350k in debt for med school

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Aubrey Graham

Aubrey Graham

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Is it possible/worth it to pay off 350k in debt after medical school?
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WedgeDawg said:
No, every doctor will have debt for the rest of their life, which will be transferred to their surviving spouse or children. This is why a lot of doctors don't get married or have children (because they're altruistic)
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LOL
 
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Aubrey Graham said:
Is it possible/worth it to pay off 350k in debt after medical school?
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It's like a mortgage. You and every physician can do it. There are also many loan repayment programs, but many will almost certainly be modified by the time someone thinking about applying now will exercise them. Do you think the public intended many of these government programs to help the 1%ers, I don't, and wouldn't bet on them continuing long after the first millionaire physicians earning 300+ go to cash in.
 
All joking aside how long would it take to pay this off considering 5-6 years of residency and all that interest


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Dang! I never heard of that kind of amount. Most docs can pay off their $200k debt if their specialty pays well.
 
We discuss this a ton on the pre-dental forums since cost of dental education at some schools is nearing 500K (it's absolutely insane).

Assuming 350K debt with 6.9% compound interest, at the end of 6 years of residency you will have (350,000)*1.06^6 =496K =500K in debt (assuming you defer your loans)

At a 10-year repayment plan, this is $5.8K/month.
 
Incis0r said:
We discuss this a ton on the pre-dental forums since cost of dental education at some schools is nearing 500K (it's absolutely insane).

Assuming 350K debt with 6.9% compound interest, at the end of 6 years of residency you will have (350,000)*1.06^6 =496K =500K in debt (assuming you defer your loans)

At a 10-year repayment plan, this is $5.8K/month.
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Welp. Guess I'm going to be living in a box while I repay my loans! Haha.
 
Sorry guys- I made a calculation error in the previous estimate, and no, it's not good news. My calculation should have been 350,000 * 1.069^6. I gave you guys a 6% interest rate. Not a 6.9%. So instead of 500K, you will be 522.3K in debt. (Hard to believe how 1 tiny % makes a $22,000 difference huh?). By the way, I didn't take into account interest generated during med school and loan fees, so actually the number will be higher than $522K too.

This equals just over $6K/month in loan repayment for 10 years.

Good luck to whoever takes out this much debt and has to deal with this for 10 years. My heart goes out to you. You must really love medicine to want to take on this financial burden.
 
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ugagrad1116 said:
Welp. Guess I'm going to be living in a box while I repay my loans! Haha.
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Well you can choose a more affordable 20 year plan and just make extra payments annually or quarterly. That's what I do with my mortgage. I got a 30 year when I refinanced as the rate was historically low. I project that it will be paid off in 15-20 at the most. Some years we pay an additional 5-6k one year we paid 80. It depends on what expenses we have or expect. It all adds up.
There's no reason you can't do the same.
 
Incis0r said:
Sorry guys- I made a calculation error in the previous estimate, and no, it's not good news. My calculation should have been 350,000 * 1.069^6. I gave you guys a 6% interest rate. Not a 6.9%. So instead of 500K, you will be 522.3K in debt. (Hard to believe how 1 tiny % makes a $22,000 difference huh?). By the way, I didn't take into account interest generated during med school and loan fees, so actually the number will be higher than $522K too.

This equals just over $6K/month in loan repayment for 10 years.

Good luck to whoever takes out this much debt and has to deal with this for 10 years. My heart goes out to you. You must really love medicine to want to take on this financial burden.
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Interest doesn't compound during times of financial hardship or during school. You're doing a compound interest equation, when the interest will only actually compound once-after graduation. It will be accumulating, but interest will not be charged on it until it compounds. Finally, you don't have the option of deferring loans these days- you have to do IBR, PAYE, or the new REPAYE system in residency. REPAYE might massively benefit physicians, as it halves the interest rate during times of severe financial hardship, but we'll have to see how the final rules shake out. Finally, you can moonlight during residency and fellowship and make quite a decent sum, depending on your field.
 
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what if I die during medical school? Will my family have to pay for the debt I incurred?
 
IlDestriero said:
Well you can choose a more affordable 20 year plan and just make extra payments annually or quarterly. That's what I do with my mortgage. I got a 30 year when I refinanced as the rate was historically low. I project that it will be paid off in 15-20 at the most. Some years we pay an additional 5-6k one year we paid 80. It depends on what expenses we have or expect. It all adds up.
There's no reason you can't do the same.
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This is a good strategy in the sense that it frees up cash-flow in the short-term for you to invest into assets. NOTICE: I SAID ASSETS. DO NOT SPEND THIS ON LIABILITIES. But one thing to keep in mind is that this freed up cash flow comes at a price, and that price is known as compound interest.

If you paid off the 522K note within 10 years, you'd have paid a total of $724.5K for your medical education including interest ($375K in interest!!!).

