MD How feasible is going into pediatrics with 260k+ debt?

[NeedSomeAdviceGuy]

I still have no idea why people are willing to spend so much money living in crappy congested apartments just because of city life but maybe i just don't understand the city life well (that and the housing market boom)

Some people rather live in 500sq ft in the middle of a big city than a mansion in the outskirts, and others the opposite. Different strokes for different folks.

Personally I like being able to look out my window and seeing all sorts of different people, the bustling of a city, etc. To me that's better than some trees, and to others that's madness. I like hearing 80 different languages as I walk down the street, authentic food at every corner, etc. Others want a yard to care for, or just want to have some solitude. People be different.

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[401KTaxPro]

Hello! First time in the MD forums, I am a clueless M-0 so just hoping for some advice.

I will be attending a mid-tier OOS state school as a low SES student. I was a borderline top-tier applicant and missed the cut at any of the rich schools with good financial aid. So, 260k debt it is. But anyways-

Pediatrics was the seed for my interest in going into medicine. I have been passionate about working with kids since I was like 7, and in college 1/3 of my activities involved kids. Growing up with a family income ~50k and now much less, I thought the 150k salary for pediatrics would be more than enough. However, I also need to take care of my parents (they sacrificed everything to bring us to the states) financially while making sure I live the life I imagined, which is living in somewhere like NYC for at least a few years (maybe residency) and eventually having a family of my own (and be able to not worry about $$$ constantly). I've also considered doing a NICU fellowship (I volunteered there and loved it), but that's pretty far away.

Can I actually do all of this as a pediatrician and not be miserable? I've read about refinancing loans/PSLF but am unclear on what that means for primary care, and the WCI basically discouraged primary care specialties. I know many people change their minds on a specialty in med school, but I just want to have an idea of what I would potentially get myself into. It'd help to hear this from any recent grads/anyone in similar financial situations. Thanks!

You will make it work as long as your primary motivation is not money. If you are passionate about working and helping children, you can handle the debt payment. Just drive an older used car while you are paying off the debt. Have a mindset of abundance.

 

[ibnalkamil1990]

I always was told that you have to be careful with moonlighting. My school always gives the example of a rads intern moonlighting in the ER. It isn't a good idea for obvious reasons. Who's taking the liability? If you're working 80 hr/week, you're now going to take an extra 20? Dicey stuff.

Maybe that's the other beauty of living where I live (and where I want to match/practice). There is lots of internal moonlighting @ $75-$100/hr and in specialties like psych or rads it's easy to do 20 hrs a week (you might be babysitting a machine in rads for example). Programs bend over backward to provide benefits, meal allowance, free parking, generous vacation, flexible days off, etc.

 

[SleepingPillow]

Why limit yourself to Peds? There are pediatric-based subspecialties that will pay much more than any Peds subspecialty and you still won’t have to take care of adults long term. I’m trained in Peds, anesthesia and Peds anesthesia. I had thought about doing PICU vs Peds anesthesia but I clinically prefer Peds anesthesia. Peds anesthesia also pays ~ twice as much as PICU at any given institution.

I have many friends who did anesthesia after peds and know no one who did the opposite. If you want to take care of children and have the ability to make enough money to live comfortably with your amount of debt, don’t limit yourself to just think about peds and its subspecialties.

What about neonatology? That's the highest paying peds subspecialty I believe. But I see what you're saying with going into other specialties after peds (like peds-> EM).

Just searching around, ENT also deal with kids a bunch apparently? Just that it's really tough to match haha... Who knows, other than peds I was looking into rads, optho, anesthesia (kinda concerned with crnas tho). As another poster said, if I see myself doing anything other than peds I would. I think I will go with that mindset for now and really think about how much working with (only) kids matters vs everything else.

 

[SleepingPillow]

Also thanks to everyone for so many thoughtful responses from both sides. It was a pleasant surprise bc I was expecting like 1-2 responses

 

[ibnalkamil1990]

What about neonatology? That's the highest paying peds subspecialty I believe. But I see what you're saying with going into other specialties after peds (like peds-> EM).

Just searching around, ENT also deal with kids a bunch apparently? Just that it's really tough to match haha... Who knows, other than peds I was looking into rads, optho, anesthesia (kinda concerned with crnas tho). As another poster said, if I see myself doing anything other than peds I would. I think I will go with that mindset for now and really think about how much working with (only) kids matters vs everything else.

