Med school debt

[Dr Dazzle]

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As a current student who will have $250K debt, I am very worried about paying that off having a career in family med. I'm wondering if family med is worth it with that level of debt. I want to have a decent lifestyle considering the delayed gratification that comes with attending med school.

Is it easy to pay off monthly loan payments with this kind of debt with average salary?

Any insights?

 

[cabinbuilder]

As a current student who will have $250K debt, I am very worried about paying that off having a career in family med. I'm wondering if family med is worth it with that level of debt. I want to have a decent lifestyle considering the delayed gratification that comes with attending med school.

Is it easy to pay off monthly loan payments with this kind of debt with average salary?

Any insights?

No problem paying the payments. My debt load is the same as yours. It's about 1.5 days pay. No worries. I have 2 kids, Plenty of money to do things with them. Great lifestyle. Sleep with comfort.

 

[Dr Dazzle]

No problem paying the payments. My debt load is the same as yours. It's about 1.5 days pay. No worries. I have 2 kids, Plenty of money to do things with them. Great lifestyle. Sleep with comfort.

Do you have any insight on payment plans or loan forgiveness opportunities through hospitals? Of course, the instate kids at my school pay only 22k tuition while out of state students like me end up paying 50k. Is there anything I can do now to have a better handle on debt in the future? I feel it's very easy to take a lot of debt out and justify using it as a student. Many other Family docs I have talked to seem very unsatisfied with their salaries with respect to their level of work.

 

[Silent Cool]

Do you have any insight on payment plans or loan forgiveness opportunities through hospitals? Of course, the instate kids at my school pay only 22k tuition while out of state students like me end up paying 50k. Is there anything I can do now to have a better handle on debt in the future? I feel it's very easy to take a lot of debt out and justify using it as a student. Many other Family docs I have talked to seem very unsatisfied with their salaries with respect to their level of work.

Dazzle,

Did those docs share any numbers with you? If so, would you tell us?

My impression is that if your loans will be 250K at the end of training, then you should be fine. Is this the value that you have come up with, accounting for the accrual of interest from day one of your schooling through the final day of your residency training?

thanx
😎

 

[cabinbuilder]

Do you have any insight on payment plans or loan forgiveness opportunities through hospitals? Of course, the instate kids at my school pay only 22k tuition while out of state students like me end up paying 50k. Is there anything I can do now to have a better handle on debt in the future? I feel it's very easy to take a lot of debt out and justify using it as a student. Many other Family docs I have talked to seem very unsatisfied with their salaries with respect to their level of work.

No, every loan forgiveness I have applied for has never come to light. I don't work for a hospital so I have never have had an employer help me with loans. Yes it is easy to take out loans as a student.

I am a locums FP so I make a lot of money and my student loan debt is 220K. I have NO PROBLEM paying my student loan payment (I consolidated) of about 1500/mo. I think my "real" payment is abut 800/mo but I pay more to get ahead. I cannot vouch for salaried FP docs. I personally would never do that again since it's quite difficult to break even.

 

[rmj254]

No, every loan forgiveness I have applied for has never come to light. I don't work for a hospital so I have never have had an employer help me with loans. Yes it is easy to take out loans as a student.

I am a locums FP so I make a lot of money and my student loan debt is 220K. I have NO PROBLEM paying my student loan payment (I consolidated) of about 1500/mo. I think my "real" payment is abut 800/mo but I pay more to get ahead. I cannot vouch for salaried FP docs. I personally would never do that again since it's quite difficult to break even.

Is it difficult to break even in the sense that if one's student loans are extremely high they are having a difficult time paying the payments every month?

 

[Toohotinvegas33]

Even at a crappy paying job your take home should be at least 10k a month, so even if you loans are something ridiculous like 4 k a month, you should be able to live off 6k quiet nicely. My advice is to do some moonlighting in residency and pay down some of the interest before it capitalizes.

