Grad PLUS and decision to apply

[penn_pal]

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Hi,

Economics researcher here. I hope that some of you might be willing to give me some insights about the effect that the presence of grad PLUS had on their decision to apply or on their decision of which school to apply to.


Try to imagine yourself in world without grad PLUS, with annual Stafford borrowing limit of $38,500 and aggregate Stafford borrowing limit of $189,125 (i.e. let's travel back in time to the pre-2006 days). Would you have had to finance a large portion of your medical education with private loans? Would your choice of which school to apply to be affected? Coming from a low-income family, would you have delayed applying to med school by one year because your practice MCAT were not where they needed to be to get accepted into a top 20 school with generous need-based grants?

Any insight will be appreciated. Thanks

P.S. If some pre-2006 prospective applicants area are still around, insights on the opposite situation of how you might have done things differently in a world with grad PLUS are equally useful.

 

[DrMidlife]

Last I checked there are only a few schools with cost of attendance under the Stafford limit, and those schools have extremely heavy in-state preference.

There are only 3 ways to do med school in the US:
1. Your family pays for it or you get a scholarship
2. You get federal loans including Grad Plus
3. You go to Eastern Carolina or Texas

The effect of GradPlus is that most premeds don't even think about cost of attendance regardless of how much it is, and cost of attendance is only one of many factors for people who have multiple acceptances. If you're a Californian and you only get into EVMS, with the highest out of state cost of attendance in the US, you're not going to say no.

The decisions changed by GradPlus are at the schools, where average cost of attendance has tripled since 2006. They are doing this because they can and because they have to with state/fed funding cuts.

 

[peter2013]

Completely agree with DrMidlife.

Types and amount of loans have a far greater impact on the specialty decision making process.

 

[DrMidlife]

Types and amount of loans have a far greater impact on the specialty decision making process.

I personally think this is a story we tell ourselves without understanding what's to come and without understanding our debt loads or repayment options. On average people go after IM and then do fellowship, or similar in surgery, and after 10+ years of training they're at the $300k level. (And burned out, on the second marriage, etc.) This doesn't reconcile with a fear of not being able to pay off debt, when you postpone so much repayment. I think the stereotype of a $90k pediatrician, or a family med doc seeing 80 patients a day, means people think those jobs aren't worth going to med school, regardless of debt repayment scenarios. I think people are avoiding primary care because primary care sucks. (For the record, I'll probably do primary care.)

tl;dr: specialty choice is about suckage avoidance. the average med student has no clue about debt/income scenarios and is just assuming it'll work out somehow.

 

[penn_pal]

Last I checked there are only a few schools with cost of attendance under the Stafford limit, and those schools have extremely heavy in-state preference.

There are only 3 ways to do med school in the US:
1. Your family pays for it or you get a scholarship
2. You get federal loans including Grad Plus
3. You go to Eastern Carolina or Texas

The effect of GradPlus is that most premeds don't even think about cost of attendance regardless of how much it is, and cost of attendance is only one of many factors for people who have multiple acceptances. If you're a Californian and you only get into EVMS, with the highest out of state cost of attendance in the US, you're not going to say no.

The decisions changed by GradPlus are at the schools, where average cost of attendance has tripled since 2006. They are doing this because they can and because they have to with state/fed funding cuts.

I appreciate the response, I should clarify: when students make a decision about whether to apply and where to apply, they know their family's income and they care about cost of attendance, net of need-based grants.

If I am from a family that makes less than 100K/year, if I am accepted at Harvard, then cost of attendance will be the unit loan ($30,400), plus $2000 or so, so significantly under $38,500. Back in 2006, there were 10-20 other schools (Cornell, Yale, U Washington St Louis, John Hopkins,...) where COA, net of need-based grants, was less than $38,500 for those from low family incomes.

Is there anyone that can imagine themselves making things differently in a world without grad PLUS?
Choosing to go for in-state physician training rather than applying to 15 med schools all over the country?
For those from low-income families, delaying taking MCAT until practice score are where they need to be to get into med school with generous need-based grants?

 

[DrMidlife]

Honestly I think you're way overestimating the cost analysis that premeds and their families do. You said you're an economics researcher - you're an anomaly in wanting to think about it. Take a look in the pre-allo forum and you'll see that the questions are naive and the answers (when sane) are not comprehended.

Choosing to go for in-state physician training rather than applying to 15 med schools all over the country?

Frequently this isn't a choice. If you're in one of the few states that has adequate seats for its own, then it's fine to just target the home schools. But for the majority of students, only applying to home state public schools is pretty much asking to be a reapplicant. Of the 45,000+ students who apply nationally to MD schools each year, 20,000+ are rejected, and it's foolish to assume that those 20,000 weren't well prepared. And there are only 2 DO schools that are public. The LECOMs are wonderfully cost-sensitive, but you can't do them just with Staffords.