If you pay it off in 20 years, you'll end up paying a total of $964.3K for your medical education....NEARLY ONE MILLION DOLLARS ($614K of this is interest!!!!)

So, what's the decision to make? Well, you need to evaluate the profit that the cash flow (from lowering your monthly payments) can bring you. If you pay the loan over 20 years, your payments drop to just above $4K. But as you see above, you're paying nearly $250K more in interest than if you paid the loan over 10 years. That's the cost of a house in some places.

In dentistry, some people belong to the school of thought that you sign up for a 30-year payment plan, take advantage of the lower monthly payments to buy a dental practice, and then use the increased income from that practice to knock out the loans. Just an example of this strategy in action.

BUT you need to sit down and do the math and see if it is worth it.

Also, houses are not investments/assets. I will be countered by "appreciation," etc. here. It's just my view that housing (unless you're talking rental properties) is a liability.

Mad Jack said:
Interest doesn't compound during times of financial hardship or during school. I thought it did compound during school, my bad. Still, this doesn't bring much comfort - my calculation did not include compound interest during school. It assumed $350K at the end of M4. You're doing a compound interest equation Yes, when the interest will only actually compound once-after graduation. That is what my calculation does, so we are fine here. OP said to assume $350K loans upon graduation. I did not compound during school, only after school i.e. starting residency. It will be accumulating, but interest will not be charged on it until it compounds. Finally, you don't have the option of deferring loans these days Kiss the meager resident income good-bye- you have to do IBR, PAYE, or the new REPAYE system in residency. REPAYE might massively benefit physicians, as it halves the interest rate during times of severe financial hardship You are assuming the program will survive....optimistic at a time when longstanding entitlements like SS and Medicare are being curbed, but we'll have to see how the final rules shake out. Finally, you can moonlight during residency OP said 6 year residency which is typically surgery...I doubt he can moonlight during an 80 hr week and fellowship and make quite a decent sum, depending on your field.
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I will respond to your points in the quote itself. My writing is in blue.
 
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IlDestriero said:
Well you can choose a more affordable 20 year plan and just make extra payments annually or quarterly. That's what I do with my mortgage. I got a 30 year when I refinanced as the rate was historically low. I project that it will be paid off in 15-20 at the most. Some years we pay an additional 5-6k one year we paid 80. It depends on what expenses we have or expect. It all adds up.
There's no reason you can't do the same.
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Yup. Amortize calc for extra payments: http://mortgage-x.com/calculators/extra_payment_calculator.asp
 
IlDestriero said:
Well you can choose a more affordable 20 year plan and just make extra payments annually or quarterly. That's what I do with my mortgage. I got a 30 year when I refinanced as the rate was historically low. I project that it will be paid off in 15-20 at the most. Some years we pay an additional 5-6k one year we paid 80. It depends on what expenses we have or expect. It all adds up.
There's no reason you can't do the same.
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I was 100% kidding with that comment. Sarcasm truly doesn't travel well over the internet.
But thank you for responding with how you manage it all! That sounds like a very reasonable and manageable plan. I shall keep that in mind for when I get to that point and must make that decision!
 
If the calculations here are correct, and I suspect they are close to the mark, this thread should be garnering much more attention. How is it possible to be paying 4.5-6,000/month on a loan with a PCP salary? That's nearly impossible, good lord.
 
Giovanotto said:
If the calculations here are correct, and I suspect they are close to the mark, this thread should be garnering much more attention. How is it possible to be paying 4.5-6,000/month on a loan with a PCP salary? That's nearly impossible, good lord.
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Thanks for the compliment 🙂 I use the following loan repayment calculator- I found it to have the most user-friendly, simple interface: http://www.youcandealwithit.com/bor...s/calculators/loan-repayment-calculator.shtml

The remainder parts of my calculation (i.e. amount of loan to punch in....522K in this case after residency before repayment) have been demonstrated in earlier posts.

On to your question: it is horrible the kind of debt students have to go through in order to enter a healthcare profession. Everyone is taking advantage of pre-health students...from the MCAT/DAT prep sellers ($2,000 Kaplan courses anyone?) to the application fees ($200 just to apply to a single dental school) to the board licensing exams ($4K for dental licensing exams BEFORE paying to recruit patients etc).

Most of the pre-dental students in my school are going to 400K+ dental schools without regard for the debt. I have tried warning them that starting dentist salaries are around 90K due to falling reimbursements, the advent of dental therapist mid-levels, etc. But they just see the comfortable cushy lifestyle that dentists who graduated 40 years ago (when debt was maximum 10K) are living.

These same people who say "let's just go for it" and "it'll be all right in the end" are the ones who will end up complaining and supporting socialization/nationalization of dental care and increased tax rates in exchange for loan forgiveness. Personal responsibility and due diligence is fast going out the window. Rant over.