 

[brats800]

You also just need to decide what you want your life AFTER residency to look like. If you want to 1) lease a new BMW every year, 2) travel the world for 2-3 months every year, and still pay off your loans in 5 years - you might be in trouble (or might need to work A LOT). If you want to see your family a lot, drive a decent but not flashy car, and pay yours loans off over an extended period (10-15 years?) then it should be doable. This is all somewhat based on where you work, too. Salaries in the Midwest (where I am), for example, can vary for full time by >50%, based on where you are and how much call / inpatient work you do. Long story short, I have similar loans as you and I'm paying them off fine.

 

[Dr Dazzle]

Dazzle,

Did those docs share any numbers with you? If so, would you tell us?

My impression is that if your loans will be 250K at the end of training, then you should be fine. Is this the value that you have come up with, accounting for the accrual of interest from day one of your schooling through the final day of your residency training?

thanx
😎

$250 K is simply the 50k tuition and the 10-15K of living expenses from each year in med school.So with interest, I'm assuming it would be a lot more. Thanks to Congress, there is an unfavorable interest rate on loans.
Btw...on average how much is your guys' monthly loan payment? I would be okay paying off loans in residency or after residency within 10-15 years. How much is you monthly take-home?

 

[cabinbuilder]

Is it difficult to break even in the sense that if one's student loans are extremely high they are having a difficult time paying the payments every month?

I guess to comes down to what other debt you have.

When I worked a salaried job my take home was 9500/month (180K) since the job took out taxes, insurance, medical, etc. I had other debt from divorce, house, car payments, credit cards, etc coming out of residency it was very difficult to swallow when my total monthy bills was about 8000 when I got out of residency. So I was making 6 figures and still felt poor.

This is THE main reason I have stayed with locums so long since my take home is more than double that so I have money up front to pay off large amounts quickly. I have to save at the end of the year to pay my taxes.

So to answer the question, it wasn't the student loan payment per se, it was the combo of all my payments that made it difficult.

 

[rmj254]

I guess to comes down to what other debt you have.

When I worked a salaried job my take home was 9500/month (180K) since the job took out taxes, insurance, medical, etc. I had other debt from divorce, house, car payments, credit cards, etc coming out of residency it was very difficult to swallow when my total monthy bills was about 8000 when I got out of residency. So I was making 6 figures and still felt poor.

This is THE main reason I have stayed with locums so long since my take home is more than double that so I have money up front to pay off large amounts quickly. I have to save at the end of the year to pay my taxes.

So to answer the question, it wasn't the student loan payment per se, it was the combo of all my payments that made it difficult.

Is it reasonably possible to get extra work in addition to the salaried position (assuming it's an outpatient 8-5 kind of job) to be able to cut student loan repayment time down?

 

[Smokemont]

I guess to comes down to what other debt you have.

When I worked a salaried job my take home was 9500/month (180K) since the job took out taxes, insurance, medical, etc. I had other debt from divorce, house, car payments, credit cards, etc coming out of residency it was very difficult to swallow when my total monthy bills was about 8000 when I got out of residency. So I was making 6 figures and still felt poor.

This is THE main reason I have stayed with locums so long since my take home is more than double that so I have money up front to pay off large amounts quickly. I have to save at the end of the year to pay my taxes.

So to answer the question, it wasn't the student loan payment per se, it was the combo of all my payments that made it difficult.

8000 in monthly bills? holy crap...

Is it reasonably possible to get extra work in addition to the salaried position (assuming it's an outpatient 8-5 kind of job) to be able to cut student loan repayment time down?

I assume you could pick up additional call with your group, or take shifts at the ED or urgent care at night on weekends...

 

[Dr Dazzle]

8000 in monthly bills? holy crap...



I assume you could pick up additional call with your group, or take shifts at the ED or urgent care at night on weekends...

So it seems that a lot of specialists don't have to worry about this. In general they break $250K right out of residency. Still, I'm wondering if finances really is the reason why a lot of students don't end up in family med, That's the most publicized reason.

 

[Smokemont]

So it seems that a lot of specialists don't have to worry about this. In general they break $250K right out of residency. Still, I'm wondering if finances really is the reason why a lot of students don't end up in family med, That's the most publicized reason.

I would say money is a big issue, but personal interest and prestige are definitely in there as well. Do what makes you happy. No amount of money will make up for you dreading going to work every morning...for the rest of your life. FM salaries most likely aren't going to decrease either, who knows with the specialists.

