+ years compared to being forced into FM/IM/peds and quitting after 10 years.
It is like that old quote, "Money doesn't buy you happiness but it does give you options." Same thing with prestige.
The vast majority of people in your situation are going to make back A LOT more than $200k by being able to easily match into derm, surgical subspeciality, internal medicine sub-speciality, etc. I mean...for example, ortho vs general surgery is $200-400k more per year as an attending. That is at least $6 million over a 30 year career as an attending. People from Stanford and Harvard match ortho with Step 1 of 220...not so much from Joe's state MD school.
And even more important than $$$ is the option to do a speciality you actually enjoy. You will make millions more, live longer, and have a better personal life getting to do something you like for 30+ years compared to being forced into FM/IM/peds and quitting after 10 years.
It is like that old quote, "Money doesn't buy you happiness but it does give you options." Same thing with prestige.
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Penny wise, pound foolish. 200k in one's lifetime really doesn't matter that much even if you only make 200k a year. I don't see people debating buying a 800k house vs a 1m house, because people want to get what they want as long as they can afford that extra 200k. That applies to medical degrees as well. I think everyone who gets accepted to a t5 can afford that extra 200k. Why not take that Ferrari out for a spin for 4 years when you have the chance. Once you are out of medical school, even if you had that extra 200k to waste on, you wouldn't be able to drive that Ferrari.
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This thread is a good example why i don't follow financial advice on SDN. Too many people think they know about finances/investing only to post inaccurate and contradictory advice that makes it hard to follow for those who are interested to learn more about finances
This is worsened by the elitist SDN perception that $200K/yr is viewed as not a lot or "just barely middle class" that's pervasive across all SDN finance/debt threads
This is worsened by the elitist SDN perception that $200K/yr is viewed as not a lot or "just barely middle class" that's pervasive across all SDN finance/debt threads
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I am confused as to what side you fall on...are you saying $50k vs $250k for a medical degree is a big deal or isn't?
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Physicians are horrible at advocating for themselves in the current fractured system, but we are not going to have specialist physicians with median incomes in the 4, 5, and $600,000 range suddenly throw up their hands in a single payer system and accept $200k/yr. Also, comparable countries to the US with single-payer/truly universal healthcare still have their physicians making bank where $50k vs $250k for a medical degree is not a big deal in the grand scheme of things.
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We are talking like debt from a MD degree is all you have to worry about and that's fine in a vacuum. Undergrad loans? Want to start a family soon and eventually a house? Sure you can still do all of that and add to your debt burden at 250K but I'd rather have it added to $0 (or as little as possible).
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Yeah, get off SDN and look at any other forum/ podcast/blog with docs who are practicing that have 200k+ of debt and dread it. It’s a burden on them and their happiness. There is research out there that shows debt can negatively affect your happiness and burn out. People saying otherwise have their head in the sand. 200k is a lot of money but with all things it’s all about prospective. If you live in a neighborhood where everyone else makes $800k then you wouldn’t feel 200k is a lot. Plus docs feel they had to delay their goals and get into debt and start out with negative net worth. There is a reason that tons of docs starting to turning to the internet and books to learn about finances because they realize the field as a whole is surrounded by people like in this thread that are begging to get taken advantage of and seem to love occurring debt and we have no idea how to navigate this space because we were never really thought how to.
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deleted1100659
UK physicians are not "making bank". Also when not given a choice, physicians will accept whatever.
Also when you borrow 200k you don't borrow 200k. That loan has interest that builds interest upon interest. A loan for 300k at 6 percent means the interest each year by itself is over 20k.
hiiiiiiiiiii
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it would be interesting to see the age distribution of each side. If I had to guess, the ones who say take prestige are younger, and those who say take the money are older (and perhaps wiser?)
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Not sure about the wiser part 😉
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I got some whole life policy to sell u guys!
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Thank you for teaching us about interest—that is very rarely brought up in discussion of medical school debt.
The actual reality is that during residency and fellowship that loan is accruing at 1/2 of the interest (so 3% not 6%) as long as you got federal loans. Refinancing as an attending to 3-3.5% is easy. Paying off $250k in 1-5 years is also doable, dare I say easy. The only way you will struggle is if you think you can’t raise a family and live a nice life on a salary in the low $100k range for 1-5 years.
And it is bold to choose a country that has a system that we will likely never have in the US. Far better comparisons are Australia, Canada, the Netherlands, Switzerland, and Belgium.
The US GDP/capita is 48% more than the UK…
I love how this debate always plays out on SDN. Someone comes in saying that nobody is doing basic math (e.g. interest), and then forget to do the slightly less basic math that proves they don’t know what is up or down when it comes to finances.
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Oof, the assumption here that doctors struggling to get out of debt are the ones to listen to is…quite an assumption.
If $200k of debt at 3% is a burden to your happiness as an attending making $200k+/yr, I don’t think $0 debt or a salary of $600k could save you from your money problems.
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Some people are going to pick prestige and wish they had less debt.
Some people are going to pick less debt and wish they had more prestige.
Morales of the story
1) don’t pay more money for less prestige unless you have some other really gooreason
2) figure out what’s important to you and be honest with yourself about it (caveat: if your priorities change mid-career that’s a tough break and I don’t know what to tell you)
edited for typo
Some people are going to pick less debt and wish they had more prestige.
Morales of the story
1) don’t pay more money for less prestige unless you have some other really gooreason
2) figure out what’s important to you and be honest with yourself about it (caveat: if your priorities change mid-career that’s a tough break and I don’t know what to tell you)
edited for typo
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I agree, with the caveat that the vast majority of medical students change what speciality they want to go into and what type of practice they want, so it’s really hard to know how much prestige will matter to you before it’s ERAS time or even down the road when applying to fellowship.