I am going to try my level best to grab an HPSP (I am passionate about the military- not just for the $$).
 
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Incis0r said:
Only if they co-signed the loan for you.
If they did, it would be a good idea to take out life insurance on yourself, naming them as the beneficiaries, for the entire amount of the loan.
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which btw, only costs the equivalent to a few trips to Starbucks per month.

For complicated reasons involving my debt I just got a policy myself. Worth if for the piece of mind.
 
Giovanotto said:
If the calculations here are correct, and I suspect they are close to the mark, this thread should be garnering much more attention. How is it possible to be paying 4.5-6,000/month on a loan with a PCP salary? That's nearly impossible, good lord.
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Which is one major reason no one wants to be a PCP.
 
Giovanotto said:
If the calculations here are correct, and I suspect they are close to the mark, this thread should be garnering much more attention. How is it possible to be paying 4.5-6,000/month on a loan with a PCP salary? That's nearly impossible, good lord.
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No one ever pays the standard 10 year repayment. IBR and PAYE are the safe (and soon default) way to pay. It's a 25 year plan rather than a 10 year one, after which your loan balance is forgiven. There's a lot of ways to swing that, particularly if you work at a job with loan forgiveness or you put in some OT. Plus the debt amounts are a bit exaggerated, honestly. The compounding is all off due to a lack of compensating for the effects of hardship, and they haven't compensated for payments made in residency, which, while small, seriously matter.
 
Mad Jack said:
No one ever pays the standard 10 year repayment. IBR and PAYE are the safe (and soon default) way to pay. It's a 25 year plan rather than a 10 year one, after which your loan balance is forgiven. There's a lot of ways to swing that, particularly if you work at a job with loan forgiveness or you put in some OT. Plus the debt amounts are a bit exaggerated, honestly. The compounding is all off due to a lack of compensating for the effects of hardship, and they haven't compensated for payments made in residency, which, while small, seriously matter.
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1. "IBR and PAYE are the safe (and soon default) way to pay." Dude, how do you know this policy will exist for the next 25 years? You're predicting 6 presidential elections with this statement. It could be repealed or amended in any single one of them. IBR/PAYE was NOT intended for doctors/dentists. Going into heavy debt banking on this policy is a recipe for disaster, not to mention irresponsible. Keep in mind, this country is running a HUGE deficit/debt. At a time when retirement ages are being postponed to reduce SS/Medicare eligibility etc., how can you so confidently say that this is a "safe" pathway? Are you willing to bet $522,000 on this? It could easily go on the chopping block.

2. "It's a 25 year plan...after which your loan balance is forgiven." Keep in mind that the remaining loan balance is TAXED as ORDINARY INCOME. This is called the Tax Bomb. It is NOT written off. And since you're only making 10% of your net income payments on the loan, the interest will BALLOON. Expect to pay A LOT in this tax bomb (HUNDREDS OF THOUSANDS OF DOLLARS)

3. "Plus the debt amounts are a bit exaggerated, honestly"- show me your calculations.

4. "The compounding is all off due to a lack of compensating for the effects of hardship"- what specific effect would "hardship" have? I would like to see your calculations.

5. "they haven't compensated for payments in residency, which, while small, seriously matter." In residency, you make around 40K right? How much of that will you throw at loans each year, seriously?
 
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Incis0r said:
1. "IBR and PAYE are the safe (and soon default) way to pay." Dude, how do you know this policy will exist for the next 25 years? You're predicting 6 presidential elections with this statement. It could be repealed or amended in any single one of them. IBR/PAYE was NOT intended for doctors/dentists. Going into heavy debt banking on this policy is a recipe for disaster, not to mention irresponsible. Keep in mind, this country is running a HUGE deficit/debt. At a time when retirement ages are being postponed to reduce SS/Medicare eligibility etc., how can you so confidently say that this is a "safe" pathway? Are you willing to bet $522,000 on this? It could easily go on the chopping block.

2. "It's a 25 year plan...after which your loan balance is forgiven." Keep in mind that the remaining loan balance is TAXED as ORDINARY INCOME. This is called the Tax Bomb. It is NOT written off. And since you're only making 10% of your net income payments on the loan, the interest will BALLOON. Expect to pay A LOT in this tax bomb (HUNDREDS OF THOUSANDS OF DOLLARS)

3. "Plus the debt amounts are a bit exaggerated, honestly"- show me your calculations.

4. "The compounding is all off due to a lack of compensating for the effects of hardship"- what specific effect would "hardship" have? I would like to see your calculations.

5. "they haven't compensated for payments in residency, which, while small, seriously matter." In residency, you make around 40K right? How much of that will you throw at loans each year, seriously?
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1- You do realize that the MPR is a contract, like any loan contract, correct? It can't legally be rescinded- this has been discussed ad nauseum. The federal government can make new plans available but has not ever in the history of the federal loan program retroactively changed the terms of an existing MPR without the consent of the borrower because it would be highly illegal and not hold up to the lender's end of the borrowing agreement. Do you even law, bro?