 

[Dr Dazzle]

I would say money is a big issue, but personal interest and prestige are definitely in there as well. Do what makes you happy. No amount of money will make up for you dreading going to work every morning...for the rest of your life. FM salaries most likely aren't going to decrease either, who knows with the specialists.

Yea...I guess with the ACA there is a possibility that salaries may increase for FM docs. Of course they won't reach the level of specialists.

 

[cabinbuilder]

Is it reasonably possible to get extra work in addition to the salaried position (assuming it's an outpatient 8-5 kind of job) to be able to cut student loan repayment time down?

Depends on your contract. Many have a "no moonlighting" clause so to speak or you can't work within a certain radius, etc. Also depends ho how much you are buried in charting the end of the week, if you have a family, etc.

 

[cabinbuilder]

8000 in monthly bills? holy crap...

QUOTE]

Yep, was true at the time. Of course I have been able to pay off about 100,000 in personal debt but I still have a ways to go. A lot of it is priorities. For me, I wanted to take trips and do things with my kids before they left home so I have paid the minimum on student loans, etc since we scrimped for so long I was ready to have some fun and put the debt on the back burner. Part of what I pay is a house payment for a house I bought in residency that I cannot sell. It's rented at a loss but at least its not getting trashed. I also have circumstance with custody and children needing to travel, etc. so a lot of what I make goes to that as well.

Had I been 30 out of residency, not 40, without baggage I could have easily paid off my student loan debt. I don't think you guys have anything to worry about.

 

[okokok]

8000 in monthly bills? holy crap...

QUOTE]

Yep, was true at the time. Of course I have been able to pay off about 100,000 in personal debt but I still have a ways to go. A lot of it is priorities. For me, I wanted to take trips and do things with my kids before they left home so I have paid the minimum on student loans, etc since we scrimped for so long I was ready to have some fun and put the debt on the back burner. Part of what I pay is a house payment for a house I bought in residency that I cannot sell. It's rented at a loss but at least its not getting trashed. I also have circumstance with custody and children needing to travel, etc. so a lot of what I make goes to that as well.

Had I been 30 out of residency, not 40, without baggage I could have easily paid off my student loan debt. I don't think you guys have anything to worry about.

This is nice to hear for once.

 

[docdaddie]

As a current student who will have $250K debt, I am very worried about paying that off having a career in family med. I'm wondering if family med is worth it with that level of debt. I want to have a decent lifestyle considering the delayed gratification that comes with attending med school.

Is it easy to pay off monthly loan payments with this kind of debt with average salary?

Any insights?

I suggest using AAMC's Medloans Calculator and educating yourself on the new "Pay as you Earn" repayment option. I think you will find that the average student loan debt is not a large burden with an average FM physician income.

 

[Dharma]

I suggest using AAMC's Medloans Calculator and educating yourself on the new "Pay as you Earn" repayment option. I think you will find that the average student loan debt is not a large burden with an average FM physician income.

A fine first post, indeed.

 

[Smokemont]

Depends on your contract. Many have a "no moonlighting" clause so to speak or you can't work within a certain radius, etc. Also depends ho how much you are buried in charting the end of the week, if you have a family, etc.

Would you say this is more the norm or the exception? How difficult do you think it would be to negotiate this out of the contract. One of the things I'm looking forward to is being able to work as much as I want if I need/want more money, and I assume moonlighting is the primary way to do this.

 

[Cooperd0g]

I can't find them right now, but there are a couple of threads about people who went locums for a year or two immediately after finishing residency. The jobs always covered travel, lodging, rental cars and malpractice so they were basically just banking everything they made minus living expenses and paid off their loans in a year or two. If you are willing to go to some rural places and be adventurous for a year or two I think it would be excellent experience and could get you on solid financial footing as well. But folks with families ready to find a home may not be too keen on this idea.

 

[cabinbuilder]

Would you say this is more the norm or the exception? How difficult do you think it would be to negotiate this out of the contract. One of the things I'm looking forward to is being able to work as much as I want if I need/want more money, and I assume moonlighting is the primary way to do this.

