Loan repayment options & healthcare reform

[immanuel11421]

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I do not owe that much for my undergraduate, roughly 25k. I have been working fulltime and going to school fulltime to support myself. But I figure that if I do go to medical school, when I am done, I will be about 280k in debt. And I am definitely not in good physical condition to be in the military / Armed service.
But just out of curiousity, how 'fit' that u have to be to qualify?
I consider doing the underserved area for repayment. But can anyone tell me how bad that is? Do they even let u choose from a list of " underserved area" for where u want to go and are they refering to 'rural' area which I don't mind or somewhere dangerous where bullets are flying everywhere and doctors may get shot ? Anyone know anybody who has done that route?

I am not doing this money but I would like to know if I can even be able to pay off my loan and still be able to live decent with the healthcare reform.
Seriously, will doctors be poorer than an average joe with the healthcare reform?
I was told by a friend whose father is a primary doctor that average primary care physician makes around 150k. With 280k in debt, will doctor at least make 150k after the healthcare reform?
My under graduate GPA wasn't good and so I know for sure I won't get any help for the 1st year in med school besides loan. But is there's any chance of scholarship if I perform well after 1st year in med school? Any recommendation of scholarship that I can start looking into?
Another ridiculous question I have, when it comes to worse that I cannot repay my loan here , can I practice medicine anywhere else or work for international organization such as the WHO as an American physician and be able make decent living?
I was told by my friend whose father is a primary doctor that their average salary is 150k in NYC. Do u see doctor making an average of less than 150k with the reform? I know there's a lot of uncertainty but do u predict any specialty that u think would be less 'untouchable' by the goverment?

 

[TMP-SMX]

I think you are worrying about nothing. 280k is a lot, but there are many people worse off than you that are doing fine. If what you are saying is true about supporting yourself, your parental income may not be that high if that is the reason you have to support yourself. In that case, then you may be eligible for need-based aid as all medical students are considered dependent in the calculation for need-based aid. Perkins loans run around 5k a year depending on the school and many schools have grants/scholarships around 10k a year.

In the future, fewer people may do primary care because of the increasing paperwork and lack of proper compensation for time spent with patients and charting.

 

[nontrdgsbuiucmd]

According to US Census Bureau, average household income in the US in a recent year was 50K per year, or around $4,200 per month. If you're earning triple this as a family care doc and paying $2015 per month student loans (that's 280K over 30 years at 7.8% which I believe is the current loan rate), you'd be doing much better than most Americans.

http://www.census.gov/Press-Release/www/releases/archives/income_wealth/012528.html

short of renouncing US citizenship, I'm not aware of a great way to evade paying back student loans. However, there is magic in deferring repayment; right now loans can be deferred indefinitely, and no interest accrues on loans that are subsidized staffords, while you are in school half time, i.e. online classes in basketweaving.

realistically, there is now a program that would only require that you pay 15% of income toward student loans for 25 yrs and then the remaining balance is forgiven; this may be a good option for lower-paying careers, although I believe even under this program, all student loans would likely be paid off in 25 yrs, assuming inflation at a few percent per year.

 

[penguin24]

Paying med school loans over 30 yrs is a bit much. I wouldn't say that's 'better' than the avg American. Med school loans have usually been designed to be paid over 10 yrs (after residency), it's only recently that tuition has skyrocketed and now ppl have loans that are basically making it impossible to practice primary care.

 

[dragonfly99]

280k is a lot of debt.
It's a level of debt at which I think you need to seriously consider trying to get into a better paying specialty than primary care.
Don't count on getting scholarships for med school as these are very hard to come by. They aren't any easier to come by after 1st year of school vs. before you start. There are a few out there, but other than some private med schools, a lot of schools don't offer scholarships or grants, at least they didn't when I was a student. And even at the schools that give scholarships, you have only a handful getting those (at my school we had 5-10 people getting academic scholarships, with 100+ getting nothing).

I think as a physician you will be very likely to be doing better than the average joe, financially speaking, even after your loan payments. However, the Average Joe didn't spend 10+ years training for a medical career and doesn't necessarily have to make a lot of life or death decisions, or work 60+ hours/week (I'm talking about postresidency work hours...you can expect 80/week as a resident and perhaps as a student).