2- This is something you should plan for. You should, at a minimum, pay the interest on your loans. The reason to take IBR is not to plan to wait the 25 years out, but to either have extra flexibility in your loan repayment, or you can save the money you'd throw at it and hope your money grows faster than the debt bomb (you only get taxed on the debt as income, so if you invest the money and make 8%, for instance, and the debt grows at 7.4% per year, you're still winning by a long shot, because that debt is ultimately cut down to the maximum federal limit of 39.6% of its value, while the money you've made investing suffers no such cut to value when you are paying your loans off). Basically, there's a lot of ways to juggle this, and you're being financially ignorant if you think that there is now way to handle it.

3. That math'd take me hours and much more information from OP to sort out perfectly, and thus if I did right now, would rely on a lot of assumptions. The interest rates are currently variable, we don't know how op came up with their 350k debt figure, etc. Calculating with minimum payments during residency and hardship interest, they'd end up with 452k under the current program and 392k under the proposed REPAYE program care of the halving of interest accrual. All of this assumes one of the longest medical paths possible (6 years). It would be financially prudent to take a break after a 3 year residency and pay down some debt before entering fellowship, do a residency that allows for moonlighting (psych, derm, rads, anesthesia, etc) or doing a residency that doesn't require fellowship and is four years or less to minimize debt. There's a lot of psych doctors, for instance, that are pulling over 100k on top of their resident salary due to moonlighting, which can make a serious impact on your debt.

4. Here's the simple way to put it. If you aren't under hardship, your interest compounds each year. Let's assume, for simplicity's sake, you have 6.9% interest (which you wouldn't have, as a good portion of your loan is under the graduate stafford program, which has a rate of 5.84%, and the rest is under the PLUS program, which has a rate of 6.84% at the moment, which could go up or down, but I digress). 350*1.069*1.069*1.069*1.069*1.069*1.069=522.32k would be your debt if you were not under hardship. (350*.069)*6+350=494.9 would be your debt under hardship. However, during both of these periods you would be paying down some of your interest, as you're under PAYE, so you'd pay (roughly) 6k*6=36k over those three years. Calculating this in the compounding scenario is obnoxious without my TI-83, so let's just do it in a simple scenario and hack 36k off of each. That leaves you with a debt of 458.9k in the hardship scenario, and 486.32k (you'd actually have a few thousand less than this, but not much) in the non-hardship scenario. That's a difference of nearly 40k, not exactly peanuts. Furthermore, the proposed REPAYE plan will reduce any interest not covered by your 10% payment by 50%, substantially reducing debt even further. REPAYE will be passed in the very near future and does not require intervention from our dysfunctional Congress to pass. This will further reduce total debt by a substantial amount for both scenarios, which, again, I'm way too lazy to calculate right now.

http://www.usnews.com/education/blo...ect-from-the-new-income-driven-repayment-plan

5. How much you make in residency depends on where you are. Here is a sample PGY-1 through PGY-7 pay package from a hospital system in the Northeast:

PGY-1 $55,700 PGY-2 $58,200 PGY-3 $60,900 PGY-4 $63,400 PGY-5 $66,400 PGY-6 $68,900 PGY-7 $70,200

On average, you'll be pulling over 60k a year during your proposed 6 year residency without any moonlighting. Almost every fellow I've ever known picks up a moonlighting shift every week or two, which pay 75-150 bucks an hour for an 8-12 hour shift, depending on specialty. You can start moonlighting in PGY-2, but it's easiest in PGY-3+, and many residents and fellows I've known have pulled 50-100k a year moonlighting (most are closer to the 50k range, but ones in psych, PM&R, and other low-hour residencies have been known to sometimes push the 100k barrier).

Basically, your assumptions are made on the worst case scenario of the simplest math you could possibly do, with the worst repayment terms possible and nearly the longest residency possible with zero moonlighting and zero payback during residency. Essentially, your analysis is naive and worthless, because it fails to take into account or simplifies not only one or two factors, but damn near a dozen very important ones.

You can handle this level of debt OP, that's the point. I've never known an employed doc that was broke or starving, and I've known docs with the levels of debt you're talking about.
 
Mad Jack said:
1- You do realize that the MPR is a contract, like any loan contract, correct? It can't legally be rescinded- this has been discussed ad nauseum. The federal government can make new plans available but has not ever in the history of the federal loan program retroactively changed the terms of an existing MPR without the consent of the borrower because it would be highly illegal and not hold up to the lender's end of the borrowing agreement. Do you even law, bro?