All depends on the contract. I have had 4 permanent job and each one had a "no moonlighting clause" so just be aware of this. May be very difficult depending on location. I'm not the expert on this but I do know that I didn't have time during the perm jobs to even consider working more than I already did.

 

[cabinbuilder]

I can't find them right now, but there are a couple of threads about people who went locums for a year or two immediately after finishing residency. The jobs always covered travel, lodging, rental cars and malpractice so they were basically just banking everything they made minus living expenses and paid off their loans in a year or two. If you are willing to go to some rural places and be adventurous for a year or two I think it would be excellent experience and could get you on solid financial footing as well. But folks with families ready to find a home may not be too keen on this idea.

This is very true. Locums pays for all of your expenses, housing, travel, rental car. You pay for your own food. I added it up and I have grossed almost 1 million in the last 4 years (WOW). But like I said before I got out of residency at 40 with a huge personal debt, two kids, 2 homes, credit cards, personal loans, etc. Plus at least 50K/yr of that went to taxes. So, yes, if you are single, want to travel, work hard, and make bank, pay off that debt in18 months it is totally doable as a locums provider.My family is older, my husband stays home and I schedule my own life around the kids's school breaks, etc. so I don't work as much as I could potentially. PM me for any questions as to who are my favorite companies.

 

[SnakeOil]

I added it up and I have grossed almost 1 million in the last 4 years (WOW).

You grossed 1 million every year the last 4 years or you grossed 1 million in 4 years?

 

[cabinbuilder]

You grossed 1 million every year the last 4 years or you grossed 1 million in 4 years?

in 4 years, not every year.

 

[SnakeOil]

in 4 years, not every year.

So you grossed $250k/year? Average gross pay for FM is about $215 last I looked. If your net pay was $250k I'd be a little more impressed.

 

[Smokemont]

So you grossed $250k/year? Average gross pay for FM is about $215 last I looked. If your net pay was $250k I'd be a little more impressed.

I think you may need to look again, or possibly look up the difference between gross and net pay.

 

[VA Hopeful Dr]

I think you may need to look again, or possibly look up the difference between gross and net pay.

For FM with inpatient but without OB, median 2012 pay was right at 200k.

 

[deleted87716]

I think you may need to look again, or possibly look up the difference between gross and net pay.

http://smallbusiness.chron.com/difference-between-reported-w2-wage-gross-pay-23839.html

 

[cabinbuilder]

So you grossed $250k/year? Average gross pay for FM is about $215 last I looked. If your net pay was $250k I'd be a little more impressed.

Not trying to impress anyone here. Just making the point that if you are able to do it right, you would be able to pay off your student loans in 4 years should your other personal debt load coming out of residency be minimal.

Remember, too, that I only work 8 months a year.

 

[SnakeOil]

I think you may need to look again, or possibly look up the difference between gross and net pay.

I understand the difference. If her net pay was $250k that would mean her gross pay had to have been about 20-30% higher based on her withholdings which is why I'd be more impressed if her net pay was $250k not her gross pay. It's possible that you're the one who needs to look up the difference between net and gross pay.

The differences in pay (especially in FM) has a lot to do with the type of job you're working, hours willing to work, location, etc. Having that said, the residents graduating from our program this year had starting salaries ranging from $180k (outpatient only, minimal at-home call, no weekends) to $300k (hospitalist, 7 days on 7 days off doing anywhere from 15-20 admissions per shift).

Middle-ground jobs (in the area I live) doing a mix of outpatient, inpatient, and some OB seem to be offering closer to $220k (benefits included) which is why I was just a bit surprised to hear CabinBuilder talk about "making bank" doing locums and making $250k/year when considering locums jobs usually come with zero health/retirement/cme benefits and force you to work away from home. That just doesn't seem like a far cry from what a lot of outpatient-only jobs are offering nowadays. Just sayin.

 

[cabinbuilder]

I can't find them right now, but there are a couple of threads about people who went locums for a year or two immediately after finishing residency. The jobs always covered travel, lodging, rental cars and malpractice so they were basically just banking everything they made minus living expenses and paid off their loans in a year or two. If you are willing to go to some rural places and be adventurous for a year or two I think it would be excellent experience and could get you on solid financial footing as well. But folks with families ready to find a home may not be too keen on this idea.

