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EM Jobs and Loan Repayment...

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Chris Knight

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I'm becoming increasingly certain that EM is where I'll end up, so I'm wondering if some of you can give me a little insight into what the outlook is for paying off my education debt as an EP or more specifically the prospect of having my employer consume portions of my debt. I know it happens a lot, but How difficult is it to find a position at a hospital that will pay off some of your debt? How much do debt do they commonly take on?

This is incredibly interested as my debt is sky high. 30k undergrad, 220k med school, 35k for the MPH.... thats 285k straight up without the interest thats already being added as we speak. :barf:
 

southerndoc

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It's hard to find a hospital that will pay off loans for an emergency physician. Usually loan repayments are a combination of a community and a hospital paying off loans to help offset the cost of starting up a new practice (they also guarantee first-year income as well).

However, with salaries in the $180-250,000 range not being unusual, it is likely you can find a job that will allow you to live comfortably while repaying your loans.
 

Baditude

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I have you beat for loans.....I am a M3 and I currently am at 335K including undergrad and MBA which I am currently working on.
 

met19

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How on earth do people rack up school loans to those kind of figures!!!!!!!!

I am VERY fortunate in having a side job/hobby that has allowed me to keep loans to a minimum, but even without that or my buddies that were in school with me still are only at 100-120K from just med school loans... a few may have another 10-20K of undergrad on top of that.


I guess its the people that think they have to go to private schools only to get a so-called 'better' education. My undergrad was around $1200 bucks per semester.

Not all of us are lucky to have someone to help with the loans. E.g. my state school was 10-11k/yr. I spent 5 years there. Didn't get into med school right away...went to grad school in DC: another 50k. Then to med school.
 

EM_Rebuilder

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Not all of us are lucky to have someone to help with the loans. E.g. my statd school was 10-11k/yr. I spent 5 years there. Didn't get into med school right away...went to grad school in DC: another 50k. Then to med school.

Wow, state schools with 10-11K/yr tuition!... I guess Texas is really a better place for more than one reason...
 

met19

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Wow, state schools with 10-11K/yr tuition!... I guess Texas is really a better place for more than one reason...

Yeah tell me about. Not much is cheap in NY. NY state just taxes to death their residents.... hopefully will be Fl bound after residency...
 

kalico

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I guess its the people that think they have to go to private schools only to get a so-called 'better' education. My undergrad was around $1200 bucks per semester.

Not everyone can get into state schools, some are really tough to get into... not all geographic areas have a state school close by (or dorms for people who have to move away from home)... Not all state schools have every major (not all pre-meds are bio majors)... Sometimes financial situations (or parents' situations) change while you are a student, and so on... all I'm saying is, please don't be judgmental.

And with respect to medical school -- I'm sure I speak for many of us here when I say that as bad as I wanted to become a physician, I wasn't gonna walk away from my med school acceptances just because they were private.

FYI: I still haven't heard from my state medical school admissions office (not a rejection nor acceptance) and it's been 6 years...
 

EctopicFetus

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One of the guys from my program signed a contract with a group. The hospital then came in to help him seal the deal.. They offered a "bonus" of paying half hsi student loans. He owed over 200K. So his bonus was 100K+, then throw in the fact he decided to split it 60/40, loan payment vs cash and he got a very very nice signing bonus to join a very very nice group.
 

EM_Rebuilder

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Not everyone can get into state schools, some are really tough to get into... not all geographic areas have a state school close by (or dorms for people who have to move away from home)... Not all state schools have every major (not all pre-meds are bio majors)... Sometimes financial situations (or parents' situations) change while you are a student, and so on... all I'm saying is, please don't be judgmental.

And with respect to medical school -- I'm sure I speak for many of us here when I say that as bad as I wanted to become a physician, I wasn't gonna walk away from my med school acceptances just because they were private.

FYI: I still haven't heard from my state medical school admissions office (not a rejection nor acceptance) and it's been 6 years...


Good points....I have skewed takes on the matter since Texas is public school laden.
 

Baditude

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I have 50k in undergrad loans after my grants and scholarships. Michigan's state school are expensive, but I had to go private which cost a lot more because all the state school are on the other side of the state. I had to go local because I have a husband and 2 kids to be home for each evening. My MBA courses are 7k a semester and then you add med school at 27K a semester and it adds up very fast.
 

EdEmEr

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Yeah tell me about. Not much is cheap in NY. NY state just taxes to death their residents.... hopefully will be Fl bound after residency...

Slightly off topic but could you give those of us who are contemplating a move to NY what the resident salary boils down to after city and state takes are taken out.
 

Chris Knight

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One of the guys from my program signed a contract with a group. The hospital then came in to help him seal the deal.. They offered a "bonus" of paying half hsi student loans. He owed over 200K. So his bonus was 100K+, then throw in the fact he decided to split it 60/40, loan payment vs cash and he got a very very nice signing bonus to join a very very nice group.

I've heard similar stories. How common is this? I'd guess its certainly not the norm, but what sets these people apart? top residency? connections? luck? Terrible locations?
 

SoCuteMD

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How on earth do people rack up school loans to those kind of figures!!!!!!!!

I am VERY fortunate in having a side job/hobby that has allowed me to keep loans to a minimum, but even without that or my buddies that were in school with me still are only at 100-120K from just med school loans... a few may have another 10-20K of undergrad on top of that.


I guess its the people that think they have to go to private schools only to get a so-called 'better' education. My undergrad was around $1200 bucks per semester.