2- This is something you should plan for. You should, at a minimum, pay the interest on your loans. The reason to take IBR is not to plan to wait the 25 years out, but to either have extra flexibility in your loan repayment, or you can save the money you'd throw at it and hope your money grows faster than the debt bomb (you only get taxed on the debt as income, so if you invest the money and make 8%, for instance, and the debt grows at 7.4% per year, you're still winning by a long shot, because that debt is ultimately cut down to the maximum federal limit of 39.6% of its value, while the money you've made investing suffers no such cut to value when you are paying your loans off). Basically, there's a lot of ways to juggle this, and you're being financially ignorant if you think that there is now way to handle it.

3. That math'd take me hours and much more information from OP to sort out perfectly, and thus if I did right now, would rely on a lot of assumptions. The interest rates are currently variable, we don't know how op came up with their 350k debt figure, etc. Calculating with minimum payments during residency and hardship interest, they'd end up with 452k under the current program and 392k under the proposed REPAYE program care of the halving of interest accrual. All of this assumes one of the longest medical paths possible (6 years). It would be financially prudent to take a break after a 3 year residency and pay down some debt before entering fellowship, do a residency that allows for moonlighting (psych, derm, rads, anesthesia, etc) or doing a residency that doesn't require fellowship and is four years or less to minimize debt. There's a lot of psych doctors, for instance, that are pulling over 100k on top of their resident salary due to moonlighting, which can make a serious impact on your debt.

4. Here's the simple way to put it. If you aren't under hardship, your interest compounds each year. Let's assume, for simplicity's sake, you have 6.9% interest (which you wouldn't have, as a good portion of your loan is under the graduate stafford program, which has a rate of 5.84%, and the rest is under the PLUS program, which has a rate of 6.84% at the moment, which could go up or down, but I digress). 350*1.069*1.069*1.069*1.069*1.069*1.069=522.32k would be your debt if you were not under hardship. (350*.069)*6+350=494.9 would be your debt under hardship. However, during both of these periods you would be paying down some of your interest, as you're under PAYE, so you'd pay (roughly) 6k*6=36k over those three years. Calculating this in the compounding scenario is obnoxious without my TI-83, so let's just do it in a simple scenario and hack 36k off of each. That leaves you with a debt of 458.9k in the hardship scenario, and 486.32k (you'd actually have a few thousand less than this, but not much) in the non-hardship scenario. That's a difference of nearly 40k, not exactly peanuts. Furthermore, the proposed REPAYE plan will reduce any interest not covered by your 10% payment by 50%, substantially reducing debt even further. REPAYE will be passed in the very near future and does not require intervention from our dysfunctional Congress to pass. This will further reduce total debt by a substantial amount for both scenarios, which, again, I'm way too lazy to calculate right now.

http://www.usnews.com/education/blo...ect-from-the-new-income-driven-repayment-plan

5. How much you make in residency depends on where you are. Here is a sample PGY-1 through PGY-7 pay package from a hospital system in the Northeast:

PGY-1 $55,700 PGY-2 $58,200 PGY-3 $60,900 PGY-4 $63,400 PGY-5 $66,400 PGY-6 $68,900 PGY-7 $70,200

On average, you'll be pulling over 60k a year during your proposed 6 year residency without any moonlighting. Almost every fellow I've ever known picks up a moonlighting shift every week or two, which pay 75-150 bucks an hour for an 8-12 hour shift, depending on specialty. You can start moonlighting in PGY-2, but it's easiest in PGY-3+, and many residents and fellows I've known have pulled 50-100k a year moonlighting (most are closer to the 50k range, but ones in psych, PM&R, and other low-hour residencies have been known to sometimes push the 100k barrier).

Basically, your assumptions are made on the worst case scenario of the simplest math you could possibly do, with the worst repayment terms possible and nearly the longest residency possible with zero moonlighting and zero payback during residency. Essentially, your analysis is naive and worthless, because it fails to take into account or simplifies not only one or two factors, but damn near a dozen very important ones.

You can handle this level of debt OP, that's the point. I've never known an employed doc that was broke or starving, and I've known docs with the levels of debt you're talking about.
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Even though your analysis has several points that I do not agree with, I am going to go ahead and thank you. Because you have just done the OP a huge favor and provided him/her with a concrete method for analyzing his/her financial future. It's this kind of thing that the OP will have to refer to when the time comes to make a call on the school.🙂

@Aubrey Graham thank you for bringing up this thread. Hopefully more pre-meds see it and can make decisions for themselves on whether or not med school is worth it based on their financial goals.
 
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Okay, soooooo....

Where exactly are you going that entails 350k worth of medical school debt?
 
WedgeDawg said:
My total COA for 4 years without any aid would be around 320K, not factoring in interest or previous debt.
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And, what if we take into account a 7% interest rate private loan to that amount. Is that nearly insurmountable debt? Any advice regarding this scenario is helpful.