Peds is only 3 years whereas anything else + peds subspecialization will be 4-7 years. Meaning you'd lose out on 200-800k of income since you'll be earning 60-70k as a resident/fellow and in the end you won't be doing what you truly want (general peds)

 

[SleepingPillow]

I still have no idea why people are willing to spend so much money living in crappy congested apartments just because of city life but maybe i just don't understand the city life well (that and the housing market boom)

For me, it's bc I grew up in a rural town across the world and always saw NYC as THE city, ya know? It's almost definitely glamorized, but it's something I want to experience in my lifetime even if briefly

 

[SleepingPillow]

Peds is only 3 years whereas anything else + peds subspecialization will be 4-7 years. Meaning you'd lose out on 200-800k of income since you'll be earning 60-70k as a resident/fellow and in the end you won't be doing what you truly want (general peds)

I didn't say general peds is what I truly want, just want something that works primarily with kids, so I am open to other specialties.
Also, based on another SDN thread where they discussed this, neonatology would be one of the few subspecialties where it would make sense financially. It's certainly not for everyone though.

 

[Bobblehead]

However, I also need to take care of my parents (they sacrificed everything to bring us to the states) financially while making sure I live the life I imagined, which is living in somewhere like NYC for at least a few years (maybe residency) and eventually having a family of my own (and be able to not worry about $$$ constantly).

Just some forward looking thoughts, but this type of recurrent theme has come to haunt many people in your situation after they've become fully employed post training. The need to support extended family (i.e. your parents) will need to be closely balanced against your own family's (spouse/kids) needs while taking into account your financial situation at that time (salary, loan/debt service, monthly mandatory expenses such as housing) and your need to eventually not work (retirement savings). While it is an admirable sentiment you should keep your financial expectations fungible. The thing that gets many people into trouble is shifting their standard of living up as soon as their salary increases without realizing that expenses can very quickly outrun income because they've never seen that much money come in at the same time.

I'm not sure I would advise taking training salary into consideration when the time comes to select a training location unless you are specifically using that as a consideration to support your spouse/kids.

Additionally, forward looking, you may not even be doing pediatrics by the time it comes time to decide on a residency match. Keeping an open mind as you enter your clinical years is important to your eventual mental well-being and job satisfaction.

tl;dr If you live like you're making 50k when you're an attending in whatever field you'll be just fine.

 

[Osteosaur]

This is really dependent on location and salaries in NYC are usually low. In most cases it's hard to find data, but salaries for state employees are public record. I checked the salaries for a few random pediatricians at SUNY Downstate Medical Center and they were all around $150K. I don't know if that particular medical center is representative of all of NYC.

Are you sure the $150k is not on top of a salary for some academic or administrative position? That's insane otherwise.

 

[snooper]

If you work for 10 years (which includes your residency) in a non profit environment, i.e. most hospitals, and repay 100/month, the rest of your loan is forgiven.

 

[oldman]

I guess I'll ask this too just to have more info, are there other non-peds specialties that do significant work with kids?

If you like doing things with your hands consideration for pediatric surgery. This is a highly compensated field, but very difficult to get into. Start with general surgery residency and then pediatric surgery fellowship. Most do research so you're looking at 5 years residency plus probably at least 2 years research and then 2 years of fellowship.

 

[oldman]

If you work for 10 years (which includes your residency) in a non profit environment, i.e. most hospitals, and repay 100/month, the rest of your loan is forgiven.

I think there's been some challenge with getting the loans forgiven. My spouse has given up on achieving that and just paying it off. This may change with the current administration, but if they only do a one time forgiveness program timing would be key.

99% Of Borrowers Rejected Again For Student Loan Forgiveness

More than 99% of borrowers were rejected for student loan forgiveness.

www.forbes.com

 

[Wolvvs]

Are you sure the $150k is not on top of a salary for some academic or administrative position? That's insane otherwise.

The figures I looked at were Total Pay. Salary was listed separately and was lower in some cases. I don't think state employees can be compensated in a way that's not reported publicly but I could be wrong.

