Advice needed: MD in bad location but good $$ VS expensive MD in great city

[WingedOx]

OP, spending your 20s in NYC + Mount Sinai is an amazing school

Spending your 30s in the city > Spending your 20s.

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[dermie1985]

These seem like odds choices to be choosing between (i.e. if you got into Mt. Sinai, which is a great school, why weren't you accepted at any in-state CA schools?). One thing to consider is that Mt. Sinai does have relatively low tuition compared to other private schools, they have subsidized housing (i.e. $600-700/month, which is absurd for NYC, so COL might not be too different), and clearly is the better of the 2 schools. It's an extra 84k in debt? (35-14=21*4 years=84). I'd just ask yourself if that's worth it or not to you. For primary care, I don't think options would be drastically different, though, keep in mind, even primary care field residencies in CA can be competitive just because of location. Mt. Sinai's name will go much further in your career that San Antonio.

 

[Cyberdyne 101]

This might be like comparing the Knicks to the Spurs. The Knicks are the most valuable franchise in the NBA, but in terms of basketball, they're mediocre at best. On the other hand, the Spurs have managed to sustain a winning formula for about a decade and a half without the fanfare.

I'm not calling Sinai mediocre, it's an awesome school. But for someone who isn't interested in research, its prestige and location probably isn't worth the $$- kinda like Amare Stoudemire's contract...

 

[ThoracicGuy]

Just looking at match lists from San Antonio:

2015: 10 of 214 matched to California spots; 106 stayed in Texas (non-military)
2013: 10 of 200 matched to California; 98 stayed in Texas (nonmil)

I can't find any equivalent from Mt. Sinai.

So going to San Antonio won't kill a dream of applying to California programs. Though I would caution you that when it comes to match time that you don't limit yourself geographically for match or that's introducing a chance for disaster for you to not match. You can always look for a job in California when you are finished if you still want that. Also, there's a chance that you go to residency in California and then can't find a job doing what you want and have to move to other states.

My recommendation? Go to Texas.

 

[Officer Farva]

Spending your 30s in the city > Spending your 20s.

Actually, I totally agree on that one. lol

 

[Med Ed]

Clever reply, but let's be serious.

Happy to.

Baseline assumptions: No additional scholarship money, COA will not increase year-over-year, loans will remain at 5.84%, OP will do six years of residency/fellowship and not make substantial loan payments during that time, chooses extended (25 year) repayment plan.

Based on COA numbers disseminated by the respective institutions, here are my rough calculations of the financial ramifications of attending each school:

UTHSCSA
Principal: $180,239
Balance at graduation: $206,477
Balance after six years GME: $269,627

Monthly payment on extended (25 year) repayment plan: $1,711
Interest paid: $243,652
Total: $513,279

Mt. Sinai
Principle: $287,768
Balance at graduation: $329,930
Balance after six years GME: $430,764

Monthly payment on extended (25 year) repayment plan: $2,733
Interest paid: $389,268
Total: $820,032

Gross earnings needed to repay each loan (assuming 25% effective tax rate):
UTHSCSA: $684,372
Mt. Sinai: $1,093,376

First of all, it's a difference of 150k, not 300k. For that money, you're going to see more of NY than you would on 5 trips there, and save the cost of going to NY later, So you have the benefit of saving perhaps 40k or more in travel,

It's 300K, or about $1,000 a month for 25 years to have the pleasure of living in NYC for 46 months. Don't get me wrong, I know that I will have more luck convincing a rock to do my taxes than convincing a hardcore New Yorker that life exists west of the Hudson, but this is a lot of money, especially if the OP wants to settle down and build a life in an expensive state.

 

[bc65]

It's 300K, or about $1,000 a month for 25 years to have the pleasure of living in NYC for 46 months. Don't get me wrong, I know that I will have more luck convincing a rock to do my taxes than convincing a hardcore New Yorker that life exists west of the Hudson, but this is a lot of money, especially if the OP wants to settle down and build a life in an expensive state.

Nah, no problem convincing me. I live in California now! It's heresy to admit this, but I don't miss it one bit any more, although I did for a long while. But it's still a great place to be a medical student for 4 years.

I agree that 150k is a significant amount of money, and your numbers are accurate so far as they go. However, OP will probably be able to pay off his loans in 5 years or less if he tries. If not, with PAYE and REPAYE, the effective interest rate on loans is about 2-3% or less, and that's not counting the fact that inflation will decrease the value of the future payments.

I may be repeating myself, but at Mt. Sinai, you're getting a top school, with a recognizable name, and a wonderful place to live. I would gladly pay 150k extra, plus interest, for that experience.

I lived and worked in Manhattan, and now I live in Silicon Valley. ( Neither place was part of a plan, but it just worked out that way ) I have paid a lot, and continue to pay a lot, for the privilege of living in two of the nicest places in the world, and despite that, I managed to become very comfortable financially. The extra expense was money was well spent, as far as I'm concerned, and I have no plans on moving, despite the fact that I pay a lot in state taxes for the privilege. Obviously, reasonable people can differ as to the value of living in certain areas. I'm just passing on my experience and opinion, as are you.

 

[Med Ed]

But it's still a great place to be a medical student for 4 years.

I don't know, it really isn't the same since they cleaned it up. Thanks a lot, broken windows policing.

Just personal preference, but I would rather do residency/fellowship in NYC than medical school. Something about having protected time and a (meager) salary.

 

[bc65]

Just personal preference, but I would rather do residency/fellowship in NYC than medical school. Something about having protected time and a (meager) salary.

Maybe you're right. I did my residency in NY, but it was in surgery, before the 80 hour limit. Back then, I think the students had it easier. Maybe residency would be the better choice today. Of course, it doesn't have to be an either/or choice, and if someone wants to do a residency in NY, they'll be better off going to med school in NY.

But I agree, the extra tuition cost is definitely something to consider. I think it's worth the money, but then, I'm paying an extra $2,000-3,000 a month in taxes, maybe more, by living in California ( and more from my pension when I retire) . I may not be wise, but at least I'm consistent .