Medical school

80K*1.07 = 85.6K
85.6K*1.07 = 91.59K
91.59K*1.07 = 98.0K
98.0K*1.07 = 104.9K

Total = 380,000 after 4 years

Residency
380K*1.07 = 406K
406K*1.07 = 434K
434K*1.07 = 464K

Total after 3-year residency = 464,000

Am I doing this math right? Cause, that seems crazy.
 
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Aubrey Graham said:
Is it possible/worth it to pay off 350k in debt after medical school?
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Possible? Yes. Worth it? That's a pretty value-laden question that will depend on the individual. Since you're asking for people's opinions, mine would be that no, it is not worth it. But I'm not you. You have to decide for yourself whether you're willing to take on that kind of debt should it be necessary in order for you to become a physician. And if it is necessary, I sure don't envy you having to make that decision.
 
Giovanotto said:
And, what if we take into account a 7% interest rate private loan to that amount. Is that nearly insurmountable debt? Any advice regarding this scenario is helpful.

Medical school

80K*1.07 = 85.6K
85.6K*1.07 = 91.59K
91.59K*1.07 = 98.0K
98.0K*1.07 = 104.9K

Total = 380,000 after 4 years

Residency
104.9K*1.07 = 112K
112k*1.07 = 119K
119K*1.07 = 127K

Total after 3-year residency = 738,000

Am I doing this math right? Cause, that seems crazy.
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I am 99% sure you are doing the math wrong.

Why are you adding 100k+ each year of residency?
 
Rising tuition is needed to raise the cost of entry for the profession. Physician salaries need to go higher to make this field competitive relative to alternative careers. Otherwise, there will be a drop in enrollment.
 
68PGunner said:
Rising tuition is needed to raise the cost of entry for the profession. Physician salaries need to go higher to make this field competitive relative to alternative careers. Otherwise, there will be a drop in enrollment.
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And then enrollment drops, but the role of the midlevel expands, which is something a number of forces and gov't and HC want in order to help "control costs." In general, certain economic forces would have providers' salaries stay stagnant or go down, not up.

See Exhibit 2:

http://www.commonwealthfund.org/pub...015/jun/primary-care-providers-first-year-aca

Sure, not the original question, but I offer this in reply to @ 68PGunner's reply.

Also, I'm not taking an opinion on it per se; rather, I am just posting an observation. The main forces immediately that will lose from this are the medical schools. But right now, they are riding the wave of applicants. Eventually people will turn away from the rising tsunami of high educational costs, b/c the financial costs to pursue medicine are becoming quite prohibitive. This will leave the door for midlevel flooding wide open IMHO. Again, I favor physicians in this; but I am not fundamentally against MLs. I just don't think they should take such strong possession of the field, but that's the coming economic reality.
 
jl lin said:
And then enrollment drops, but the role of the midlevel expands, which is something a number of forces and gov't and HC want in order to help "control costs." In general, certain economic forces would have providers' salaries stay stagnant or go down, not up.

See Exhibit 2:

http://www.commonwealthfund.org/pub...015/jun/primary-care-providers-first-year-aca

Sure, not the original question, but I offer this in reply to @ 68PGunner's reply.

Also, I'm not taking an opinion on it per se; rather, I am just posting an observation. The main forces immediately that will lose from this are the medical schools. But right now, they are riding the wave of applicants. Eventually people will turn away from the rising tsunami of high educational costs, b/c the financial costs to pursue medicine are becoming quite prohibitive. This will leave the door for midlevel flooding wide open IMHO. Again, I favor physicians in this; but I am not fundamentally against MLs. I just don't think they should take such strong possession of the field, but that's the coming economic reality.
Click to expand...

Sure let the mid level role expands. It will hit a brick wall once patient safety is compromised resulting in high cost lawsuits against the mid levels and the hospitals. Seeing the quality of care by mid-levels and real physician, I'm not worried about the doom scenario against physicians.
 
Just like clinical cases, each applicant has his or her unique circumstances and perspectives so it really depends on context.

I personally don't think it's worth it for me. One of my college friends got her MD last year but didn't match and that amounts to financial suicide.



Aubrey Graham said:
Is it possible/worth it to pay off 350k in debt after medical school?
Click to expand...
 
68PGunner said:
Sure let the mid level role expands. It will hit a brick wall once patient safety is compromised resulting in high cost lawsuits against the mid levels and the hospitals. Seeing the quality of care by mid-levels and real physician, I'm not worried about the doom scenario against physicians.
Click to expand...


I am not fundamentally against what you are saying. I have family and certain people that are too complex to, in general, to be regularly seen by a ML. Still, overall, we are not yet seeing the dipping quality of care from MLs--quantitatively at least--not statistically significant differences. We have certainly seen that is true in the stats w/ CRNAs--but I feel it's imperative to remember they are mostly supervised by BC anesthesiologists. Also, I say this, having met a few CRNAs that shouldn't be any kind of nurses, period--much less function in a ML role.