 

[OraclePL]

I think there's been some challenge with getting the loans forgiven. My spouse has given up on achieving that and just paying it off. This may change with the current administration, but if they only do a one time forgiveness program timing would be key.

99% Of Borrowers Rejected Again For Student Loan Forgiveness

More than 99% of borrowers were rejected for student loan forgiveness.

www.forbes.com

You should do more research before giving up on this program. Every intelligent financial advisor who has looked closely at the situation is telling people not to be misled by these headlines. Although 99% of people rejected, most of these were people who were applying when they shouldn’t have been applying. For example, many people applied long before they made their 120 qualifying payments. Many people did not have accurate documentation. Other people just did not meet the requirements.

So a lot of it was people not understanding the requirements for the program. Now there were some hiccups with the actual administration for sure, but my understanding is that was a minority of cases.

 

[futureMD618]

I'm gonna be that annoying person who tells you not to worry about money until you're done with school..... take out as few loans as possible while in school to minimize the burden later on. Live cheap while in school, eat ramen, use second hand books, etc. Beyond that you're just stressing yourself out more than it's worth.. Also, the average salary for pediatricians in New York is 180k (and that's the average meaning 50% of pediatricians make more than that). Neonatologists make 300k+ annually. Money will not be a problem.

 

[Gilakend]

I still have no idea why people are willing to spend so much money living in crappy congested apartments just because of city life but maybe i just don't understand the city life well (that and the housing market boom)

Step 1: make the city you live in your entire personality

 

[<(^_^)>]

I think a good balance would be to attempt to secure a residency position NYC, and then decide whether to move to suburbs as an attending. Resident pay is pretty decent in NYC (many are mid 70s pgy-1 to mid 80s pgy-3) so you aren’t really giving up anything from a financial standpoint to do residency there. Afterward you can decide whether the extra ~60,000 in disposable income a year is worth suburbia. Recognize that even if you do “lock in” a career in pediatrics you are not remotely “locking in” a particular practice environment.

 

[Vyzzle]

The trick is you were supposed to dump all your loan money into memestocks and coins and retire yesterday.

But in all seriousness. It's still very doable. I garner from your post you're not from NYC, so the city itself may or may not be a fit for you regardless. As such I'd at first try to get a feel for it (maybe an away rotation to start) to see if you even want to live there.

Personally, I'm from NYC. Can't see myself living anywhere else, but it's certainly not for everybody. By far.

 

[mvenus929]

Where are you getting 150k from? Unless you're doing some subspecialized niche that pays less, MGMA suggests you should be able to crack at least 200 if not more in most pediatric fields.

Intraspecialty variability is real. Right out of residency (or fellowship), many grads going to employed jobs are not going to crack 200K. Private practice is different, as your productivity is what drives your income, but again, new grads aren't going to be doing that as they'll still be getting used to increased volume.

That's a pretty sweet deal in queens! Honestly, as someone who has spent most of my life in rural/suburban areas, I just want to experience NYC as a young professional for a few years. I don't think it would be the same if I waited until as an older attending. Most importantly, I am a huge Yankees fan

Not to discourage you from NYC, but have you considered another city? There are lots of cities that are much more affordable than NYC but still give a taste of the city life. Going from rural to CITY may be a little intense for you, so maybe for residency?

NO not realistic unless you go into pedi specialty like neuro/endocrine etc. Not specialty like adolescent or behavioral

Weird choice of specialties... most people don't go into peds neuro from peds (they go into it from Neuro). Peds Endo makes less than gen peds. Adolescent medicine is about on par with gen peds.

I think there's been some challenge with getting the loans forgiven. My spouse has given up on achieving that and just paying it off. This may change with the current administration, but if they only do a one time forgiveness program timing would be key.

99% Of Borrowers Rejected Again For Student Loan Forgiveness

More than 99% of borrowers were rejected for student loan forgiveness.

www.forbes.com

You should look more into it. There have been many physicians who have gotten forgiveness through the program, and it's all about having your ducks in a row and having the correct loans and being on the correct repayment plan.

 

[SleepingPillow]

Not to discourage you from NYC, but have you considered another city? There are lots of cities that are much more affordable than NYC but still give a taste of the city life. Going from rural to CITY may be a little intense for you, so maybe for residency?