Wow, way to make a snap judgment. My home state has 100 spots PER YEAR for medical school. Other than that, you've got to go out of state or private. This year will cost me 70K total. I guess that's just the way the chips fall.
 

EM_Rebuilder

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Wow, way to make a snap judgment. My home state has 100 spots PER YEAR for medical school. Other than that, you've got to go out of state or private. This year will cost me 70K total. I guess that's just the way the chips fall.


Certainly was poor judgement made on my part due to my ignorance. I have mentored to many undergrad students and often would talk to freshman at a public college for 'just the basics' then they would be going to such and such private college because 'they would have a better shot at getting into medical school' which I think is completely a false statement....but try to convince them otherwise.

Obviously, there are evidently times out there in the rest of the world where private is the only option, and I would strongly agree, that is mucho better than nothing...
 

Mutt22

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I got a $10,000 dollar signing bonus from thr ER group, as well as a $40,000 loan repayment that the hospital tagged on to the ER group's offer. There are strings attached to the $40,000. I am basically an indentured servent for the next 4 years, and if I leave early, I will have to pay back those loans. If I die, my life insurance policy has to pay off the remaining loan (It is considered a loan from the hospital to me, to pay off my loan...I hope that makes sense). It is not the greatest location for your average poster on SDN, but it felt good to me and I think will suit me for what I want in my life. My department Chair said an interesting thing, "the more of a bonus that a group is willing to pay you, the worse the job, and the more desparate they are." Money doesn't grow on trees... that money comes from somewhere. Your wage ultimately comes from your RVUs. In general, I think it might be said, that the more of a bonus you get, the less the hourly wage will be. Wouldn't it have been just as good for me to have a higher hourly wage over the next 5 years? The trick is, that now, between a buy-in period, and the loan repayment deal, I am obligated to tough it out for 4 years. It is a sneaky way to keep people around jobs that tend to have high turnover.
 

docB

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I got a $10,000 dollar signing bonus from thr ER group, as well as a $40,000 loan repayment that the hospital tagged on to the ER group's offer. There are strings attached to the $40,000. I am basically an indentured servent for the next 4 years, and if I leave early, I will have to pay back those loans. If I die, my life insurance policy has to pay off the remaining loan (It is considered a loan from the hospital to me, to pay off my loan...I hope that makes sense). It is not the greatest location for your average poster on SDN, but it felt good to me and I think will suit me for what I want in my life. My department Chair said an interesting thing, "the more of a bonus that a group is willing to pay you, the worse the job, and the more desparate they are." Money doesn't grow on trees... that money comes from somewhere. Your wage ultimately comes from your RVUs. In general, I think it might be said, that the more of a bonus you get, the less the hourly wage will be. Wouldn't it have been just as good for me to have a higher hourly wage over the next 5 years? The trick is, that now, between a buy-in period, and the loan repayment deal, I am obligated to tough it out for 4 years. It is a sneaky way to keep people around jobs that tend to have high turnover.
These are excellent points. Great money sometimes means crappy working conditions. Big money at sign on with strings attached may be being used to mask the stink you would otherwise smell.

Remember the part about all money in EM coming from your RVUs because that's very true. There's a pot of money that is filled by your work and the work of your group. You can divide that pot up anyway you like, straight fee for service, straight hourly, high hourly low bonuses, low hourly high bonuses, etc. The size of that pot is dependent on your volume, payor mix and efficiency/charting.
 

met19

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Slightly off topic but could you give those of us who are contemplating a move to NY what the resident salary boils down to after city and state takes are taken out.

couldnt tell you since im a pgy-1...but they take out enough to fund a small thrid world country. Do I have enough to live on. Yes. Have fun- check. Would my dollars go further in the south or midwest or any place other than NYC, boston, chicago, SF, LA- most definitely.
 

southerndoc

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couldnt tell you since im a pgy-1...but they take out enough to fund a small thrid world country. Do I have enough to live on. Yes. Have fun- check. Would my dollars go further in the south or midwest or any place other than NYC, boston, chicago, SF, LA- most definitely.
www.paycheckcity.com

You can calculate your take home pay there.
 

roja

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Slightly off topic but could you give those of us who are contemplating a move to NY what the resident salary boils down to after city and state takes are taken out.



Depends on a anumber of things. How tax savvy are you? (ie do you own property?)

How much are you goign to be paying for rent?

Our residents, in general 'take home' about 1K. but that is after thier rent is taken out of thier paychecks, I think.

Certainly livable.
 

edinOH

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I was offered $60k loan repayment by a hospital in a town of about 30k people. This was about an hour outside a major city.

The job I took with a multihospital independant group offers a standard $10k signing bonus.
 

docB

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Another word of caution about signing bonuses. Many groups that pay strictly fee for service give a signing bonus because you won't get paid until the collections from your billing start coming in, usually 90 days or so. In those groups it usually takes at least 6 months before your monthly income stabilizes. The flip side is that you will keep getting money for several months after you leave a group like that. But bear in mind that in a straight fee for service group the signing bonus may be all you get for your first few months.
 

southerndoc

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Another word of caution about signing bonuses. Many groups that pay strictly fee for service give a signing bonus because you won't get paid until the collections from your billing start coming in, usually 90 days or so. In those groups it usually takes at least 6 months before your monthly income stabilizes. The flip side is that you will keep getting money for several months after you leave a group like that. But bear in mind that in a straight fee for service group the signing bonus may be all you get for your first few months.
Some don't offer a signing bonus, but instead offer an interest-free advance that must be repaid over a period of six months to a year.
 
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