But I think there's is the model at which many HC groups are looking; i.e., anesthesiologist managing CRNAs and other kinds of physicians managing NPs and PAs, and that's what is in place now. It just isn't QUITE as widespread--and, again, those advanced practice nurses and PAs are overseen by physicians. The physicians, at least hopefully, fill in the knowledge and experience gaps in order to more fully protect the patients.

The fear is where there is limited physicians, and so NPs and such argue for independent practice in order to get the job done. This is what is being used to push for more independent, ML practice. Apparently, however, the bulk of APNs and such aren't flocking to these areas, and that part of their argument falls to the ground stone dead. But even NPs and PAs have been used as fillers in the hospitals for years. I can only see this as increasing. One way or another, NP & PA numbers will increase as a means of controlling costs, and the incredible and prohibitive costs of medical education--debt, and loss of opportunity costs--will only further this along.
 
If debt is your only concern then I highly suggest that you move to Texas, work a year to gain residency and/or clinical experience then apply as Texas in state. TCOM cost was barely over 13k last year, and even Baylor tuition & fees are no more than 16k a year I think. Plus, all Texas public schools must accept at least 90% Texas residents, even BCM has to accept at least 75% for state grants per state law.

As for OOSers, all Texas schools cost no more than 31-32k per year.
 
I can attest to that as a practicing pharmacist. Generally speaking the prescriptions or medication orders written by NP's have the most problems and are the most questionable; whereas for physicians the main problem is illegible handwriting.

Not to offend any physicians in training but I'd lump residents together with the NP's, as far as my job as a pharmacist is concerned.


68PGunner said:
Sure let the mid level role expands. It will hit a brick wall once patient safety is compromised resulting in high cost lawsuits against the mid levels and the hospitals. Seeing the quality of care by mid-levels and real physician, I'm not worried about the doom scenario against physicians.
Click to expand...
 
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Dohnut said:
If debt is your only concern then I highly suggest that you move to Texas, work a year to gain residency and/or clinical experience then apply as Texas in state. TCOM cost was barely over 13k last year, and even Baylor tuition & fees are no more than 16k a year I think. Plus, all Texas public schools must accept at least 90% Texas residents, even BCM has to accept at least 75% for state grants per state law.

As for OOSers, all Texas schools cost no more than 31-32k per year.
Click to expand...

That's some Texas love and sweetness!

But if you are already coming out of state, you have to remember setting up a place to live and such--and this will add to your expense of schooling. I realize many would be moving anyway. It depends upon how many schools are w/i commuting distance of where one currently lives and how eligible of candidate one is for them. At any rate, depending on the nitty-gritty specifics, coming out of state could still put you at costs of $50,000/ year.
 
Dohnut said:
I can attest to that as a practicing pharmacist. Generally speaking the prescriptions or medication orders written by NP's have the most problems and are the most questionable; whereas for physicians the main problem is illegible handwriting.

Not to offend any physicians in training but I'd lump residents together with the NP's.
Click to expand...

Many of the scripts are produced by computers now. Reading docs' notes and scripts years ago was too often tortuously time-consuming--and often enough entailed passing the chart around asking other nurses or whomever if they could make out this word or that word. As you get more experience, familiarity with stuff and the context clues just come to you, but sometimes it was still a PITA. My position always was this: It doesn't have to be pretty. We just have to be able to clearly understand it. (Sometimes I wanted to ask some people if they took it home for their own mother's to read, would they be able to make it out?)
 
post: 17028522 said:
Many of the scripts are produced by computers now. Reading docs' notes and scripts years ago was too often tortuously time-consuming--and often enough entailed passing the chart around asking other nurses or whomever if they could make out this word or that word. As you get more experience, familiarity with stuff and the context clues just come to you, but sometimes it was still a PITA. My position always was this: It doesn't have to be pretty. We just have to be able to clearly understand it. (Sometimes I wanted to ask some people if they took it home for their own mother's to read, would they be able to make it out?)
Click to expand...


Some oldschool physicians still do it, well, the oldschool way. Also, vast majority of prescriptions for schedule II controlled substances still have to be handwritten, at least in Texas.

Also a pen and a piece of paper are a lot cheaper than setting up an eRx program; and sometimes even those programs mess up, such as missing e-signatures or Sig for tapering down prednisone is too long to fit. Mostly technical problems here.
 
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THE major problem with electronic prescriptions, imho, is therapeutic duplication aif sent more than once to more than one pharmacy (not to mention that's technically illegal). And also revising the eRx after the previous erroneous one sent out earlier was already picked up by the pt.

