tealeafexplorer

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Graduating with 350k+ debt, great step score, and past ambitions of choosing a competitive specialty, but I hate the specialties I thought I would have liked, and loved family med instead. I love outpatient, continuity of care, relationships, and emphasis on prevention.

I’m scared because of my high debt burden and plan on starting a family as a PGY-2 and moving back to SoCal right after residency. I’m scared of the debt burden, while living in a high COL area and trying to start a family, all with trying to save for retirement etc...

I could care less about reputation, but I’m just nervous of my potential financial situation until I’m like 40.

kind of shallow I agree. Just thought I’d share my feelings here.
 

EmergDO

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Does your spouse work? How high are your expectations for house size/fancy cars living in LA? You can pay down 350k of loans on a PCP salary most places as long as you live frugally, or try for PSLF as well. Plenty of FM doctors make it work in NYC, California, etc, you just have to decide if it’s worth it for you.
 
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Shinken

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Graduating with 350k+ debt, great step score, and past ambitions of choosing a competitive specialty, but I hate the specialties I thought I would have liked, and loved family med instead.

I’m scared because of my high debt and plan on starting a family as a PGY-2 and back to SoCal right after residency. I’m of the debt burden, while living in a high area and trying to start a , all with trying to save for retirement etc...

Find an employer that is willing to pay your student loans. Many fam med job offers now include loan repayment precisely because new grads feel like you do.
 
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AMEHigh

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Ehh, it's not too bad. My loans are same as yours and I live in a hcol. I love my job and of course I would LOVE if I made more money, but it is what it is. I still live a comfortable life and I wouldn't change anything, except maybe to be born as a trust fund kid who never had to work a day in their life instead. It's worth it to me to have a job that I love and a comfortable life. My student loans are just another bill like my mortgage, electric, etc, so I just try not to think of it too much.
 
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Reboa

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Do what makes you happy, but also realize you can find happiness and satisfaction in any specialty. You could always do a fellowship and do primary care clinic if you really love it.
 
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tealeafexplorer

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Does your spouse work? How high are your expectations for house size/fancy cars living in LA? You can pay down 350k of loans on a PCP salary most places as long as you live frugally, or try for PSLF as well. Plenty of FM doctors make it work in NYC, California, etc, you just have to decide if it’s worth it for you.

Nonprofit work. We don’t need a big house, nice cars, or good school district/neighborhood. Just want a comfortable life, and comfortable retirement
 

SLC

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I have more loans than you, I haven’t paid anything on them in 2yrs with employer and state loan repayment. I’ve been socking away cash equal to the loan repayment instead. I’ve got 5yrs left and I should be payed off.

you’ll be fine. Just do what you love, the loans will get paid eventually.
 
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Hippocrates II

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I'm the same way. Will graduate older than most students and with a decent amount of loans, really didn't want to like FM because of that. Probably one of my favorite rotations so far. Ultimately, you can reliably earn 250k+ as a FM doc, and that is more than enough to pay off loans and live a great life. If it's purely financial reasons that are making you hesitate, I would keep FM in mind. You'll be doing this for the next ~40 years, don't spend each day doing something you don't enjoy just so you can take more money to the grave.
 

Sushirolls

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Liking is FM is one of the greatest gifts. I wish I had liked FM / IM more than Psychiatry. The ability to truly open your own practice and make it your own and pick which fee structure you want in addition to picking any location in the country - rural / urban / suburb - is a pure gift. Pat yourself on the back for liking FM.
 
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Liking is FM is one of the greatest gifts. I wish I had liked FM / IM more than Psychiatry. The ability to truly open your own practice and make it your own and pick which fee structure you want in addition to picking any location in the country - rural / urban / suburb - is a pure gift. Pat yourself on the back for liking FM.
I thought Psych was able to do this too, with possibly even less overhead costs?
 
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Liking is FM is one of the greatest gifts. I wish I had liked FM / IM more than Psychiatry. The ability to truly open your own practice and make it your own and pick which fee structure you want in addition to picking any location in the country - rural / urban / suburb - is a pure gift. Pat yourself on the back for liking FM.

Can’t you do this in psych as well though?
 

Sushirolls

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Yes Psych can, but there are aspects of Psych that pull a little harder toward bigger population centers than FM/IM. You also don't have any real conceierge DPC ability with Psych. Just insurance or cash only fee for service.
 
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Candidate2017

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Yes Psych can, but there are aspects of Psych that pull a little harder toward bigger population centers than FM/IM. You also don't have any real conceierge DPC ability with Psych. Just insurance or cash only fee for service.

I'm not sure I'd want to do concierge or direct care psychiatry. Psych patients paying a retainer aren't calling for same day xrays, stitches, lisinopril refills, or Z packs for da sniffles. Its more like: "I need to talk on the phone or see you now because my cat died, I had an argument with my spouse, my kid wont stop getting high, my stocks had a bad day etc". 1 hour weekly or daily cash therapy at $500+ would be better for everyone's boundaries and sanity.
 
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krazynestle

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I'm going into primary care in a high COL area and have loans up to 450K and the salary + bonuses I'm getting will make me more than comfortable to live. You'll be fine as a PCP. The money may not be as high as some subspecialties but if you enjoy it then you'll be fine. I'm going to pay off my loans in 10 years and will have more than enough for a mortgage and saving for my kids' college expenses. Also consider that right now there is a push in legislation for higher pay in primary care in the current political climate while sub specialties are looking at pay cuts.
 

sloh

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I'm going into primary care in a high COL area and have loans up to 450K and the salary + bonuses I'm getting will make me more than comfortable to live. You'll be fine as a PCP. The money may not be as high as some subspecialties but if you enjoy it then you'll be fine. I'm going to pay off my loans in 10 years and will have more than enough for a mortgage and saving for my kids' college expenses. Also consider that right now there is a push in legislation for higher pay in primary care in the current political climate while sub specialties are looking at pay cuts.

I disagree with this. And I came out of residency with no debt. It's hard to grasp just how debilitating debt can be and how much money you need to live well in a high COL city until you're actually in the thick of it.
 
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krazynestle

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I disagree with this. And I came out of residency with no debt. It's hard to grasp just how debilitating debt can be and how much money you need to live well in a high COL city until you're actually in the thick of it.
You're right, it is short sighted for me to say. My experiences won't be similar to someone else and California has a high tax burden I thankfully don't get in Texas.

But, the best thing is to just work somewhere else, which unfortunately isn't something everyone can do.
 
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AMEHigh

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I disagree with this. And I came out of residency with no debt. It's hard to grasp just how debilitating debt can be and how much money you need to live well in a high COL city until you're actually in the thick of it.

I’m in the thick of it and it’s fine.
Of course I wish I had no debt and made 500k a year as that would make things easier, but to me it’s worth it for a career I love. It’s true everyone should consider money and their career path, but I don’t think picking a career just because it makes more money is always the correct path.
Plus you said you had no debt so it’s likely hard for you to imagine how the rest of make it work, but we do!
 
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TheOther

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I was in the same place. Ended up pulling out of ortho at the last minute, cancelled all my aways right as 4th year started. Also tabled other competitive specialties because FM was it for me.

Thankfully, FM pays pretty well in SoCal. Kaiser is leading the way -- they've recognized that high quality, physician-led primary care is both best for patient-centered care and saves costs. So they pay accordingly, which has also driven up salaries in the area. If you want details, shoot me a message.

I'm a current PGY-2. I have similar loans and even with higher COL, I have a clear plan to pay it all down in about 5-7 years.
 
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