150k sounds right for primary care...would likely be less your first few years. 150k in rural Iowa is good dough...but not so much in New York City.

Nobody knows what will happen to physician salaries under health care reform. I would expect them to be stagnant or drop for certain high paid specialties like radiology and ortho, but perhaps stay the same for primary care (taking into account inflation, etc.). I think that more than cutting reimbursements directly, the gov't will try to just hold the line on any increases in costs, including reimbursement to docs, leading to stagnation of salaries in some of the subspecialties. Nobody really knows, though.

One thing I think is for sure - in primary care you are likely always to have a job. PA's and NP's are out there, but I think there will be a continued need for physicians in this area. PA's and NP's aren't stupid, and a lot of them don't want to do primary care either, just b/c it's a hard job involving mountains of paperwork and sometimes little respect from patients and some colleagues.

 

[WNT Signaling]

A few things

1. 280k really is not that bad. There are much more expensive schools, and if this does not make you feel better, look at how much more expensive dental school is than medical school

2. Read the posts on the military med forum--if dozens and dozens of posters regret taking the scholarship, and there are no posters that are actually glad that they did, it says a lot about the military. Remember, someone is going to have you by the balls: would you perfer it to be a bank or the military?

3. It is possible to pay the debt back quickly, but it will mean living like a resident for a few more years. Now, while right now that might not sound bad, after 3-5 years of 80 hour work weeks as a resident, you might feel entitled to a better quality of living, so you might not be willing to pay off as much as you think you would.

4. If you're from the Midwest of South and know you'd like to end-up back in the region, higher salaries and lower costs of living will make repayment much easier. However, if you HAVE to be in the Northeast or California, you'll have more difficulty paying off your loans.

5. What kind of life do you want? If you want a trophy wife, 3 kids, and a million dollar home, things don't look too good. If you don't want kids (remember, kids, not loans, are the biggest drain on your income!), paying off loans will be easier. Also realize, just because you can afford a million dollar home or a BMW doesn't mean you should or that it makes financial sense to do so

6. The new income based repayment program means that you willl not be forced to pay more than 15% of your income minues 150% of the poverty line. After 25 years, the governemtn discharges any remaining loans, although at this time, the amount of loans discharge is considered taxable, however it seems likely that the governemtn will do away with this tax burden. Alternatively, the government will cancel your loans, without the tax burdern, if you do 10 years of public service. All years of your residency and fellowship count, but you job has to be for a non-for-profit, i.e. a hospital or university and NOT a private group the hospital contracts with. This program, however, is new, and it's hard to tell if this program will still be around 14 years from now, and whether they will close the loophole allowing physicians to qualify for this

7. MANY states have loan reapyement options. For instance, North Dakota will pay 100,000 in loan forgiveness on top of a salary to any primary care providers who agree to serve in the state for 2 years. Kansas and Texas have similar, albeit less generous, programs. Also, if you go into private practice, a lot of groups provide loan foregiveness, and if not, and you are an attractive candidate, you can try and negotiate a ceratin amount of loan foregiveness into your contract. However, these offers tend to be for only one year, and the tax foregiveness amount is taxed, where as NHSC loan foregiveness is not

I wish I could give you a hug; I bet you need one!

 

[medicinesux]

I disagree with the comment from WNT that 280K is not really bad. Unless you can land a high paying specialty, which would be a gamble, you will be wearing those golden hand cuffs for an awfully long time if you do primary care. Listen to dragonfly she knows what she is talking about.

 

[WNT Signaling]

I disagree with the comment from WNT that 280K is not really bad. Unless you can land a high paying specialty, which would be a gamble, you will be wearing those golden hand cuffs for an awfully long time if you do primary care. Listen to dragonfly she knows what she is talking about.

I think 280 says a lot about how the cost of med school attendance is skyrocketing like crazy: 10 years ago, no one would have graduated with this much debt, but there will be people enrolling this and next you who will face this debt, if not higher. It's difficult to tell when medical school will no longer make financial sense--since it is solely the decision of the individual, different people having different limits on what they are and aren't willing to tolerate