I'd rather take the handwritten ones that do no harm than putting a pt on multiples of the same drug b/c of the duplication problem caused by the proliferation of electronics.


jl lin said:
Many of the scripts are produced by computers now. Reading docs' notes and scripts years ago was too often tortuously time-consuming--and often enough entailed passing the chart around asking other nurses or whomever if they could make out this word or that word. As you get more experience, familiarity with stuff and the context clues just come to you, but sometimes it was still a PITA. My position always was this: It doesn't have to be pretty. We just have to be able to clearly understand it. (Sometimes I wanted to ask some people if they took it home for their own mother's to read, would they be able to make it out?)
Click to expand...
 
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Giovanotto said:
If the calculations here are correct, and I suspect they are close to the mark, this thread should be garnering much more attention. How is it possible to be paying 4.5-6,000/month on a loan with a PCP salary? That's nearly impossible, good lord.
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Nope. That's why my personal PCP is against me applying to med school on financial grounds.
 
jl lin said:
I am not fundamentally against what you are saying. I have family and certain people that are too complex to, in general, to be regularly seen by a ML. Still, overall, we are not yet seeing the dipping quality of care from MLs--quantitatively at least--not statistically significant differences. We have certainly seen that is true in the stats w/ CRNAs--but I feel it's imperative to remember they are mostly supervised by BC anesthesiologists. Also, I say this, having met a few CRNAs that shouldn't be any kind of nurses, period--much less function in a ML role.

But I think there's is the model at which many HC groups are looking; i.e., anesthesiologist managing CRNAs and other kinds of physicians managing NPs and PAs, and that's what is in place now. It just isn't QUITE as widespread--and, again, those advanced practice nurses and PAs are overseen by physicians. The physicians, at least hopefully, fill in the knowledge and experience gaps in order to more fully protect the patients.

The fear is where there is limited physicians, and so NPs and such argue for independent practice in order to get the job done. This is what is being used to push for more independent, ML practice. Apparently, however, the bulk of APNs and such aren't flocking to these areas, and that part of their argument falls to the ground stone dead. But even NPs and PAs have been used as fillers in the hospitals for years. I can only see this as increasing. One way or another, NP & PA numbers will increase as a means of controlling costs, and the incredible and prohibitive costs of medical education--debt, and loss of opportunity costs--will only further this along.
Click to expand...

Yeah, I understand the current model. This is what's going to be when it comes to the anesthesia field. The board certified anesthesia MD/DO will either get a huge increase in pay due to bigger responsibility for more possible malpractice from supervised mid-levels, or nobody is going to go to anesthesia. When it comes to the supply of docs in certain fields, there is always a 7-10 years lag due to the training obligations. However, I personally believe that many current changes are already made by current med students which will make today fields with huge gluts into tomorrow fields with huge shortages.
 
jl lin said:
I am not fundamentally against what you are saying. I have family and certain people that are too complex to, in general, to be regularly seen by a ML. Still, overall, we are not yet seeing the dipping quality of care from MLs--quantitatively at least--not statistically significant differences. We have certainly seen that is true in the stats w/ CRNAs--but I feel it's imperative to remember they are mostly supervised by BC anesthesiologists. Also, I say this, having met a few CRNAs that shouldn't be any kind of nurses, period--much less function in a ML role.

But I think there's is the model at which many HC groups are looking; i.e., anesthesiologist managing CRNAs and other kinds of physicians managing NPs and PAs, and that's what is in place now. It just isn't QUITE as widespread--and, again, those advanced practice nurses and PAs are overseen by physicians. The physicians, at least hopefully, fill in the knowledge and experience gaps in order to more fully protect the patients.

The fear is where there is limited physicians, and so NPs and such argue for independent practice in order to get the job done. This is what is being used to push for more independent, ML practice. Apparently, however, the bulk of APNs and such aren't flocking to these areas, and that part of their argument falls to the ground stone dead. But even NPs and PAs have been used as fillers in the hospitals for years. I can only see this as increasing. One way or another, NP & PA numbers will increase as a means of controlling costs, and the incredible and prohibitive costs of medical education--debt, and loss of opportunity costs--will only further this along.
Click to expand...

BTW, you're not seeing a dip in quality of care bc it's still a fairly new trend with insufficient data. However, having worked and received care from both physicians and mid-levels, I know that there's a difference in quality of care. I won't get into the specifics here, but my care was severely compromised when I was seen by a mid-level. I personally don't consider myself to be a fairly complex case at all. I'm a young healthy American who has instances of back pain due to my work environment.
 
Dohnut said:
Nope. That's why my personal PCP is against me applying to med school on financial grounds.
Click to expand...
It's crazy how if we turn those yearly values from 80K to 65K (as is possible with some schools) then the total cost owned after a 3-year residency (assuming you don't pay a penny back till after residency, and at 7%) is 378,000K.

Big difference versus 464,000. That compounding interest is a killer.
 
Don't forget to visit Redneck Haven while you're in Texas!
 
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