@Snakeoil. I was commenting on this comment and agreeing, nothing more.

 

[cabinbuilder]

I understand the difference. If her net pay was $250k that would mean her gross pay had to have been about 20-30% higher based on her withholdings which is why I'd be more impressed if her net pay was $250k not her gross pay. It's possible that you're the one who needs to look up the difference between net and gross pay.

The differences in pay (especially in FM) has a lot to do with the type of job you're working, hours willing to work, location, etc. Having that said, the residents graduating from our program this year had starting salaries ranging from $180k (outpatient only, minimal at-home call, no weekends) to $300k (hospitalist, 7 days on 7 days off doing anywhere from 15-20 admissions per shift).

Middle-ground jobs (in the area I live) doing a mix of outpatient, inpatient, and some OB seem to be offering closer to $220k (benefits included) which is why I was just a bit surprised to hear CabinBuilder talk about "making bank" doing locums and making $250k/year when considering locums jobs usually come with zero health/retirement/cme benefits and force you to work away from home. That just doesn't seem like a far cry from what a lot of outpatient-only jobs are offering nowadays. Just sayin.

Again, I could make more if I wanted but I don't want to work more than 8 months. The whole point of locums is you get cash up front if you need to pay off debt quickly and you are free to make your own schedule. Sounds like it's not for you, so no one is going to force you to have that lifestyle.

 

[Dr Dazzle]

Seems like there are a lot of good options with family med if it's something you end up liking in rotations. I wonder why so many family docs are so negative and extend that attitude towards med students. One even said it's better than "working in the warehouse, you have job security."

 

[Smokemont]

For FM with inpatient but without OB, median 2012 pay was right at 200k.

Do you have a source for this? Location? Just following your patients in the hospital? I have never seen a survey/source that high for FM (which doesn't say much but I would love to see it)

I understand the difference. If her net pay was $250k that would mean her gross pay had to have been about 20-30% higher based on her withholdings which is why I'd be more impressed if her net pay was $250k not her gross pay. It's possible that you're the one who needs to look up the difference between net and gross pay.

The differences in pay (especially in FM) has a lot to do with the type of job you're working, hours willing to work, location, etc. Having that said, the residents graduating from our program this year had starting salaries ranging from $180k (outpatient only, minimal at-home call, no weekends) to $300k (hospitalist, 7 days on 7 days off doing anywhere from 15-20 admissions per shift).

Middle-ground jobs (in the area I live) doing a mix of outpatient, inpatient, and some OB seem to be offering closer to $220k (benefits included) which is why I was just a bit surprised to hear CabinBuilder talk about "making bank" doing locums and making $250k/year when considering locums jobs usually come with zero health/retirement/cme benefits and force you to work away from home. That just doesn't seem like a far cry from what a lot of outpatient-only jobs are offering nowadays. Just sayin.

Wasn't trying to insult you but 250k seems to be on the high end of FM. 300k right out of residency for 7on/7off? I have a hard time believing this based on what I've read/heard from mentors. Maybe I'm wrong. Actually, I hope I'm wrong.

 

[VA Hopeful Dr]

Do you have a source for this? Location? Just following your patients in the hospital? I have never seen a survey/source that high for FM (which doesn't say much but I would love to see it)



Wasn't trying to insult you but 250k seems to be on the high end of FM. 300k right out of residency for 7on/7off? I have a hard time believing this based on what I've read/heard from mentors. Maybe I'm wrong. Actually, I hope I'm wrong.

http://www.merritthawkins.com/Candidates/BlogPostDetail.aspx?PostId=39443

 

[SnakeOil]

Wasn't trying to insult you but 250k seems to be on the high end of FM. 300k right out of residency for 7on/7off? I have a hard time believing this based on what I've read/heard from mentors. Maybe I'm wrong. Actually, I hope I'm wrong.

Yes, right out of residency 7 days on, 7 days off admitting 15-20 patients per shift. You might not have a good understanding of what that means at this point in your training, but it's a lot of work. You're earning your pay admitting that many patients per shift.

And yes, it's absolutely possible to make that kind of money as a FM doc, but you have to work for it. Cabinbuilder is making $250k only working 8 months out of the year. Doing locums year-round I'm sure you'd be making at least $300k.