Well I did go to college in a "city", and will be for med school. But, they are both small compared to NYC (metro has a couple million). I would be open to places like Chicago, Atlanta, Philadelphia, LA, etc, at SOME point after I experience NYC for myself. ATM, I am honestly wavering from pediatrics due to the financials (and I haven't even started school yet). Radiology is another field I am interested in, so I think if I see myself doing that I would just do that instead (and NYC would be more reasonable then). Plus, I could always specialize in peds radiology if I really want to (unsure about the job market for that tho)

 

[brownman23]

Well I did go to college in a "city", and will be for med school. But, they are both small compared to NYC (metro has a couple million). I would be open to places like Chicago, Atlanta, Philadelphia, LA, etc, at SOME point after I experience NYC for myself. ATM, I am honestly wavering from pediatrics due to the financials (and I haven't even started school yet). Radiology is another field I am interested in, so I think if I see myself doing that I would just do that instead (and NYC would be more reasonable then). Plus, I could always specialize in peds radiology if I really want to (unsure about the job market for that tho)

For now, just focus on passing M1.

Once you do M3, you’ll likely change your speciality choice at least once. I went from Family Medicine during M0, to EM in M1, to ophtho, peds, anesthesia, and finally Rads in the beginning of M4.

Good luck with medical school! Hope you figure stuff out these next 4 years!

 

[Vyzzle]

For now, just focus on passing M1.

Once you do M3, you’ll likely change your speciality choice at least once. I went from Family Medicine during M0, to EM in M1, to ophtho, peds, anesthesia, and finally Rads in the beginning of M4.

Good luck with medical school! Hope you figure stuff out these next 4 years!

Not to derail, but OOC that's a pretty big jump but not one I haven't heard of before but curious in your case - why the jump from EM to Optho/Anesthesia to finally Rads?

 

[brownman23]

Not to derail, but OOC that's a pretty big jump but not one I haven't heard of before but curious in your case - why the jump from EM to Optho/Anesthesia to finally Rads?

EM is still my favorite non-Rads field, but I didn't think my 40-year-self would be happy with the sleep schedule changes. Ophtho was a minor flirtation after getting back my Step 1 (and for whatever reason I enjoyed learning about eye pathology during preclinicals), but a 2 week elective showed me the field was way more procedure focused than I imagined. I liked Anesthesia for similar reasons to Rads (both deal with less hospital/admin B.S., more focus on "pure medicine", lifestyle friendly, etc), but I ended up liking the reading room way more than I imagined.

Overall, I spent most of M3 neither hating nor loving any of the core rotations. EM and Rads were really the only rotations that got me somewhat excited about the day ahead.

 

[Vyzzle]

EM is still my favorite non-Rads field, but I didn't think my 40-year-self would be happy with the sleep schedule changes. Ophtho was a minor flirtation after getting back my Step 1 (and for whatever reason I enjoyed learning about eye pathology during preclinicals), but a 2 week elective showed me the field was way more procedure focused than I imagined. I liked Anesthesia for similar reasons to Rads (both deal with less hospital/admin B.S., more focus on "pure medicine", lifestyle friendly, etc), but I ended up liking the reading room way more than I imagined.

Overall, I spent most of M3 neither hating nor loving any of the core rotations. EM and Rads were really the only rotations that got me somewhat excited about the day ahead.

Yeah I def get the flirtation with Optho and the like after getting your scores. Even had my advisor push it, given my abnormally high debt.

Well I'm glad you found something you love!

 

[mvenus929]

Well I did go to college in a "city", and will be for med school. But, they are both small compared to NYC (metro has a couple million). I would be open to places like Chicago, Atlanta, Philadelphia, LA, etc, at SOME point after I experience NYC for myself. ATM, I am honestly wavering from pediatrics due to the financials (and I haven't even started school yet). Radiology is another field I am interested in, so I think if I see myself doing that I would just do that instead (and NYC would be more reasonable then). Plus, I could always specialize in peds radiology if I really want to (unsure about the job market for that tho)

Fair enough. Your posts made it sound like you were going from rural/small town life to NYC, which would be a huge culture shock.

I agree with the above posters--just focus on getting through M1-M3 first, and then figure out what you want to do in life. It's hard to say what will happen to the medical landscape in that time. There are currently efforts to get additional loan forgiveness for pediatric specialists ($35k/year) for working in underserved areas, so that may potentially work to your advantage as well.