In California or New York, for instance, you have by far the most premeds and the lowest percentage of instate public seats per premed. Vermont is the extreme opposite, but that doesn't mean Vermonters get into UVM with low stats - UVM takes high-paying out of state students instead of low-stats locals. So if the goal is to be a doctor, and to avoid applying and reapplying, then targeting schools where there's no financial advantage is just what you do.

For those from low-income families, delaying taking MCAT until practice score are where they need to be to get into med school with generous need-based grants?

Where are you seeing these need-based grants? There are some states that have programs like these for undergrad, but generally with med school cost of attendance averaging $250k you're not going to see states that front more than a little bit of that load. If you're Harvard material then you have access to more free money than most, but the rest of us have to be rich or borrow federal loans.

But in general the best plan is to put together your strongest possible app (of which MCAT is just one part) before applying, to apply early and broadly, and to be extremely vigilant in pursuing your home state's public schools as a best choice. In general it's a dumb plan to be concerned about some gap years in the meantime.

You had me thinking you had some insights and were honing in on the real politico-economic phenomenon of GradPlus, but it seems your concerns are the usual premed type.

 

[peter2013]

I personally think this is a story we tell ourselves without understanding what's to come and without understanding our debt loads or repayment options. On average people go after IM and then do fellowship, or similar in surgery, and after 10+ years of training they're at the $300k level. (And burned out, on the second marriage, etc.) This doesn't reconcile with a fear of not being able to pay off debt, when you postpone so much repayment. I think the stereotype of a $90k pediatrician, or a family med doc seeing 80 patients a day, means people think those jobs aren't worth going to med school, regardless of debt repayment scenarios. I think people are avoiding primary care because primary care sucks. (For the record, I'll probably do primary care.)

tl;dr: specialty choice is about suckage avoidance. the average med student has no clue about debt/income scenarios and is just assuming it'll work out somehow.

I'm not sure with which med students you interact. Among my fourth year classmates, a large number didn't consider family medicine or pediatrics because they had >$200,000 in loans. I would be surprised if the students at my school were the only ones who are influenced by debt.

If you think primary care sucks, why on earth are you going into it?

 

[DrMidlife]

I'm not sure with which med students you interact. Among my fourth year classmates, a large number didn't consider family medicine or pediatrics because they had >$200,000 in loans. I would be surprised if the students at my school were the only ones who are influenced by debt.

As I said above: people are saying they can't do primary care because of debt. But choosing something other than primary care has little to no effect on debt management. Doubly so now that there are loan repayment and forgiveness programs (that may or may not exist 5 years from now).

Your M4 friends are saying what their M4 friends were saying, and this goes back to when average debt was "only" $100k. It's a longstanding tradition to cite debt instead of saying "I don't want to do primary care." OMG I have six figures of debt I have to be a urologist. OMG no you don't.

If you think primary care sucks, why on earth are you going into it?

Primary care sucks in the aggregate. It sucks if you don't have choices. It doesn't suck for every provider in every situation. Just like all the other specialties, there are good places to be and not so good. There are competitive FM/Peds/ObGyn residencies and not so good. There are good employers and not so good. Dirty little secret here: it's the same in every specialty.

If GradPlus wasn't an option, cost of attendance would still be under the Stafford limit. End of story.

 

[penn_pal]

Choosing to go for in-state physician training rather than applying to 15 med schools all over the country?

Sorry, the choice I was going after was between in-state physician assistant training and applying to med school. Could the absence of grad PLUS push the balance in the direction of going for physician assistant training rather than going to med school for some?

 

[penn_pal]

Types and amount of loans have a far greater impact on the specialty decision making process.

Thanks for the suggestion. Despite, DrMidlife's opinion, I think it is a reasonable way for some to respond to the huge debt they took.

 

[DrCharlemagne]

The problem with your premise is there are too many other variables without the applicant's control that take precedence ahead of COA, like straight-up admission, to really allow any of us but those who have multiple acceptances to even consider costs. Even peter2013's assertion that specialty decisions are affected by loan burden kind of blows past the rigors of matching and the variables which govern that process, variables that also take precedence ahead of debt burden. The availability of extra loans doesn't rank very high on the meat and potatoes factors that are considered when one applies to medical school or for a residency.

 

[sazerac]

I'm not sure with which med students you interact. Among my fourth year classmates, a large number didn't consider family medicine or pediatrics because they had >$200,000 in loans. I would be surprised if the students at my school were the only ones who are influenced by debt.

If you think primary care sucks, why on earth are you going into it?

I never understood this whole "I need an annual income larger than my total debt" justification. If that were really a valid argument, nobody would ever purchase a house either since mortgages are also generally larger than annual income.

If people don't want to do primary care, they should just admit they don't want to do primary care. There is no shame in that.