Considering debt load when choosing a speciality

[Chemdude]

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I'm going to be graduating with a lot of debt: close to $300K (private loans). I'm considering surgical sub-specialities, but the added debt that will come with a 6-year residency is making me reconsider. If I decide to go into IM, I can reduce my debt by ~ $200K. Would it be a financially sound idea to sacrifice my interest in surgery for a decreased debt load?

 

[secants]

I keep hearing about doing the IBR+PSLF combo, which works out if your residency is on the longer end and you also elect to do a fellowship. You pay a % based on income and if all 10 years are done at a 501ac(aka nonprofit hospital), the remainder is forgiven. I think the major problem is if this will still be around/exclude docs completely.

 

[Chemdude]

I keep hearing about doing the IBR+PSLF combo, which works out if your residency is on the longer end and you also elect to do a fellowship. You pay a % based on income and if all 10 years are done at a 501ac(aka nonprofit hospital), the remainder is forgiven. I think the major problem is if this will still be around/exclude docs completely.

The problem is that I have private loans. I'm not sure if IBR+PSLF covers private loans.

 

[DrMidlife]

The problem is that I have private loans. I'm not sure if IBR+PSLF covers private loans.

No, federal repayment programs such as IBR/ICR/PSLF don't cover private loans. Private lenders have no obligation to be helpful.

Two things:

1. Now would be a good time to find out your options for deferment and/or forbearance during residency, for each of these loans. Student lenders are required to provide a residency forbearance, but this option has side effects in interest capitalization. But private lenders aren't required to offer any better options.

2. I suggest you should start spreadsheeting out the amortization and capitalization schedule for each of these loans, so that you can figure out the monthly payments. Assume each loan has different rules until proven otherwise. Even if all of your loans are with, say, Sallie Mae, each loan may have different rules. It's a fairly major project to find out what the financial terms are, and you may even have to struggle to find (online) the paperwork you signed before you got the loans. If your loans have adjustable rates, that's a magnitude more complicated, but you can run numbers for a high and low rate estimate. Point being, once you understand the range of possible monthly payments, you can then think about what salary you are going to need. Assume that it will take 20+ hours to get all this in order.

Best of luck to you.

 

[netminder]

Would it be a financially sound idea to sacrifice my interest in surgery for a decreased debt load?

It might be a financially sound idea;
only you can answer that. But if you truly love surgery and you ditch it
for financial reasons, what if you're miserable when you wake up every day? It's not worth it, bro.

 

[tco]

I'm going to be graduating with a lot of debt: close to $300K (private loans). I'm considering surgical sub-specialities, but the added debt that will come with a 6-year residency is making me reconsider. If I decide to go into IM, I can reduce my debt by ~ $200K. Would it be a financially sound idea to sacrifice my interest in surgery for a decreased debt load?

I don't think that would be a wise idea, unless surgery is choice 1A and something else that is shorter or less intense is 1B (are you stopping with IM or thinking fellowship?). I've never seen a surgeon starve to death or not be able to pay his bills...As long as they were reasonable.

 

[ArcGurren]

If you enjoy both surgical subspecialty AND internal medicine and are thinking of choosing based on this issue, then it's a perfectly valid choice.

If you only like the subspecialty and hate/dislike medicine, it is not a good idea. I'm applying for IM and I can guarantee if I had to do surgery or psych or neuro instead, I would be miserable. Do what you like and you'll be a happier person, whether or not it takes a little longer to pay off your loans. And quite honestly, in IM, unless you become a hospitalist/generalist, with fellowships added in it will still take something like 5-8 years anyway (and in some fellowships, sub-fellowships are almost a necessity, such as in cardiology).

 

[notbobtrustme]

If you are truly interested in surgery, then you would be losing money by not pursuing that career choice. Surgeons, on average, earn 25-50% more than internists and that difference only grows if you choose to subspecialize. This can translate to millions of dollars of potential income over the course of your career and you'd sacrifice these earnings on 200k. You should be thinking of returns on investment, not the total debt load. You can have zero debt and earn 80k/year or you can have 250k in debt and earn 250k/year; which person do you think will come out ahead?

 

[NotAsking4Much]

If you are truly interested in surgery, then you would be losing money by not pursuing that career choice. Surgeons, on average, earn 25-50% more than internists and that difference only grows if you choose to subspecialize. This can translate to millions of dollars of potential income over the course of your career and you'd sacrifice these earnings on 200k. You should be thinking of returns on investment, not the total debt load. You can have zero debt and earn 80k/year or you can have 250k in debt and earn 250k/year; which person do you think will come out ahead?

80k? That's a bit low. That's worse than most PAs. Of note, some medicine specialties pay as good if not better than surgery specialties (notable interv cards + GI).

 

[45408]

80k? That's a bit low. That's worse than most PAs. Of note, some medicine specialties pay as good if not better than surgery specialties (notable interv cards + GI).

Yes, but their residency+fellowship takes just as long or longer than a surgeon's, which was the whole point.

 

[ArcGurren]

Yes, but their residency+fellowship takes just as long or longer than a surgeon's, which was the whole point.

And used misleading numbers. 80k is closer to a general pediatrician salary, internists typically make upwards of 150k with many hospitalist gigs making upwards of 200k. If he's gonna use numbers to make his point they might as well not be total BS.

 

[badasshairday]

And used misleading numbers. 80k is closer to a general pediatrician salary, internists typically make upwards of 150k with many hospitalist gigs making upwards of 200k. If he's gonna use numbers to make his point they might as well not be total BS.

lol, absolutely. 80K is very low even for general peds. Hospitalists in the community setting routeinly make >200K.

 

[notbobtrustme]

80k? That's a bit low. That's worse than most PAs. Of note, some medicine specialties pay as good if not better than surgery specialties (notable interv cards + GI).

I wasn't thinking of any career in particular and certainly nothing medically related; I was just pointing out the folly of looking solely at debt accumulated without respect to return on that debt in the form of higher salaries.

 

[tco]

And used misleading numbers. 80k is closer to a general pediatrician salary, internists typically make upwards of 150k with many hospitalist gigs making upwards of 200k. If he's gonna use numbers to make his point they might as well not be total BS.

ID typically makes around 150 and they're on the low end of internist salary.

 

[DreamingTheLive]

I'd do what you enjoy most. Unless you're clairvoyant, predicting physician reimbursement in the future seems like risky business. If Gen surg is 1a and IM 1b (lol, funny just typing that), then I suppose length of training becomes more of a factor.

 

[45408]

And used misleading numbers. 80k is closer to a general pediatrician salary, internists typically make upwards of 150k with many hospitalist gigs making upwards of 200k. If he's gonna use numbers to make his point they might as well not be total BS.

I don't think the $80K number was in reference to physicians at all, because he said "zero debt" as compared to med school debt.