 

[SurfingDoctor]

It'll be fine. None of that stuff matters on the back end (ie if you are bad at managing money and can't retire comfortably as a doctor... nothing will save you).

The most important thing is finding something you actually enjoy doing. This consistently bears out in surveys of people in their 40s and 50s who are talking about career choices. The rest is irrelevant by comparison.

Not unique to medicine, but the real question is 2 decades down the road, what was the "right" choice...

Cope or Quit? Facing a Mid-Career Crisis

A philosopher’s perspective.

hbr.org

 

[7331poas]

The most important thing is finding something you actually enjoy doing. This consistently bears out in surveys of people in their 40s and 50s who are talking about career choices. The rest is irrelevant by comparison.

I know this uworld question! Its called "survivorship bias".

 

[SurfingDoctor]

I know this uworld question! Its called "survivorship bias".

That's a good question. Does burnout lead to poor finances via impulsive decisions? Yes. Does poor finances lead to increased burnout? Maybe. I mean, you can incentivise people with money. Interestingly, in my personal experience, if you burnout, there is no financial incentive I've seen colleagues be offered that has offset that and a majority say "F-ck it" and go out in a blaze of horrendous glory until they up an quit.

I have literally had colleagues say "I don't care if they pay me $10,000 per call. They can kick my a-s if they think I'm going to do just 1 more shift". They are all gone now, but 1 who stills says that and refuses to additional shift work for incentive pay. They are still around... but I always wonder when their time will come.

 

[Lucca]

everyone in this thread has completely missed the boat.

OP, listen to me:

marry rich.

 

[SleepingPillow]

everyone in this thread has completely missed the boat.

OP, listen to me:

marry rich.

That was always the plan but I was too afraid to say it

 

[sylvester500]

My ortho program allows moonlighting... Most of the residents do it once they are upper level and have more time.... 2k/weekend to take home hand call. Easily double their salary this way.

How does one moonlight without being board-certified? Like what are the duties that you take as an ortho resident moonlighting and making 2k/weekend?

 

[NickNaylor]

Didn't read much of the thread - just responding to the OP's post - but the fact is that you will be able to pay off any amount of student debt as a physician unless you're absolutely terrible at basic financial management and planning. The question is how painful it's going to be and how long you'll be experiencing that pain.

I think picking a specialty based primarily or solely on the income you can potentially generate is a terrible strategy. Income is extremely important and should absolutely be a factor when thinking about what you want to do, but I think it's just as important that you find what you do interesting because you're likely going to be spending a lot of time for a long time doing it. It's certainly a lot easier to work more (and make more money) if you love what you to do than if you hate your job every single day of your life.

I've been working 6 days/week for nearly 4 years at this point, mostly to make extra money. I'm not burned out and I don't hate my life despite this. It's hard, there are certainly aspects of my work that I don't enjoy, and there are sacrifices that come along with that decision, but at its core I love my work and I've been able to sustain an excessive work schedule because I genuinely enjoy the core clinical work that I do. I don't think I could do that if I didn't really enjoy what I was doing.

Additionally, you're way too early in your development to be deciding on a career path at this point. You may do your pediatrics clerkship and realize that you hate it. Do your best to learn as much as you can, identify the things that are important to you in a career, and keep an open mind, and things will work out. It's far too early to be gaming things out in this way when there's a very good chance that your interests may change.

 

[Aheadbyacentury]

I think you missed the point. It’s that this big queens apartment costs 2600/mo, which is very doable for any attending.

Who knows where that apartment is? Most of NYC is a huge ****hole.... especially the outer-boroughs. Peoplle think its glamorous because it is NYC. Its the dumps.

 

[mvenus929]

How does one moonlight without being board-certified? Like what are the duties that you take as an ortho resident moonlighting and making 2k/weekend?

Varies hugely based on the moonlighting gig, but often internal moonlighting just has you as first line but still reporting to the attending. We had moonlighting options in the NICU, where we would take an NP shift (and the NPs did the same thing as the residents, so we were well qualified for it).

In contrast, working at an urgent care after intern year would have you seeing patients on your own, but you have to have your own malpractice, etc. Internal moonlighting avoids all those extra things.