 

[SnakeOil]

Again, I could make more if I wanted but I don't want to work more than 8 months.

I missed that part and I agree, that's pretty good pay. That sounds more in line with what I thought you could make doing locums.

 

[cabinbuilder]

Yes, right out of residency 7 days on, 7 days off admitting 15-20 patients per shift. You might not have a good understanding of what that means at this point in your training, but it's a lot of work. You're earning your pay admitting that many patients per shift.

.

OMG, the pay could never be high enough for this much work. A good H&P with admit orders takes a good hour and that's if you are fast and thorough. NO WAY. Plus all the discharge summaries that go with it and all the rounding and all the pages. OUCH.

 

[Smokemont]

Yes, right out of residency 7 days on, 7 days off admitting 15-20 patients per shift. You might not have a good understanding of what that means at this point in your training, but it's a lot of work. You're earning your pay admitting that many patients per shift.

And yes, it's absolutely possible to make that kind of money as a FM doc, but you have to work for it. Cabinbuilder is making $250k only working 8 months out of the year. Doing locums year-round I'm sure you'd be making at least $300k.

Agreed. I don't have a good understanding of the work it entails.

 

[SnakeOil]

OMG, the pay could never be high enough for this much work. A good H&P with admit orders takes a good hour and that's if you are fast and thorough. NO WAY. Plus all the discharge summaries that go with it and all the rounding and all the pages. OUCH.

I agree, you couldn't pay me enough to do what he's doing. He says he enjoys it so far, but then again, it's only been 2 months... 🙁

 

[cabinbuilder]

I missed that part and I agree, that's pretty good pay. That sounds more in line with what I thought you could make doing locums.

Yes, If I worked year round and took minimal vacation time I would break 300K (gross) pretty easily.

 

[Postictal Raiden]

Yes, If I worked year round and took minimal vacation time I would break 300K (gross) pretty easily.

Besides taxes, what is deducted from the gross income?

 

[cabinbuilder]

Besides taxes, what is deducted from the gross income?

Not sure what you mean? I pay my taxes out of that at the end of the year. Otherwise it's all cash up front. Of course I pay all my own licensing fees, CME, health insurance, and personal bills

 

[Cooperd0g]

Besides taxes, what is deducted from the gross income?

I think he means "other than taxes, what is the difference between gross income and net income?"

Gross income is what you earn. Net income is what you take home. Typically when you are an employee you will have federal and state/local (if applicable) taxes, social security, medicare. All of those are generally viewed as taxes though depending on who you talk to. That's about it.

 

[Postictal Raiden]

Not sure what you mean? I pay my taxes out of that at the end of the year. Otherwise it's all cash up front. Of course I pay all my own licensing fees, CME, health insurance, and personal bills

I thought you pay for things like malpractice insurance and travel and lodging costs.

 

[cabinbuilder]

I thought you pay for things like malpractice insurance and travel and lodging costs.

NO, NEVER on a locums job. All that is paid for by the site, the locums company covers the malpractice. I only cover my food. I will say that I don't pay for any airline tickets either but I get the frequent flyer benefits so I make sure my tickets are all within the same airline group. I also have rewards through certain hotel chains that rack up points for free nights quickly especially when I'm out there 8 months a year. One year I spent 7 months in a Hampton. Great rewards that year.

 

[primadonna22274]

CB, you've inspired me to do this type of thing after residency, at least for a few years to pay off debt and get in a good position financially. My husband is very independent and doesn't need me around so much--and no kids.

 

[cabinbuilder]

CB, you've inspired me to do this type of thing after residency, at least for a few years to pay off debt and get in a good position financially. My husband is very independent and doesn't need me around so much--and no kids.

I'm glad. It's a lot of fun to go to a site and be the relief help. Very appreciated. Can easily pay down debt if that is your goal. I have 2 great companies who place me so PM me when you get to that point. Just remember that you will need an active license in each state you go to (I have 4 currently) that give me lots of options.

Just remember that certain companies place doctors in various areas of the country so you will need to determine where you want to go and get with the company that has the majority of sites in that area.