I'm in the same shoes without the spouse. I recommend that you find anecdotal mentorship among older practicing docs who have done aid work. I understand the urge to figure out the logistics for multiple year aid commitments now, but I do think you're jumping the gun. Have you and your spouse done any voluntourism/mission trips, like ISL or Unite for Sight or whatnot? That would be an excellent first step. But in general, if you and your spouse want to do overseas aid work long term, assume you'll have opportunities, and the specifics as you understand them now aren't likely to be all that relevant in 8 years.
1. I've heard and read that they will NOT let a spouse come on assignment, what do people who are married do if a person wants to work for multiple years with these organizations?
MSF is one of maybe 500 orgs that put US docs to work, so just keep looking. Look at Mercy Ships, PIH, CFHI, etc. Understaffed hospitals do recruiting all over the world, and these are better set up to support families. Ask US docs where they go, ask who they know who goes. By the time you're ready to commit to a multiple year gig, you'll have met plenty of people who do aid gigs.
2. How does it work financially? I've read they pay about 1400 or so a month and they will pay your interest on your loans, I've also read that it is unlikely that their letter to your student lender asking for forbearance is ineffective. Is it possible to have enough money to survive if you have 170k in student loans? Can you at least stay afloat and pay some of the loan (I guess that would eat up the 1400 a month salary)
I think it's asking too much for an aid org to keep you and your wife solvent for years while you still have loans. $170k in student loans grows to $250k pretty quickly during school and residency, and no, I don't think you can stay afloat on a subsistence wage. Maybe for a six month gig, but not for years. Personally I expect to do short term aid gigs until I'm free and clear, and then I can look into long term work. I'm finding folks who do a "research year" overseas between residency and practice, and funding for this can be found. (And the paper that comes out of it is always a variation on a MacGyver / "wow it sucks here" theme.)
3. Does it help to have a specialty like emergency medicine? They all say you need experience in the field, so does that just mean your residency of 3 years is your in field experience?
Field experience means you've done low-resource medicine, where there's maybe no running water, generators provide the electricity, there are limited labs and imaging, no internet, etc. And it means you've experienced working in a country where you don't speak the language, not just with patients but with the other health workers. You'll have a bazillion opportunities to go get exposed to this, during med school and during residency - do a student trip to Guatemala, and/or do a 4th year rotation in Tanzania, for examples. And bring your spouse on these trips if possible.
As for specialty, EM is as good as anything, but if you're choosing EM so that you can do aid work, step back from that a bit and wait for more to be revealed. In aid work you're generally going to see that the average patient is WAY more sick than people get in the industrialized world, and how that translates to medical care varies a great deal. If you want to have an international focus in your career, then wait to see what happens to you during rotations in the US and on short aid trips or international rotations. You might find that you want to do anesthesia because it's the least depressing. You might find that you want to do ob/gyn because the impact is so dramatic. You might find that the greatest need is actually fundraising, and doing FM with a non-profit-MBA is where you'll thrive.
Other items where you'll want to gather perspective:
1. Language. If there's a particular part of the world where you know for sure you want to work, such as Mexico or Rwanda, then start working towards fluency in Spanish or French now. (Learning a local dialect will need to wait until you're there.)
2. Coming back. Find out if you'll be in a pickle to find a job after being away for a while. For example, you wouldn't be in a position to work in an academic capacity if you missed the last 3 years of developments (and weren't involved in them).
Best of luck to you.
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